10.28: Renal II Flashcards
What is RPGN?
- Rapidly progressing glomerulonephritis to renal failure
- Gross hematuria with red urine
3 types of RPGN?
- Anti GBM antibody
- Severe immune complex
- ANCA: anti-neutrophilic cytoplasmic antibodies
* **Crescents seen in all 3 types
Presentation of RPGN?
- Rapidly progressing loss of renal function
- Nephritis with gross hematuria: red urine
- Crescents always seen
What is a crescent?
- Glomerular stopper that stops bleeding when glomerular vasculature is punctured
- Forms in a crescent shape of parietal epithelial cells
- Decreases GFR leading to rapid renal failure
When are crescents seen?
Severe glomerular basement membrane injury with necrosis and breaks
Presentation of RPGN I?
- Gross hematuria
- Decreased urine output
- Hemoptysis: injury to pulmonary alviola too
- History of smoking, working in car garage or industrial exposure
- Urine Cr
- Chest x ray with bilateral pulmonary opacities
Who is RPGN I usually seen in?
Young men
Pathogenesis of RPGN I?
- Expose to virus, smoking, dyes or drugs
- Body forms anti-glomerular basement membrane antibodies
- Antibodies are deposited along entire length of glomerulus
- Creates sieve like holes allowing RBCs to leak through
What is goodpasture syndrome?
- Antibody formed in RPGN I has cross reactivity with alveolar basement membrane
- Leads to hemoptysis
What is hemoptysis?
Pulmonary hemorrhage
What is the most deadly part of RPGN I?
- Pulmonary fibrosis
- Kidneys can be saved with dialysis but not lungs
- Plasmapheresis used for treatment
Pathogenesis of RPGN II?
- Severe immune complex formation with necrosis and breaks in glomerular membrane
- Can be associated with lupus or post infectious
Presentation of RPGN III?
- Usually in older patients
- Low urine output with hematuria
- Hemoptysis with SOB
- Complexes not seen in laboratory test: test for ANCA
Pathogenesis of RPGN III?
c-ANCA: “Antineutrophil cytoplasmic autoantibodies”
- React with neutrophil antigens
What is pulmonary angiitis and granulomatosis characteristic of?
- AKA “Wegener’s syndrome”
- RPGN III “ELK”
Seen in:
E- ear, nose, throat
L - Lungs
K - Kidneys
What is ELK?
RPGN III
Infection is also seen in ear, lung, kidney
What is goodpasture syndrome?
RPGN I
What is wegener granulomatosis?
RPGN III
What is c-ANCA seen in? p-ANCA?
c-ANCA: Wegener’s granulomatosis
p-ANCA: Churg strauss
What is foamy urine characteristic of?
NephROTIC syndrome
Is hematuria seen in nephrotic syndrome?
- No, holes in glomeruli are only big enough for proteins
How does glomeruli prevent albumin filtration?
- Holes in it are too small for albumin to pass
- Negative charge repels albumin
Characteristics of nephrotic syndrome?
- Urine protein > 3.5g/day
- Hypoalbuminemia
- Edema
- Hyperlipidemia
Clinical presentation of membranous nephropathy?
- Generalized edema seen around eyes as well
- ## Thrombosis: antithrombin III is lost in urine
