What investigations would you do for Sjogren’s syndrome?
- Anaemia of chronic disease, low Hb
- Raised immunoglobulins, IgG
- High ESR
- ANA positive
- Anti Ro/La positive
What are the different types of allergic reactions?
Type I - IgE mediated release of histamine and other mediators
Type II - Cytotoxic hypersensitivity reactions
Type III - Immune-complex reactions
Type IV - Cell mediated reactions
What are the signs of nephrotic syndrome?
- Proteinuria > 3.5g/day (normal <150mg/24hr)
- Hypoalbuminaemia
- Oedema
- Hypercholesterolaemia
How would you distinguish between glomerular and non-glomerular origins of haematuria?
Glomerular:
- RBC casts
- Dysmorphic RBCs
- Brown urine
- Associated proteinuria
Non-glomerular:
- Presence of blood clots
- Reddish/pink urine
- Eumorphic RBCs
What are the signs of nephritic syndrome?
- Haematuria with red blood cell casts (glomerular in origin)
- Proteinuria
- Hypertension
- Degree of renal insufficiency
What is AKI?
- A significant deterioration in renal function which is potentially reversible, over a period of hours or days
- RIFLE, AKIN, KDIGO criteria
What are the causes of AKI?
- Pre renal failure 85%
Hypoperfusion - Intrinsic renal failure 5%
Many causes
Acute tubular necrosis - Post renal failure 10%
Obstruction
What is CKD?
- Progressive loss of kidney function
- Kidneys attempt to compensate with hyperfiltration, with time hyperfiltration results in loss of more function
- Loss of volume (shrinkage) of kidney and scarring
- Not symptomatic until >70% of combined function of both kidneys is lost.
What are the signs and symptoms of CKD?
- When GFR <30
- Nausea, vomiting, Itching, Loss of concentration, poor sleep, fatigue, poor appetite, breathlessness
- Anaemia, weightloss, signs of salt and water retention
- Elevation of Ur and Creatinine
- Symptoms
- Associated features;
- Anaemia
- Raised PTH
- Low Ca
- Raised Ph
- Raised K
- Low Na
- Low Bicarbonate, Low pH
What is creatinine?
A waste product of muscle breakdown. Exclusively excreted by the kidneys - marker of renal function.
What are the functions of the kidney?
A - Acid base balance W - Water removal E - Erythropoietin production T - Toxin removal = uraemia B - Blood pressure control E - Electrolyte balance D - Vitamin D activation
What is the RIFLE criteria for AKI?
Risk:
- Increased creatinine x1.5
- Urine output <0.5mL/kg/h x 6h
Injury:
- Increased creatinine x2
- Urine output <0.5mL/kg/h x 12h
Failure:
- Increased creatinine x3
- Urine output <0.3mL/kg/h x 24h OR anuria x12h
Loss:
- Persistent ARF = complete loss of renal function > 4 weeks
End Stage Renal Disease
Who can override a refusal of consent in minors?
- A court
- Their parents
What is the lumbar cistern?
The CSF filled subarachnoid space located distal to the termination of the spinal cord. The lumbar cistern is the target site for lumbar puncture.
Where is a lumbar puncture performed in an adult?
L3-L4 to L5-S1 interspinous space
Where is a lumbar puncture performed in children?
L4-L5 or L5-S1 interspinous space. The infant spinal cord terminates at the L2 body level (ranges from L1-L3)
How does the lumbar puncture needle need to be angled?
15 degrees antero-superiorly
What does LOSS stand for?
- Loss of joint space
- Osteophytes
- Subchondral sclerosis
- Subchondral cysts
