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