10.27: Renal I Flashcards
2 main categories of kidney disease?
- NephrOTIC: proteinuria > 3-3.5g/day
2. NephrITIC: hematuria
Which form of kidney disease is hematuria a hallmark of?
Nephritic
What is frothy urine characteristic of?
Proteinuria (nephrotic syndrome)
Some causes of hematuria?
- Glomerulonephritis
- Carcinoma
- Trauma
- Infarct
Characteristics of nephritic syndrome?
- Hematuria w/ dysmorphic cells and RBC casts
- Some degree of oliguria and azotemia
- Htn.
- Active urinary sediment
What does active urinary sediment mean?
Dysmorphic RBCs or RBC casts in urine
What is acute postinfectious glomerulonephritis? presentation?
- Usually presents in children "Acute nephritic syndrome" 1. Hematuria 2. Edema 3. Htn. 4. Renal failure
Normal cause for acute postinfectious glomerulonephritis? and pathology?
- 1 - 4 weeks post pharyngitis from group A Beta hemolytic strep
- These bacteria have M protein virulence factor
- Antigen + IgG immune complexes deposit in renal capillaries activating complement C5a
- Neutrophils are attracted causing damage
- Damage to tissue allows RBCs to pass through leading to hematuria
What characteristic of immune complex is unique to postinfectious glomerulonephritis?
- In situ formation of immune complex leading to subepithelial “humps”
What is subepithelial humps of immune complex characteristic of?
Post infectious glomerulonephritis
What are trilobed cells?
Usually neutrophils
Laboratory tests indicative of post infectious glom.?
- Tea color, smoke, coca cola urine
- Hematuria w/ mild proteinuria
- Increased ASO titer (antistrep)
- Decreased complement levels
Prognosis in acute postinfectious glomerulonephritis?
- 95% recover in children
- Adults can become chronic glomerulonephritis
- Small subset of children with gross hematuria can develop severe acute syndrome with renal failure
When is renal biopsy needed in acute post infectious glom.?
- Only if the course is a typical
- Not if the course is typical
What is the main Ig in the body?
- IgG
- IgA is main Ig in secretions and mucosal immunity
What is Berger Disease?
IgA nephropathy
Clinical presentation of IgA nephropathy?
- RECURRENT hematuria
- PAINLESS
- Sometimes after upper respiratory tract infection
- Last for days recurring every few months
What is recurrent, painless hematuria characteristic of?
IgA nephropathy
Pathogenisis of IgA nephropathy?
- Mucosal infection leading to IgA production
- IgA immune complex deposits in mesangium
How do complement levels present in IgA nephropathy?
- IgA actives complex system at slow rate so we do not see drop
- Drop in immune complex levels are seen in post infectious
What is hematuria with normal complement levels characteristic of?
IgA nephropathy
What is necessary for definitive diagnosis in IgA Nephropathy?
Kidney needle biopsy
What is hereditary nephritis?
- Mutations in glomerular basement membrane proteins
- Often in collagen type IV
- Alport syndrome is best known type
Where is type IV collagen found?
- Glomerular basement membrane
- Eyes
- Ears
Triad of symptoms in alport syndrome?
- Nephritis
- Nerve deafness: hearing abnormalities
- Eye disorders such as early cataracts
What is Alport syndrome?
- Most common form of hereditary nephritis
- X linked
- Triad of symptoms
What is lamina densa splitting and basket weave lamination characteristic of?
- Hereditary nephritis
- Alport syndrome
Prognosis of hereditary nephritis?
- Kidney failure at 2 - 50 years of age
- Genetic testing needed for diagnosis
What is atypical postinfectious glomerulonephritis?
- Normally we would see pharyngitis 2 weeks before
- In “A typical” this is not the case
