Podcast
Questions and Answers
What is the primary characteristic of nephritic syndrome?
What is the primary characteristic of nephritic syndrome?
In nephrotic syndrome, which of the following is NOT typically observed?
In nephrotic syndrome, which of the following is NOT typically observed?
Which of the following conditions is a common cause of glomerular damage?
Which of the following conditions is a common cause of glomerular damage?
What is a hallmark feature of glomerular disease that can be found even in mild cases?
What is a hallmark feature of glomerular disease that can be found even in mild cases?
Signup and view all the answers
What key factor might indicate a need for immunosuppressive therapy in glomerulonephritis?
What key factor might indicate a need for immunosuppressive therapy in glomerulonephritis?
Signup and view all the answers
Which statement about acute kidney injury (AKI) is correct?
Which statement about acute kidney injury (AKI) is correct?
Signup and view all the answers
What is the major risk factor associated with poor outcomes in patients with glomerular disease?
What is the major risk factor associated with poor outcomes in patients with glomerular disease?
Signup and view all the answers
Which condition is most commonly associated with nephrotic syndrome?
Which condition is most commonly associated with nephrotic syndrome?
Signup and view all the answers
In chronic interstitial nephritis, which of the following is a common finding on renal biopsy?
In chronic interstitial nephritis, which of the following is a common finding on renal biopsy?
Signup and view all the answers
What characterizes the hematuria associated with nephritic syndrome?
What characterizes the hematuria associated with nephritic syndrome?
Signup and view all the answers
Which lab finding is most likely indicative of the severity of nephrotic syndrome?
Which lab finding is most likely indicative of the severity of nephrotic syndrome?
Signup and view all the answers
Acute interstitial nephritis often results from which type of immune response?
Acute interstitial nephritis often results from which type of immune response?
Signup and view all the answers
Which factor increases the likelihood of developing acute kidney injury in older adults?
Which factor increases the likelihood of developing acute kidney injury in older adults?
Signup and view all the answers
What is the primary characteristic of chronic interstitial nephritis (CIN)?
What is the primary characteristic of chronic interstitial nephritis (CIN)?
Signup and view all the answers
Which of the following is NOT a typical presentation of patients with chronic interstitial nephritis?
Which of the following is NOT a typical presentation of patients with chronic interstitial nephritis?
Signup and view all the answers
In acute interstitial nephritis, what type of casts may form within affected tubules?
In acute interstitial nephritis, what type of casts may form within affected tubules?
Signup and view all the answers
Which of the following interventions is crucial when managing acute kidney injury (AKI) related to dehydration?
Which of the following interventions is crucial when managing acute kidney injury (AKI) related to dehydration?
Signup and view all the answers
What is a common underlying factor contributing to acute interstitial nephritis?
What is a common underlying factor contributing to acute interstitial nephritis?
Signup and view all the answers
What distinguishes acute kidney injury from chronic kidney disease?
What distinguishes acute kidney injury from chronic kidney disease?
Signup and view all the answers
Which of the following is a crucial step when a patient with AKI presents with hyperkalemia?
Which of the following is a crucial step when a patient with AKI presents with hyperkalemia?
Signup and view all the answers
Which process leads to the creation of casts in acute kidney injury?
Which process leads to the creation of casts in acute kidney injury?
Signup and view all the answers
What is a common characteristic feature found in chronic interstitial nephritis?
What is a common characteristic feature found in chronic interstitial nephritis?
Signup and view all the answers
Which of the following is typically NOT associated with acute interstitial nephritis?
Which of the following is typically NOT associated with acute interstitial nephritis?
Signup and view all the answers
In the context of chronic kidney disease, which of the following statements best describes the relationship between kidney function and proteinuria?
In the context of chronic kidney disease, which of the following statements best describes the relationship between kidney function and proteinuria?
Signup and view all the answers
Which of the following best distinguishes acute interstitial nephritis from chronic interstitial nephritis?
Which of the following best distinguishes acute interstitial nephritis from chronic interstitial nephritis?
