Nier 2
,Klinischenefrologieinleiding.....................................................................................................3
Clinicalrenalsyndromes..........................................................................................................4
Klinischenefrologie....................................................................................................................5
Deel1:hematurie/proteïnurie..................................................................................................5
Hematurie................................................................................................................................6
Proteïnuria.............................................................................................................................11
Deel 2: Chronische nierziekte, Nierfunctie/klaring meten versus inschatten &
Nierbiopsie/casuïstiek............................................................................................................17
Casussen...............................................................................................................................22
Acutenierinsufficiëntie.............................................................................................................28
AKI.........................................................................................................................................28
PrerenaleAKI........................................................................................................................32
(Prerenaal→)RenaleAKI-acutetubulusnecrose(ATN).....................................................34
RenaleAKI–Intratubulaireobstructie...................................................................................37
RenaleAKI–Glomerulonefritis.............................................................................................43
AKI-Postrenaal.....................................................................................................................43
Arteriëlehypertensie.................................................................................................................46
Hypertensie–behandeling....................................................................................................55
Geneesmiddelenendenier......................................................................................................59
Overdenierfunctie................................................................................................................59
Patiëntenmetchronischenierinsufficiëntie:Voorschrijfprincipes..........................................62
Diabetischenefropathie............................................................................................................71
Inleiding.................................................................................................................................71
1.Epidemiologie....................................................................................................................71
2.Pathofysiologie..................................................................................................................72
3.Histologie...........................................................................................................................74
4.Hoesteljedediagnose?..................................................................................................75
5.Preventieenbehandeling..................................................................................................78
Takehomemessages............................................................................................................82
Zwangerschapendenier.........................................................................................................83
Doelstellingen........................................................................................................................83
Fysiologischeadaptaties.......................................................................................................83
Nefrologischeproblemenzwangerschap...............................................................................87
ZwangerschapbijCKDofniertransplantatie.........................................................................89
Chronischenierinsufficiëntie‘ChronicKidneyDisease’=CKD...........................................92
Doelvandeles......................................................................................................................92
Overzicht................................................................................................................................92
1.Inleiding:definitie,oorzaken,epidemiologie......................................................................92
2.Classificatie&prognose....................................................................................................95
3.Progressie..........................................................................................................................96
4.Screening.........................................................................................................................101
2
, .Klinischemanifestaties....................................................................................................102
5
Cardiovasculaireco-morbiditeit...........................................................................................106
7.Nierfunctievervangendetherapie(dialyse)......................................................................108
8.Zorgplanning....................................................................................................................114
Glomerulonefritis(immunologischeziektenvandeglomerulus).......................................115
Inleiding................................................................................................................................115
Ziektesyndromen/fysiopathologie........................................................................................119
Enkeletypischevoorbeelden...............................................................................................125
Glomerulonefritis:Takehomemessages.............................................................................132
Water,natrium,kalium............................................................................................................133
Natrium................................................................................................................................133
Hyponatriëmie......................................................................................................................136
Hypernatriëmie:eenwaterprobleem....................................................................................140
Kalium..................................................................................................................................141
Calcium&Fosfaat...................................................................................................................147
Deverschillendehoofdrolspelers.........................................................................................147
