Credit lesson in nephrology

Pregnancy

Diabetes mellitus

Being female

Catheterization

Urinary obstruction 

The sensitivity of dipstick for nitrites is 96%

A positive dipstick for leucocyte esterase is 96% specific for >10 wbc/mm3

A bacterial culture with > 10^5 has 95% probability of representing infection.

Use of blood cultures in does not change management when urine culture is taken

All patients with pyelonephritis require follow-up USS of kidneys.

Acute simple cystitis – trimethoprim for 3 days in otherwise well young women

Pregnancy associated cystitis – nitrofurantoin 5 mg QID for 14 days

Acute uncomplicated pyelonephritis – gentamycin + amoxicillin IV initially followed by 7 days of Augmentin orally.

Acute simple cystitis in male patients – Augmentin or trimethoprim for 14 days.

Dysuria with < 10 3 organisms grown on culture failed to improve on trimethoprim – doxy.

In pre-renal failure the ratio of urea: creatinine is increased above normal.

Post-renal obstruction is an uncommon cause of ARF.

The most common cause of renal ARF is acute tubulointerstitial nephritis.

Urinalysis with microscopic hematuria, pyuria, and presence of granular, epithelial and RBC casts is consistent with acute glomerulonephritis.

In renal ARF the urine Na is > 10mmol/l and osmolality < 350. 

Rhabdomyolysis

Nephrotoxic ATN

Ischaemia ATN

Acute glomerulonephritis

Severe dehydration. 

Refractory hyperkalemia >6.5 mmol/l.

Pulmonary oedema.

Encephalopathy

Uncontrollable acidosis

Creatinine .1.0 mmol/l. 

Post streptococcal

IgA nephropathy

Rapidly progressive glomerulonephritis

Goodpasture’s syndrome

Membranous glomerulonephritis. 

> 3g proteinuria per day.

Associated with hyperlipidemia.

May be caused by drugs such as gold and ACEI.

Membranous glomerulonephritis is the most common cause of primary nephrotic syndrome in adults.

Hypertension is characteristic. 

Metastatic calcification.

Peripheral neuropathy

Hypophosphatemia

Hyperparathyroidism

Peptic ulcer disease and GI bleeding. 

Gram stain will be positive in approx 10-40% of culture positive bags

Staph aureus is the most common organism isolated.

Antibiotics are not needed parentally usually.

Vancomycin as a one off 2 grams to CAPD bags is all that is needed for proven gram positive infection.

Cell count in bags must be > 100 leucocytes with > 50% neutrophils

Identical twin donor and recipient, require no immunosuppression

Graft rejection may present with graft tenderness, decreased urine output and increased creatinine.

Infection is the most common cause of morbidity and mortality in the early stages, with 80% developing infection in the first year.

Rejection of graft over 1 year post transplant indicated chronic rejection which results in progressive loss of renal function.

Cyclosporine toxicity rarely is a complication due to predictable levels. 

diabetes mellitus

hypertension

glomerulonephritis

polycystic kidney disease

analgesic nephropathy 

infection/sepsis

cardiac causes

Malignancy

Self withdrawal from dialysis

Hyperparathyroidism (secondary)

hypocalcemia

hyperphostphatemia

increased erythropoietin (secondary)

anaemia 

they usually rupture intraperitoneally rather than extraperitoneal

they are usually associated with a pelvic fracture

inability to void and macroscopic haematuria and meatal blood are symptoms

investigation of choise is retrograde cystogram

the rupture can be both intra and extraperitoneal