Treat the cause Restrict salt intake Diuretics ACE inhibitors if chronic Treat infections quickly Flu and pneumococcal vaccines Prophylactic heparin Treat hypertension
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What are the complications of nephrotic syndrome? (3)
Increased risk of infections Thromboembolism Hyperlipidaemia
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What are the investigations for nephrotic syndrome? (6)
What is the management for acute renal failure? (5)
Treat shock if present Urgent ultrasound Stop any nephrotoxic drugs Stop metformin if creatinine is above 150mmol/l Find and treat any exacerbating factors
At what stage does chronic renal failure typically present?
Stage 4 when GFR is below 30
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How do you manage chronic renal failure? (7)
Refer to renal medicine Treat any reversible causes Treat the symptoms Restrict dietary sodium Moderate protein Give bicarbonate Vitamin D and calcium supplements
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What are the common causes of chronic renal failure? (10)
What other investigations should be done in chronic renal failure? (9)
Urine dipstick Urine MC&S 24 hour urine protein Urine PCI Renal ultrasound DTPA scan Chest x-ray Bone x-ray Renal biopsy
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What are the clinical features of chronic renal failure? (19)
Recurrent UTIs Fatigue Weakness Anorexia Vomiting Metallic taste in the mouth Pruritis Restless legs Bone pain Impotence Dyspnoea Ankle swelling Pallor Jaundice Brown nails Purpura Bruising Excoriation Seizures
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What are the renal causes of haematuria? (7)
Neoplasia Glomerulonephritis Tubulointerstitial nephritis Poly-cystic kidney disease Papillary necrosis Infection such as pyelonephritis Trauma
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What are the extrarenal causes of haematuria? (4)
Calculi Infection such as cystitis, prostatitis, and urethritis Neoplasia such as bladder, prostate, and urethra Trauma
What are the management options for benign prostatic hypertrophy? (8)
Transrectal incision of the prostate Transurethral incision of the prostate Retropubic prostatectomy Transurethral laser Alpha blockers 5 Alpha reductase inhibitors Phytotherapy Wait and see
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How does diabetic nephropathy occur?
Hyperglycaemia causes renal hyperperfusion which increases GFR causing hypertrophy and increased renal size. Mesangial hypertrophy and focal glomerulosclerosis occur due to increased glomerular pressure. This causes microalbuminuria that later progresses to proteinuria
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What is the management for diabetic nephropathy? (4)
Good glycaemic control Antihypertensives Smoking cessation Combined pancreas and renal transplant
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What is myeloma?
Malignant proliferation of B lymphocyte derived cells. Normally different plasma cells produce different immunoglobulins which are polyclonal but in myeloma there is a single clone of plasma cells that produce identical immunoglobulins
What are the functions of parathyroid hormone? (3)
Increases osteoclast activity to release calcium and phosphate from the bones Increases calcium reabsorption and decreases phosphate reabsorption in the kidneys Increases active 1,25-dihydroxyvitaimin D3 production
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What is the goal of parathyroid hormone?
To increased calcium in the blood
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What are the causes of primary hyperparathyroidism? (3)
Solitary adenoma Hyperplasia of all glands Parathyroid carcinoma
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What are the clinical features of primary hyperparathyroidism? (13)
What are the causes of secondary hyperparathyroidism? (3)
Hypocalcaemia Low vitamin D intake Chronic renal failure
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What will the bloods show in secondary hyperparathyroidism? (2)
Decreased calcium Increased PTH
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What will the bloods show in tertiary hyperparathyroidism? (2)
Raised calcium Very high PTH
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What happens in tertiary hyperparathyroidism?
There is prolonged secondary hyperparathyroidism that causes the gland to act autonomously after hyperplastic or adenomatous change so there is no feedback control
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How do you manage hyperparathyroidism? (4)
Surgical excision where appropriate Increase fluid intake where surgery is not indicated High calcium and vitamin D intake where surgery is not indicated Cinacalcet
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What is sarcoidosis?
A multisystem granulomatous disease that has an unknown cause
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What are the pulmonary manifestations of sarcoidosis? (6)
A multisystem autoimmune disease where antibodies are produced against a variety of autoantigens. There is secretion of polyclonal B cells of pathogenic autoantibodies which causes the formation of immune complexes that deposit in places such as the kidneys
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What are the three main investigations for systemic lupus erythematosus?
Double stranded DNA autoantibody titres Complement - Low C3 and C4 ESR - Raised
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What other investigations should be done in systemic lupus erythematosus? (6)
Blood pressure Urinalysis for blood and protein FBC U&Es LFTs CRP
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