Signup and view all the answers
Which feature would least likely be found during the assessment of a patient with chronic interstitial nephritis?
Which feature would least likely be found during the assessment of a patient with chronic interstitial nephritis?
Signup and view all the answers
Which factor is NOT associated with an increased risk of developing acute kidney injury (AKI)?
Which factor is NOT associated with an increased risk of developing acute kidney injury (AKI)?
Signup and view all the answers
In the context of chronic interstitial nephritis, which finding is least likely to be observed on renal biopsy?
In the context of chronic interstitial nephritis, which finding is least likely to be observed on renal biopsy?
Signup and view all the answers
Which statement about chronic kidney disease (CKD) is false?
Which statement about chronic kidney disease (CKD) is false?
Signup and view all the answers
Which type of casts would be most indicative of acute interstitial nephritis?
Which type of casts would be most indicative of acute interstitial nephritis?
Signup and view all the answers
What is NOT a prognostic indicator for poor outcomes in glomerular disease?
What is NOT a prognostic indicator for poor outcomes in glomerular disease?
Signup and view all the answers
Which of the following correctly identifies a mechanism leading to the injury of the glomerulus?
Which of the following correctly identifies a mechanism leading to the injury of the glomerulus?
Signup and view all the answers
Which condition is most closely linked to the development of tubulo-interstitial fibrosis?
Which condition is most closely linked to the development of tubulo-interstitial fibrosis?
Signup and view all the answers
Which characteristic is observed in the acute phase of interstitial nephritis?
Which characteristic is observed in the acute phase of interstitial nephritis?
Signup and view all the answers
What is a common histological finding in acute interstitial nephritis?
What is a common histological finding in acute interstitial nephritis?
Signup and view all the answers
Which of the following clinical features is most associated with chronic interstitial nephritis (CIN)?
Which of the following clinical features is most associated with chronic interstitial nephritis (CIN)?
Signup and view all the answers
In the management of acute kidney injury due to fluid overload, what should be prescribed if loop diuretics are ineffective?
In the management of acute kidney injury due to fluid overload, what should be prescribed if loop diuretics are ineffective?
Signup and view all the answers
Which of the following is a risk factor associated with the development of chronic kidney disease (CKD) in patients with chronic interstitial nephritis?
Which of the following is a risk factor associated with the development of chronic kidney disease (CKD) in patients with chronic interstitial nephritis?
Signup and view all the answers
What key feature distinguishes chronic interstitial nephritis from acute interstitial nephritis?
What key feature distinguishes chronic interstitial nephritis from acute interstitial nephritis?
Signup and view all the answers
Which complication can arise from untreated acute interstitial nephritis?
Which complication can arise from untreated acute interstitial nephritis?
Signup and view all the answers
Which electrolyte disturbance is commonly managed in patients with acute kidney injury who present with hyperkalemia?
Which electrolyte disturbance is commonly managed in patients with acute kidney injury who present with hyperkalemia?
Signup and view all the answers
What is the primary pathophysiological change observed in chronic interstitial nephritis?
What is the primary pathophysiological change observed in chronic interstitial nephritis?
Signup and view all the answers
Study Notes
Approach to the Patient with Kidney Disease
- Examination techniques for renal abnormalities:
- Blood pressure measurements
- Blood tests for creatinine and electrolytes
- Urinalysis for protein, blood, nitrites and leucocytes
- Abdominal examination for palpable kidneys
- Percussing for tenderness in renal angle
- Digital rectal examination for prostate enlargement
- Checking sacrum and ankles for pitting oedema
The Kidneys
- Central role in excreting metabolic breakdown products (ammonia, urea, creatinine, uric acid, drugs, toxins).
- Produce large volumes of ultrafiltrate (120 mL/min, 170L/24h) at the glomerulus.
- Selectively reabsorb components of the ultrafiltrate along the nephron.
- Filtration and reabsorption rates are controlled by hormonal and haemodynamic signals to regulate fluid and electrolyte balance, BP, and calcium and phosphorus homeostasis.
