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nephro - Coggle Diagram
nephro
3.
Analgesic Induced Nephropathy
History:
Long history of analgesic intake
Labs:
Increased creatinine
Treatment:
Stop analgesics
Goodpasture Syndrome
Organs affected:
Lung:
Hemoptysis
Dyspnea
Kidney:
Hematuria
Chest X ray:
Bilateral lung involvement
Screening test:
Anti basement membrane antibody
Most accurate investigation:
Renal biopsy
Treatment:
Plasmapheresis
Steroids
Wegener Granulomatosis
Organs affected:
Upper respiratory tract:
Sinusitis
Epistaxis
Otitis
Lung:
Cough
Hemoptysis
Kidney:
Hematuria
Screening test:
C ANCA antibody
Most accurate investigation:
Renal biopsy
Treatment:
Steroids
Cyclophosphamide
Renal Failure
Types
Prerenal:
Most common type
Causes:
Hypotension
Hypovolemia
Renal:
Causes:
Toxins
Ischemia
Post renal:
Causes:
Obstruction
Stones
Prostate enlargement
Complications of Renal Failure
1. Anemia
Type:
Iron deficiency anemia
Treatment:
Correct iron first
Erythropoietin
2. Hypocalcemia
Leads to:
Osteoporosis
3. Bleeding
Cause:
Platelet dysfunction
4. Hyperphosphatemia
Important complication
Treatment:
Dietary phosphate restriction
Oral phosphate binders
5. Uremic Pericarditis
Clinical picture:
Sharp chest pain
Worse with respiration
Better with leaning forward
ECG:
ST segment elevation in all leads
Treatment:
Immediate dialysis
6. Hyperkalemia
ECG:
Tall T waves
First step:
IV calcium gluconate until dialysis is ready
Second step:
Dialysis
Dialysis
Indications for Urgent Dialysis
Hyperkalemia
Metabolic acidosis
Pericarditis
Encephalopathy
Fluid overload
Complications of Dialysis
Hypotension:
Most common complication
Cause:
Excessive fluid removal
Treatment:
IV fluids
Kidney Transplant Rejection
Types
Hyperacute rejection:
Occurs on the table
Acute rejection:
Most common
Timing:
Days to months
Treatment of choice:
Steroids
Chronic rejection:
Timing:
Months to years
Treatment:
Re transplantation
Renal Transplantation
Best treatment for renal failure:
Kidney transplantation
Best donor:
Living related donor
Most common cause of death on dialysis:
Cardiovascular disease
Drug of choice for hypertension in dialysis patients:
ACE inhibitors
Calcium channel blockers
Best way to assess patient with renal failure:
Body weight
2.
Proteinuria – Mind Map Bullets
Orthostatic Proteinuria
Age:
Usually children and adolescents
First step:
Repeat urine test
If still positive:
12 or 24 hour urine collection
Treatment:
Reassurance
Transient Proteinuria
Causes:
Fever
Exercise
Dehydration
Cold exposure
Seizures
Fate:
Resolves spontaneously
Management:
Reassurance
Recurrent Proteinuria
Next step:
Renal biopsy
Proteinuria + Hematuria in children with URTI
First step:
Repeat urine test after recovery from URTI
Nephrotic Syndrome
Clinical picture:
Marked edema
Periorbital edema
Most common type:
Minimal change disease
Labs:
Proteinuria ++++
Hypoalbuminemia
Hyperlipidemia
Renal function:
Usually normal
Complications
Infections:
Organism: Streptococcus pneumoniae
Most common infection: Spontaneous bacterial peritonitis
Thrombophilia:
Renal vein thrombosis
Scenario:
Nephrotic syndrome + abdominal pain + hypertension
Do duplex
Start anticoagulation
Treatment
Hospital admission
Diet:
Increase protein
Edema management:
Salt restriction
Fluid restriction
Albumin
Furosemide
Drug of choice:
Steroids
If persistent proteinuria despite treatment:
Renal biopsy
Vesico Ureteral Reflux
Definition:
Backflow of urine from bladder to kidney
Clinical picture:
Recurrent UTI since childhood
Complications:
Recurrent pyelonephritis
Renal scarring
Renal failure
Investigations:
Investigation of choice: Voiding cystourethrogram
For renal scarring: DMSA scan
Treatment:
Continuous prophylactic antibiotics
Trimethoprim sulpha
Posterior Urethral Valve
Most common cause:
Post renal obstruction in children
Diagnosis:
Voiding cystourethrogram
Associated finding:
Hydronephrosis
Ureteropelvic Junction Obstruction
Clinical features:
Renal mass
Pain
Recurrent UTI
Hepato Renal Syndrome
Definition:
Renal failure secondary to liver failure
Key features:
New onset renal failure
No improvement with fluids or diuretics
Treatment:
Octreotide
Albumin
Midodrine
Athero Embolism After Cardiac Catheterization
Cause:
Cholesterol emboli in small capillaries and arterioles
Clinical picture:
History of cardiac catheterization
Blue or purple lesions on fingers and toes
Livedo reticularis
Eosinophilia
Elevated kidney functions
Treatment:
None
Contrast Induced Nephropathy
History:
Contrast exposure
Cardiac catheterization
Labs:
Increased creatinine
Prevention:
IV hydration before procedure
4.
