If proteinuria >3.5 g/day, hypoalbuminaemia, oedema ± hyperlipidaemia THINK
Nephrotic Syndrome
If child (esp. <10 years), sudden oedema, following viral infection, normal renal function
Then likely Minimal Change Disease → treat with steroids.
If EM shows podocyte foot process effacement, LM normal, IF negative
Then confirm Minimal Change Disease.
If EM shows segmental foot process fusion, LM with segmental sclerosis,
Then that’s FSGS — often resistant to steroids.
If middle-aged, “spike and dome” on silver stain, subepithelial deposits on EM
Membranous Nephropathy
“renal stones, painful bones, abdominal groans, and psychiatric moans”
Hypercalcemia
IF AKI develops after starting a PPI, NSAID, or antibiotic +urinalysis shows sterile pyuria + WBC casts + Eosinophilia
THEN suspect
Acute tubulointerstitial nephritis
is a hypersensitivity reaction, most often triggered by a medication.
Definition of chronic kidney disease
Evidence of kidney damage OR
- eGFR < 60 mL/min/1.73 m² for ≥ 3 months.
Evidence of KIDNEY damage includes:
- Persistent albuminuria (uACR ≥3.0 mg/mmol)
- Abnormal imaging (e.g., polycystic kidneys)
- Abnormal urine sediment (e.g., RBC casts)
- Histological changes on biopsy
The stages of CKD based on eGFR are:
G1: ≥90 mL/min/1.73m2
G2: 60-89 mL/min/1.73m2
G3a: 45-59 mL/min/1.73m2
G3b: 30-44 mL/min/1.73m2
G4: 15-29 mL/min/1.73m2
G5: <15 mL/min/1.73m2 (or commenced dialysis).
Based on the urinary albumin-creatinine ratio, the categories for albuminuria are:
- A1 (normal): <2.5 mg/mmol (male) and <3.5 mg/mmol (female)
- A2 (moderately increased albuminuria): 2.5–25 mg/mmol (male) and 3.5–35 mg/mmol (female)
- A3 (severely increased albuminuria): >25 mg/mmol (male) and >35 mg/mmol (female).
Management of acute obstructed renal tract with superimposed infection
Ureteric stent insertion
Order of investigations for suspicious change on prostate + elevated PSA
1) MRI: Locate lesion
2) US guided biopsy: Confirm malignancy
3) PSMA PET (prostate specific membrane antigen): Staging
Lithium effects on the kidneys
Cause nephrogenic diabetes insipidus by
- reducing the kidney’s ability to concentrate urine in response to antidiuretic hormone.
- Excessive free water loss and subsequent HYPERNATRAEMIA
The International Prostate Symptom Score
- 0-7 indicating mild symptoms,
- 8-19 moderate symptoms, and
- 20-35 severe symptoms.
Thin basement membrane nephropathy Microscopy:
Microscopic haematuria with dysmorphic red cells and thin glomerular basement membrane on electron microscopy
Thin basement membrane nephropathy Management
No active management required
If patient presents in adulthood with hypertension and multiple renal cysts. THINK
Autosomal dominant polycystic kidney disease
Management of patients with low-risk prostate cancer+ life expectancy > 10 years and are fit enough to tolerate definitive treatment if disease progression occurs:
Active surveillance with PSA monitoring
This involves regular PSA testing, digital rectal examinations, and repeat biopsies with the intention of offering curative treatment if the cancer progresses.
Management of patients with low-risk prostate cancer and limited life expectancy (<10 years) due to significant comorbidities
Watchful waiting is appropriate
Indications for surgical intervention in the setting of renal colic
-Fever (suggesting possible urosepsis)
- Renal angle tenderness
- Persistence of pain despite adequate analgesia
- Single kidney (on CT)
- Impaired renal function
- Stone size >7 mm
Gleason score
Gleason 6 = low
Gleason 7 = intermediate
Gleason 8-10 = high
This indicates the tumours aggressiveness and is used to determine risk.