- Activate Vitamin D and control red blood cell synthesis by producing EPO.
Functional Anatomy of the Kidney
- Composed of cortex and medulla.
- Contains nephrons:
- Afferent arteriole
- Efferent arteriole
- Glomerulus
- Bowman's capsule
- Proximal convoluted tubule
- Loop of Henle
- Distal convoluted tubule
- Collecting duct
Glomerular Architecture
- Filtration barrier:
- Fenestration endothelium
- Glomerular basement membrane
- Podocytes (epithelial visceral cells)
- Mesangial cells
- Blood vessels:
- Afferent and efferent arterioles
- Bowman's space
Glomerular Diseases
- Most patients present asymptomatically until abnormalities are detected on routine screening.
- Various causes of injury:
- Immunological
- Inherited (eg, Alport's syndrome)
- Metabolic (eg, diabetes)
- Deposition of abnormal proteins (eg, amyloid)
- Glomerular cells are the target.
- Clinical features vary according to the insult type.
Nephritic and Nephrotic Syndromes
- Nephritic syndrome:
- Haematuria
- Hypertension
- Oliguria
- Fluid retention
- Nephrotic syndrome:
- Heavy proteinuria (>3.5 g/24 hrs)
- Hypoalbuminaemia
- Oedema
- Many patients may not exhibit all features but some are typical of rapidly progressive glomerulonephritis.
Glomerular Diseases Mechanisms and Pathology
- Various mechanisms lead to glomerular injury.
- Mechanisms involve:
- Deposition of immune complexes
- Inflammation
- Cell injury (e.g., podocyte injury)
- Different staining will reveal different characteristics of the diseases.
Renal Ultrasound
- Used to image the kidneys.
- Shows different components:
- Normal kidney
- Simple renal cyst
- Hydronephrosis
- Renal stone
- Renal tumour
Imaging Techniques
- Various imaging techniques are available for kidney diagnosis. Including simple X-rays, ultrasound, CT scan (angio), MRI and myocardial perfusion.
Acute Kidney Injury (AKI)
- Sudden and often reversible loss of renal function (days or weeks).
- Associated with reduced urine volume.
- Significant complications, poor outcome (mortality = 50-70% in sepsis/multi-organ failure).
- Elderly patients at higher risk than non-elderly patients.
- Pre-renal, renal, and post-renal sub-types
- AKI can be classified using RIFLE criteria and AKIN criteria
Pathophysiology of AKI
- Pre-renal: decreased perfusion to kidney.
- Renal: damage to the kidney itself.
- Post-renal: obstruction to urine flow.
- Stages of damage include: initiation, extension, maintenance, and recovery.
Phases of AKI
- Initiation: ischemia, cell injury.
- Extension: microvascular injury, inflammation.
- Maintenance: dedifferentiation, proliferation.
- Recovery: redifferentiation/repolarization.
Renal Haemodynamics
- Afferent arteriole: prostaglandins cause vasodilation.
- Efferent arteriole: angiotensin II vasoconstricts.
- NSAIDs inhibit prostaglandins.
- ACE inhibitors / ARBs inhibit angiotensin II.
Acute Kidney Failure
- Tubule destruction, inflammation.
- Loss of function (decreased renal function).
Classification of AKI
- RIFLE (Risk, Injury, Failure, Loss, ESRD) and AKIN systems used to classify AKI based on
- Creatinine levels
- Urine output criteria
Management of AKI
- Assess fluid status (hypovolemia, fluid overload)
- Administer calcium and glucose/insulin to correct hyperkalemia
- Sodium bicarbonate to correct acidosis.
- Discontinue/reduce nephrotoxic drugs
- Ensure adequate nutritional support
- Screen for intercurrent infections
- Treat any urinary tract obstructions.
Acute Interstitial Nephritis
- Immune-mediated disorder.
- Primarily drug-induced (e.g., antibiotics, NSAIDs, diuretics)
- Can also be caused by infections (bacterial or viral), or toxins (e.g., heavy metals, certain fungi).
- Renal biopsy (Bx) usually required for diagnosis.