Renal Artery Stenosis (RAS)
Causes
Young age → Fibromuscular dysplasia
Old age → Atherosclerosis
Clinical clues
Hypertension in young patient resistant to medications
HTN + small kidney on one side
HTN + abdominal bruit
Examination
Abdominal bruit
Labs
Increased renin
Due to activation of renin angiotensin system
Investigations
Initial investigation → Duplex ultrasound of renal vessels
Investigation of choice → Angiography
Treatment
Unilateral RAS → ACE inhibitors
Bilateral RAS → Angioplasty with stent (treatment of choice)
Sterile Pyuria
Definition
Pus cells in urine with no organism
Causes
Tuberculosis (important)
Chlamydia
Fluid Overload in Renal Failure
Most common symptom
Dyspnea
Most important investigation
ABG to rule out hypoxia
Most important treatment
Dialysis
Rash Scenarios
Rash after URTI and antibiotics
Raised, non blanching → Vasculitis
Raised rash + joint pain + abdominal pain + hematuria
Henoch Schonlein Purpura (HSP)
Maculopapular rash after ampicillin
EBV infection
Rash + wheezy chest + vomiting
Anaphylaxis
Fluid Assessment
Most accurate way to assess fluid input and output
Body weight
Followed by 24 hour urine measurement
Nephrotoxic Drugs
Most nephrotoxic antibiotic combination
Gentamycin + Cephalexin
Pediatric Renal Imaging
Child with recurrent UTI + small kidneys
DMSA scan
Glomerular Disease
4 year old boy with
Hematuria
Proteinuria
Hypertension
Initially steroid responsive
Diagnosis
Focal segmental glomerulonephritis (FSGN)
Uremic Complications
Confusion with high urea
Uremic encephalopathy
Most common neurological complication of renal failure
Peripheral neuropathy
Post Transplant Infection
Patient on immunosuppressants after renal transplantation
Symptoms
Weight loss
Night sweats
Meningitis
Suspicion
Tuberculosis
Test
Ziehl Neelsen stain
1.
Glomerulonephritis
Post Streptococcal Glomerulonephritis (PSGN)
History:
URTI in the last 1 to 2 weeks
Organism:
Group A beta hemolytic streptococci
Clinical picture:
Oliguria
Edema
Facial puffiness
Hypertension
Tea colored urine
RBC casts
Labs:
Hematuria
Mild proteinuria
Investigations:
ASOT
ESR
Investigation of choice:
Renal biopsy
Treatment:
First step: admission
Diet:
Increase carbohydrates
Decrease protein
Antihypertensive drugs
Fluid restriction (most important step)
Prognosis:
More than 95% complete recovery
School exclusion:
None
IgA Nephropathy (Berger disease)
History:
URTI in last 1 to 2 days
Followed by hematuria and proteinuria
Clinical picture:
Hypertension
Hematuria
Labs:
Hematuria
Proteinuria
Best investigation:
Renal biopsy
Key differentiation:
Renal affection 1 to 2 days after URTI → IgA nephropathy
Renal affection 1 to 2 weeks after URTI → PSGN
Thin Basement Membrane Nephropathy (Benign Hematuria)
Most common cause of hematuria in children and adults
Clinical features:
Hematuria
Mild proteinuria
Normal findings:
Blood pressure
Kidney function
Treatment:
Reassurance only
Prognosis:
Excellent
Hemolytic Uremic Syndrome (HUS)
Causative organism:
E coli O157 H7
History:
Child with bloody diarrhea
5 to 7 days later:
Intravascular hemolysis
Pallor
Kidney affection
Clinical picture:
Oliguria
Renal insufficiency
Thrombotic Thrombocytopenic Syndrome (TTP)
Similar scenario to HUS
Commonly affected system:
CNS
Typical patient:
Adult female
Clinical picture:
Neurological symptoms
Fever
Elevated kidney functions
Labs:
Schistocytes anemia due to hemolysis
Low platelets due to intravascular thrombosis
Treatment:
Plasmapheresis is treatment of choice
Never give platelets
Henoch Schoenlein Purpura (HSP)
Pathology:
IgA vasculitis
Clinical picture:
Hematuria
Abdominal pain
Joint pain especially knee
Rash:
Maculopapular
Affects buttocks and knees
History:
Starts with URTI
Few days later develops:
Abdominal pain
Rash
Hematuria
Arthralgia
Complication:
Intussusception
Prognosis:
Usually resolves spontaneously
Treatment:
None in most cases
Resistant cases:
Cortisone is drug of choice