What are the symptoms of nephrotic syndrome?
PHO
Proteinuria
Hypoalbuminemia
Oedema
What are the symptoms of nephritic syndrome?
Haematuria
Hypertension
What are the GN’s that cause nephrotic syndrome?
FOCME MINI MEMBRANO Focal segmental Membranous Minimal change Membranoproliferative
What are the GN’s that cause nephritic syndrome?
POST RAPID DIFFUSE IGA
Post streptococcal
Rapidly progressive
Diffuse proliferative
IgA nephropathy
What is your approach to managing CRF?
- Diagnose cause; classify severity
- Address underlying etiology
- Treat acute symptoms
- Manage CKD, prevent progression
- Manage complications
- Long term issues - transplantation
- Social issues
What investigations for CKD?
- renal function: EUC, CMP, urine protein/casts, urine ACR
- renal structure: U/S, CT KUB, cystoscopy
- underlying disease: renal biopsy, ANA, hepatitis, HIV, EPG/IEPG
- complications: FBC, iron studies, CMP, Vit D, PTH
What are the indications for acute/urgent dialysis?
- refractory hyperkalemia
- metabolic acidosis
- fluid overload
- uremic symptoms (encephalopathy, pericarditis, coagulopathy)
How to prevent progression of CKD?
- diet: salt restriction
- normalize calcium and phosphate
- ACEi
- control BP
- control BSL
- immunosuppressives in diseases like SLE
- preserve vessels in preparation for dialpysis
What is the main factor in mortality in CKD?
Cardiovascular disease
What are the complications of CKD?
- anemia
- bone disease
- cardiovascular disease
- calciphylaxis: calific obstruction of blood vessels
- infection risk increased
- neuropathy, encephalopathy
- nutrition
- fluid status/overload
- sexual dysfunction and fertility (anovulatory in CKD)
What are the advantages of peritoneal dialysis?
- simple
- cardiovascularly safe
- freedom of diet/fluid intake
- no heparin
- independence
What are the advantages of haemodialysis?
- large volumes can be filtrated
- efficient solute removal
- no protein loss
What are the issues or disadvantages with PD?
- requires good hygiene
- patient education
- manual dexterity/vision/function
- needs residual urine output
- catheter malfunction
- may worsen DM due to the dextrose in the dialysate
- infection: peritonitis, site infection
What are the issues with haemodialysis?
- disruption to life
- cardiovascular instability
- heparin exposure
- infection
- amyloidosis
What are the GFR’s fir each stage of kidney disease?
- > 90
- 60-90
- 30-60
- 15-30
5.
When to start dialysis?
When eGFR 8-11 (usually uremic symptoms by this time)
What are causes of worsening renal function in a transplanted kidney?
Consider pre renal and post renal causes
Immediate:
- hyper acute rejection, thrombosis
1-12 weeks:
- rejection, CNI toxicity, infection (CMV, BK), recurrence of primary disease
> 3 months:
- as above plus drugs, sepsis, etc
What are long term problems after renal transplant?
- malignancy
- hypercalcemia (tertiary PTH)
- steroid complications
- HTN
- anemia
How to investigate and manage CMV disease in renal transplant?
Ix:
- CMV DNA PCR
- biopsy
Mx:
- reduce immunosupression
- avoid rejection
- eliminate virus with ganciclovir