Regelingsmechanismen......................................................................................................153
Pathologischetoestanden...................................................................................................154
Niertransplantatie....................................................................................................................159
Renaltransplantation...........................................................................................................159
Immediaterenalallograftdysfunction..................................................................................160
HLA-matching......................................................................................................................164
Post-transplantfollow-up.....................................................................................................166
Post-transplantmalignancies...............................................................................................167
Keyparametersofclinicalimmunosuppression..................................................................168
Evolution/acceptanceofdonortype.....................................................................................171
SamenvattingTransplantatie...............................................................................................173
Niertransplantatie:complicaties...........................................................................................173
Autosomaaldominantepolycystischenierziekten(ADPKD)..............................................175
Inleiding...............................................................................................................................177
Kliniek..................................................................................................................................177
Diagnose..............................................................................................................................180
Behandeling.........................................................................................................................180
3
, Klinische nefrologie inleiding
Clinical renal syndromes
1. Nephritic syndrome
a. Hematuria(erythrocyturia: dysmorphic; cilinders)
i. Asymptomatic, isolated (microscopic) hematuria
ii. Hematuria with proteinuria and/or hypertension and/or reduced GFR
1. Vnl hematurie maar er kan ook eiwitlek zijn of functieverlies
2. Nephrotic syndrome
a. Proteïnuria(nephrotic range: ≥3 g/day)
i. Hypalbuminemia, edema, hypercholesterolemia
ii. Inactiveurinary sediment
1. Vnl proteïnurie met meestal een niet-actief sediment = zonder
RBC
3. Acute Kidney Injury
a. Acuterenal failure (GFR in hours-weeks)
i. Non-glomerular: Ischemic, toxins, pigments, sepsis
ii. Glomerular: e.g. acute poststreptococcal GN(GlomeruloNefritis)
4. RPGN
a. Rapidly progressiverenal failure (wks-months)
i. Crescentic GN: systemic vasculitis, autoimmune disease
ii. Nephritic sediment, proteinuria <3 g/day
iii. Hypertension, edema
5. Chronic Kidney Disease
a. CKD-staging I to V
b. Chronisch > 3 maanden
Acuut, progressief of chronisch → eGFR kunnen berekenen
→
yndroom
S
= constellatie van verschijnselen, bevindingen van het lichamelijk onderzoek en die
samenbundeling van informatie die je krijgt = presentaties van ziektes
● Syndroom ≠ ziekte= verzameling van feiten/symptomendie je verzamelt die bij 1 of
meerdere ziektes kunnen horen
○ Bestaat uit bouwstenen bv hematurie (RBC in de urine)
● Je moet de GFR bepalen
ymptomen/verschijnselen → Syndromen
S
→ Oorzakelijke ziekten
● Je kan het in syndroom passen
● En kan in tijdsperiode stellen: acuut vs
chronisch
4
,Klinischenefrologieinleiding.....................................................................................................3
Clinicalrenalsyndromes..........................................................................................................4
Klinischenefrologie....................................................................................................................5
Deel1:hematurie/proteïnurie..................................................................................................5
Hematurie................................................................................................................................6
Proteïnuria.............................................................................................................................11
Deel 2: Chronische nierziekte, Nierfunctie/klaring meten versus inschatten &
Nierbiopsie/casuïstiek............................................................................................................17
Casussen...............................................................................................................................22
Acutenierinsufficiëntie.............................................................................................................28
AKI.........................................................................................................................................28
PrerenaleAKI........................................................................................................................32
(Prerenaal→)RenaleAKI-acutetubulusnecrose(ATN).....................................................34
RenaleAKI–Intratubulaireobstructie...................................................................................37
RenaleAKI–Glomerulonefritis.............................................................................................43
AKI-Postrenaal.....................................................................................................................43
Arteriëlehypertensie.................................................................................................................46
Hypertensie–behandeling....................................................................................................55
Geneesmiddelenendenier......................................................................................................59
Overdenierfunctie................................................................................................................59
Patiëntenmetchronischenierinsufficiëntie:Voorschrijfprincipes..........................................62
Diabetischenefropathie............................................................................................................71
Inleiding.................................................................................................................................71
1.Epidemiologie....................................................................................................................71
2.Pathofysiologie..................................................................................................................72
3.Histologie...........................................................................................................................74
4.Hoesteljedediagnose?..................................................................................................75
5.Preventieenbehandeling..................................................................................................78
