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REGUB Medicine: CKD/Nephritic/Nephrotic Syndrome (iii) (Nephrotic syndrome…
REGUB Medicine: CKD/Nephritic/Nephrotic Syndrome (iii)
Renal bx
performed by nephrologist/interventional radiologist
US/CT guided
sterilise skin surface, inject local anaesthetic
comps
pain around site
bleeding
haematuria
perinephric haematoma (uncontrollable bleeding from lesion)
AV fistula (if needle forms connection between art + vein)
damage to surrounding structures
Nephrotic syndrome
Clinical features
peripheral oedema
overfill hypothesis: Na retention - but no RAAS activation so no HTN - suggests intrinsic defect in Na excretion by the kidneys
underfill hypothesis: loss of albumin - lower plasma colloid pressure
foamy urine
weight gain
fatigue
anorexia
hyperchol
hypoalbuminuria
hypercoaguable state
immunoscuppresion
normal protein excretion < 150mg/24hrs
microalbuminuria = 30-300mg/24hrs
non-nephrotic proteinuria < 3.5g/24hrs
nephrotic proteinuria > 3.5g/24hrs
Causes
diabetic nephropathy
min change disease
FSGS
membranous nephropathy
SLE
amyloidosis
Nephritic syndrome
GN - glom inflamm
can occur @ any age
clinical features
haematuria
oliguria
peripheral oedema (not as severe as nephrotic syndrome)
HTN
proteinuria present but usually <3g/24hrs
causes
IgA nephropathy
a/w RTIs
presents @ same time as infection (diffuse mesangial IgA deposition) - synpharyngitic GN
Post-strep GN
a/w RTIs
doesn't occur until wks after infection (ICD)
membranoprolif GN
Goodpasture's
granulomatosis with polyangiitis
Henoch-Schonlein purpura