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MHD V: Renal > 10.28: Renal II > Flashcards

10.28: Renal II Flashcards

1
Q

What is RPGN?

A
  • Rapidly progressing glomerulonephritis to renal failure

- Gross hematuria with red urine

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2
Q

3 types of RPGN?

A
  1. Anti GBM antibody
  2. Severe immune complex
  3. ANCA: anti-neutrophilic cytoplasmic antibodies
    * **Crescents seen in all 3 types
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3
Q

Presentation of RPGN?

A
  1. Rapidly progressing loss of renal function
  2. Nephritis with gross hematuria: red urine
  3. Crescents always seen
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4
Q

What is a crescent?

A
  • 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
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5
Q

When are crescents seen?

A

Severe glomerular basement membrane injury with necrosis and breaks

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6
Q

Presentation of RPGN I?

A
  1. Gross hematuria
  2. Decreased urine output
  3. Hemoptysis: injury to pulmonary alviola too
  4. History of smoking, working in car garage or industrial exposure
  5. Urine Cr
  6. Chest x ray with bilateral pulmonary opacities
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7
Q

Who is RPGN I usually seen in?

A

Young men

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8
Q

Pathogenesis of RPGN I?

A
  • 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
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9
Q

What is goodpasture syndrome?

A
  • Antibody formed in RPGN I has cross reactivity with alveolar basement membrane
  • Leads to hemoptysis
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10
Q

What is hemoptysis?

A

Pulmonary hemorrhage

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11
Q

What is the most deadly part of RPGN I?

A
  • Pulmonary fibrosis
  • Kidneys can be saved with dialysis but not lungs
  • Plasmapheresis used for treatment
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12
Q

Pathogenesis of RPGN II?

A
  • Severe immune complex formation with necrosis and breaks in glomerular membrane
  • Can be associated with lupus or post infectious
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13
Q

Presentation of RPGN III?

A
  1. Usually in older patients
  2. Low urine output with hematuria
  3. Hemoptysis with SOB
  4. Complexes not seen in laboratory test: test for ANCA
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14
Q

Pathogenesis of RPGN III?

A

c-ANCA: “Antineutrophil cytoplasmic autoantibodies”

- React with neutrophil antigens

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15
Q

What is pulmonary angiitis and granulomatosis characteristic of?

A
  • AKA “Wegener’s syndrome”
  • RPGN III “ELK”
    Seen in:
    E- ear, nose, throat
    L - Lungs
    K - Kidneys
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16
Q

What is ELK?

A

RPGN III

Infection is also seen in ear, lung, kidney

17
Q

What is goodpasture syndrome?

A

RPGN I

18
Q

What is wegener granulomatosis?

A

RPGN III

19
Q

What is c-ANCA seen in? p-ANCA?

A

c-ANCA: Wegener’s granulomatosis

p-ANCA: Churg strauss

20
Q

What is foamy urine characteristic of?

A

NephROTIC syndrome

21
Q

Is hematuria seen in nephrotic syndrome?

A
  • No, holes in glomeruli are only big enough for proteins
22
Q

How does glomeruli prevent albumin filtration?

A
  • Holes in it are too small for albumin to pass

- Negative charge repels albumin

23
Q

Characteristics of nephrotic syndrome?

A
  1. Urine protein > 3.5g/day
  2. Hypoalbuminemia
  3. Edema
  4. Hyperlipidemia
24
Q

Clinical presentation of membranous nephropathy?

A
  • Generalized edema seen around eyes as well
  • ## Thrombosis: antithrombin III is lost in urine
25
Q

What is puffy eyes characteristic of?

A
  • Nephropathy
26
Q

Pathogenesis of membranous nephropathy ?

A
  • In situ subepithelial immune complex formation
  • Occurs on basal surface of podocytes losing slit diaphragms
  • Leads to capillary wall thickening
  • No cellular reaction, inflammation, or proliferation
  • Can be caused by cancer, penicillin, gold
27
Q

What is spike and dome pattern characteristic of?

A

Membranous nephropathy

28
Q

What needs to be ruled out in membranous nephropathy?

A

Cancer

29
Q

Does membranous nephropathy lead do drop in complement?

A
  • No, slower more chronic development
30
Q

Typical characteristic of membranous nephropathy?

A
  • DVT
  • Edema with eye puffiness
  • SOB
  • Foamy urine
31
Q

Kidney biopsy needed in membranous nephropathy?

A

Yes

MHD V: Renal (28 decks)

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