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12.09.27 Renal revision

Nephrotic syndrome
  • The bad one!
  • Has an O:
    • O SHIT
    • Oedema
  • Triad
    • Proteinuria >3 g/day
    • Albumin <30
    • Oedema
  • Maybe also raised cholesterol
  • Exogenous albumin is little use
    • Only lasts 30 mins
  • Give high dose steroids
    • 2 mg/kg prednisolone up to 60 mg max
    • Beware activation of chicken pox!
    • Takes 10 days to work, during which they'll get worse
  • Alternative drugs if multiple relapses:
    • Cyclophosphamide
    • Tacrolimus
  • DON'T give them diuretics!
    • Worsens the decreased circulating volume
    • Don't be confused by their oedema
    • Can maybe give in combination with albumin
  • Penile oedema
    • Blocks micturition
    • Squeeze it hard to deflate
  • Prophylactic penicillin?
  • 30-80% relapse rate
    • Especially if Asian


Nephritic syndrome

  • Completely different beast to nephrotic!
  • Not nearly so bad
  • Inflammation injures capillary walls, permitting escape of red cells into urine
  • PHARAOH criteria:
    • Proteinuria
    • Hematuria,
    • Azotemia
    • RBC casts
    • Anti-strep titres (if post-strep)
    • Oliguria
    • Hypertension
  • Kidneys are not working at all:
    • =>Oliguria
    • HTN
    • Deranged electrolytes
  • Catheterise them
    • Crucial to monitor fluid balance


Notes
  • Treatment of hyperkalaemia
    • Calcium carbonate
    • Insulin + glucose
    • Salbutamol
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