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