- Biopsy will show intense inflammation in the tubules and interstitium, with PMN and lymphocyte infiltrates.
Chronic Interstitial Nephritis
- Renal dysfunction with fibrosis and infiltration of the renal parenchyma by lymphocytes and plasma cells.
- Damage to tubules.
- Can lead to chronic kidney disease (CKD).
Chronic Kidney Disease (CKD)
- Irreversible deterioration in renal function over years
- Initially, only a biochemical abnormality.
- Eventually, loss of excretory, metabolic, and endocrine functions leads to clinical symptoms.
- CKD grade 5 = end-stage renal disease (ESRD).
Investigations of CKD
- Kidney function tests (GFR or Cr)
- Urine analysis (albumin/creatinine ratio)
- Other tests (electrolytes, blood counts, etc)
- Imaging studies
Management of CKD
- Monitor renal function
- Prevent or slow further renal damage
- Limit complications of renal failure
- Treat risk factors for cardiovascular disease
- Prepare for renal replacement therapy (RRT) if appropriate
End-Stage Renal Disease (ESRD)
- Complication of CKD
- Conservative management or dialysis/transplantation
Indications for Dialysis
- Fluid overload
- Hyperkalemia
- Metabolic acidosis
- Other relative indications (e.g., severe hypertension, intractable oedema)
Options for Renal Replacement Therapy
- Haemodialysis
- Haemofiltration
- Peritoneal dialysis
- Transplants
Haemodialysis Access
- Catheter
- Arteriovenous fistula
- Arteriovenous graft
Diagnostic Methods
- Non-invasive
- X-ray
- Ultrasound
- CT scan
- AngioCT
- Myocardial perfusion
- MRI
- Invasive
- Angiography
- IVUS
- Angioscopy
- Functional
- Tonometry
- Physical Exam
Physical Signs in Advanced CKD
- Possible physical findings include yellow complexion, pallor, raised jugular venous pressure, pulsations, pericardial friction rubs, etc.
The Progress of CKD
- Progression can be accelerated by various factors (disease, treatments).
Prevention of Early and Late CKD
- Early intervention and control of risk factors can slow the progression of CKD and reduce the risk of complications.
Cardiovascular and Renal Events Associated With Albuminuria
- Increased risk for cardiovascular and renal events with higher levels of albuminuria.
Biomarkers
- Early markers for progressive kidney disease include FGF-23, 1,25-dihydroxyvitamin D, parathyroid hormone, phosphorous.
Vascular Calcification in CKD
- Both intimal and medial calcification are noted.
- Specific factors, like Klotho and FGF-23, are involved.
Coronary Artery Calcification in CKD
- Atherosclerosis and Uremic arteriopathy frequently occur together.
- Uremic arteriopathy is associated with inflammation and oxidative stress
Calcifilaxis
- Skin condition, usually associated with chronic kidney disease.
Diagnostic Methods for CKD
- Non-invasive: simple X-rays, ultrasound, CT angio, myocardial perfusion, MRI
- Invasive: angiography, IVUS, angioscopy
- Functional tests: tonometry
Physical Signs in Advanced CKD
- Possible physical findings include yellow complexion, pallor, raised jugular venous pressure, pulsations, pericardial friction rubs, etc.
End-Stage Renal Disease (ESRD) Pathway
- Conservative or dialysis/transplantation are management options.
Indications for Dialysis
- Fluid overload, hyperkalemia, metabolic acidosis, and related clinical features can dictate the need for dialysis.
Options for Renal Replacement Therapy
- Haemodialysis involves filtering blood through a machine. Haemofiltration filters blood via a different process. Peritoneal dialysis involves using the peritoneum to filter waste. Renal transplant involves replacing the patient's diseased kidney with a healthy donor kidney.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
Test your knowledge on nephrology and glomerular diseases with this quiz. Explore characteristics of nephritic syndrome, nephrotic syndrome, and common causes of glomerular damage. Challenge yourself with critical questions related to acute kidney injury and interstitial nephritis.