Takehomemessages............................................................................................................82
Zwangerschapendenier.........................................................................................................83
Doelstellingen........................................................................................................................83
Fysiologischeadaptaties.......................................................................................................83
Nefrologischeproblemenzwangerschap...............................................................................87
ZwangerschapbijCKDofniertransplantatie.........................................................................89
Chronischenierinsufficiëntie‘ChronicKidneyDisease’=CKD...........................................92
Doelvandeles......................................................................................................................92
Overzicht................................................................................................................................92
1.Inleiding:definitie,oorzaken,epidemiologie......................................................................92
2.Classificatie&prognose....................................................................................................95
3.Progressie..........................................................................................................................96
4.Screening.........................................................................................................................101
2
, .Klinischemanifestaties....................................................................................................102
5
Cardiovasculaireco-morbiditeit...........................................................................................106
7.Nierfunctievervangendetherapie(dialyse)......................................................................108
8.Zorgplanning....................................................................................................................114
Glomerulonefritis(immunologischeziektenvandeglomerulus).......................................115
Inleiding................................................................................................................................115
Ziektesyndromen/fysiopathologie........................................................................................119
Enkeletypischevoorbeelden...............................................................................................125
Glomerulonefritis:Takehomemessages.............................................................................132
Water,natrium,kalium............................................................................................................133
Natrium................................................................................................................................133
Hyponatriëmie......................................................................................................................136
Hypernatriëmie:eenwaterprobleem....................................................................................140
Kalium..................................................................................................................................141
Calcium&Fosfaat...................................................................................................................147
Deverschillendehoofdrolspelers.........................................................................................147
Regelingsmechanismen......................................................................................................153
Pathologischetoestanden...................................................................................................154
Niertransplantatie....................................................................................................................159
Renaltransplantation...........................................................................................................159
Immediaterenalallograftdysfunction..................................................................................160
HLA-matching......................................................................................................................164
Post-transplantfollow-up.....................................................................................................166
Post-transplantmalignancies...............................................................................................167
Keyparametersofclinicalimmunosuppression..................................................................168
Evolution/acceptanceofdonortype.....................................................................................171
SamenvattingTransplantatie...............................................................................................173
Niertransplantatie:complicaties...........................................................................................173
Autosomaaldominantepolycystischenierziekten(ADPKD)..............................................175
Inleiding...............................................................................................................................177
Kliniek..................................................................................................................................177
Diagnose..............................................................................................................................180
Behandeling.........................................................................................................................180
3
, Klinische nefrologie inleiding
Clinical renal syndromes
1. Nephritic syndrome
a. Hematuria(erythrocyturia: dysmorphic; cilinders)
i. Asymptomatic, isolated (microscopic) hematuria
ii. Hematuria with proteinuria and/or hypertension and/or reduced GFR
1. Vnl hematurie maar er kan ook eiwitlek zijn of functieverlies
2. Nephrotic syndrome
a. Proteïnuria(nephrotic range: ≥3 g/day)
i. Hypalbuminemia, edema, hypercholesterolemia
ii. Inactiveurinary sediment
1. Vnl proteïnurie met meestal een niet-actief sediment = zonder
RBC
3. Acute Kidney Injury
a. Acuterenal failure (GFR in hours-weeks)
i. Non-glomerular: Ischemic, toxins, pigments, sepsis
ii. Glomerular: e.g. acute poststreptococcal GN(GlomeruloNefritis)
4. RPGN
a. Rapidly progressiverenal failure (wks-months)
i. Crescentic GN: systemic vasculitis, autoimmune disease
ii. Nephritic sediment, proteinuria <3 g/day
iii. Hypertension, edema
5. Chronic Kidney Disease
a. CKD-staging I to V
b. Chronisch > 3 maanden
Acuut, progressief of chronisch → eGFR kunnen berekenen
→
yndroom
S
= constellatie van verschijnselen, bevindingen van het lichamelijk onderzoek en die
samenbundeling van informatie die je krijgt = presentaties van ziektes
● Syndroom ≠ ziekte= verzameling van feiten/symptomendie je verzamelt die bij 1 of
meerdere ziektes kunnen horen
○ Bestaat uit bouwstenen bv hematurie (RBC in de urine)
● Je moet de GFR bepalen
ymptomen/verschijnselen → Syndromen
S
→ Oorzakelijke ziekten
● Je kan het in syndroom passen
● En kan in tijdsperiode stellen: acuut vs
chronisch
4
