ECG changes in uraemia

A prolonged QT interval is due to hypocalcaemia and tall T waves to hyperkalaemia and/or acidosis, which can be caused by uraemia. The main ECG change resulting from hypocalcaemia is a long QT interval due to prolongation of the ST segment.

Glomerular disease

Amyloidosis and fibrillary glomerulonephritis

• Diagnosis of primary (AL) amyloidosis
• Fibronectin glomerulopathy
• Glomerular diseases due to nonamyloid fibrillar deposits
• Pathogenesis and clinical features of AL (primary) amyloidosis and light and heavy chain deposition diseases
• Prognosis and treatment of immunoglobulin light chain (AL) amyloidosis and light and heavy chain deposition diseases
• Renal amyloidosis
• Treatment of secondary (AA) amyloidosis

Urinary tract infection in adults

Urinary tract infection (UTI) Childhood UTI: OHCS p174

Definitions

• Bacteriuria: Bacteria in the urine, may be asymptomatic or symptomatic.
• UTI: The presence of a pure growth of >105 organisms per mL of fresh MSU.
• UTI sites:
• urethra (urethritis),
• bladder (cystitis),
• prostate (prostatitis), or
• renal pelvis pyelonephritis).
• Up to ? of women with symptoms have bacteriuria; (=abacterial cystitis or the urethral syndrome).

Renal biopsy

Most acute renal failure is due to pre-renal causes or acute tubular necrosis, and recovery of renal function typically occurs over the course of a few weeks.

Renal biopsy should be performed only if knowing histology will influence management.

Once chronic renal failure is established, the kidneys are small, there is a higher risk of bleeding from biopsy, and the results are usually unhelpful.

Urine tests

Examine mid-stream urine (MSU) whenever you suspect renal disease.

Renal medicine/ nephrology

Renal syndromes:

• proteinuria and nephrotic syndrome,
• haematuria and nephritic syndrome,
• renal pain and dysuria,
• oliguria and polyuria,
• acute renal failure,
• chronic renal failure or chronic kidney disease,
• silence

Urine tests

• urine dipstick
• mid stream urine

Renal biopsy

Urinary tract infection

Complications of end stage kidney disease (ESRD): Anaemia

Causes of anaemia

Anaemia is universal in ESRD, primarily due to a relative lack of EPO. 

Plasma EPO levels are within the ‘normal’ range (6–30 mU/ml), but not increased to the levels seen in other severe anaemias (>100 mU/ml), due to the failure of diseased renal tissue to respond to the anaemic hypoxic stimulus. 

Anaemia usually develops as the GFR falls below 35 ml/min, and worsens with declining GFR.

Other causes of anaemia in renal failure include: