01-16 Glomerulonephritis Redux PATH

Question 1

Nephrotic syndrome cardinal s/sx

Answer 1

1. edema
2. hypoalbuminemia
3. proteinuria (usually > 3.5 g/24 hr).
   —GFR can be normal (e.g. minimal ∆ dz)
   —edema is usu why pts present

Question 2

Nephritic syndrome
—s/sx (mnemonic)
—most worrisome cause

Answer 2

PHARAOH
P-Proteinuria
H-Hematuria
A-Anti-Strep Titer
R-RBC Casts
A-Azotemia
O-Oliguria
H-HTN

—Rapidly Progressive Glomerulonephritis (RPGN) is most worrisome cause
—malig HTN in ED? check BUN/Cr

Question 3

NIL/Focal sclerosis
—Presentation
—Disease States
—Helpful Lab(s)?
—Therapy

Answer 3

—nephrotic syndrome, proteinuria
—Idiopathic Nephrotic syndrome; Tumors; Drugs
—None
—Steroids, immunosuppressives

Question 4

Membranous GN
—Presentation
—Disease States
—Helpful Lab(s)?
—Therapy

Answer 4

—nephrotic syndrome, proteinuria
—INS, Tumors, Infections, SLE, Drugs
—ANA (SLE), C3, HBsAg (Hep B)
—?steroids, ?immunosuppressives

Question 5

Membrano- proliferative GN (Mesangiocapillary)
—Presentation
—Disease States
—Helpful Lab(s)?
—Therapy

Answer 5

—Hemato-proteinuria, Renal failure
—immune complexes from outside the kidney: Idiopathic, Infections,
—C3, IgG
—?Steroids ?Immunosuppressive

Question 6

Crescentic Glomerulonephritis (RPGN = Rapidly Progressive)
—Presentation
—Disease States
—Helpful Lab(s)?
—Therapy

Answer 6

—Hemoproteinuria, Renal failure (more than just nephrotic syndrome b/c of the renal failure)
—Idiopathic, Infections, HSP, etc.
—Everything
—Steroids, Immunosuppressive, Plasmapheresis

Question 7

What are the big 5 for nephrotic syndrome again?

Answer 7

—DM
—Minimal ∆ Dz
—Focal necrosis
—Membranous
—Amyloid

Question 8

spikes/mountains of BM on EM?

Answer 8

membranous GN

—anti-phospholipase A2 on podocyte

Question 9

blue on trichrome stain?

Answer 9

fibrosis
—blue is bad
—never undo that