13: Glomerular Disease- Belz Flashcards
nephrotic v. nephritic
Nephrotic syndrome involves the loss of a lot of protein, whereas Nephritic syndrome involves the loss of a lot of blood
s/s glomerulonephritis
- edema
- –gross hematuria (RBC casts and dysmorphic RBC)
- lipiduria
- proteinuria (correlates with glomerular damage)
- renal failure can be rapidly progressive
pt with hematuria but no protein in urine likely has
asymptomatic hematuria
biopsy will show normal, thin BM nephropathy or IgA nephropathy
describe IgA nephropathy **
Asymptomatic hematuria with proteinuria
Macroscopic hematuria associated with upper respiratory infection***
This can be associated with Henoch-Schönlein Purpura
pt with asymptomatic heamturia post upper respiratory infection. prtn 1.5 g — what would you do diagnosis and how?
Would you pursue a renal biopsy? Yes – he has more than 1 g prtn/day
What is the most likely finding? IgA nephropathy
What correlates best with this patient’s prognosis long term? By how much prtn is the urine
describe rapidly progressive glomerulonephritis
Renal failure Oliguria Edema Hypertension Proteinuria Hematuria – active sediment
MEDICAL EMERGENCY
Pathologically, this class of glomerular disease is characterized by the presence of cellular crescents
these crescents are a result of proliferation of parietal epithelial cells
Rapidly Progressive Glomerulonephritis
causes rapidly progressive glomurelonephritis
Direct immunoglobulin attack (goodpasture syndrome) —-Linear deposits of IgG in the glomerular basement membrane
Immune complex deposition (post infectious GN among other cuases — Granular pattern of immune complex deposition )
Pauci-immune (ANCA + associated - lack of immune complexes — Granulomatosis with Polyangiitis (GPA) (Wegener Granulomatosis)
Eosinophilic Granulomatosis with Polyangiitis (EGPA) (Churg-Strauss Syndrome)
Microscopic Polyangiitis (MPA)
pt with 3 mo hx edema, normal edema, urinalysis revealed red blood cell casts and lots of prtn
what diagnosis? how?
nephritic syndrome (glomerular nephritis)
How would you treat this patient initially? Steroid – immune suppression
Would you pursue a renal biopsy? yes
What pathologic finding is likely in the glomeruli? proliferation of parietal epithelial cells – see crescents
What blood testing would you do to evaluate this patient further? – check ANCA, antibody tests
most common cause of acute glomerulonephritis worldwide
Post infectious glomerulonephritis
In situ immune complex formation due to glomerular deposition of streptococcal nephritogenic antigens
Clinical Characteristics = ??? Usually an antecedent history of group A strep infection. Latent period is weeks Edema Gross hematuria Hypertension
Post Infectious Glomerulonephritis
the latent period distinguishes from IgA nephropathy
Laboratory findings:
Hematuria with and without red blood casts***
Proteinuria
Depressed C3 and CH50 complement activity(Return to normal within 4-8 weeks)
Elevated antibody titers to extracellular streptococcal antigens
An 8 year old male with no significant past medical history presents with gross hematuria, proteinuria (3 g/24 hours) and acute kidney injury. He had an upper respiratory infection 2 weeks ago. Testing for group A strep was positive
Would you biopsy this patient?
What would you likely find?
Would you expect resolution of the hematuria and proteinuria over time?
Would you expect improvement in his renal function?
Yes - renal failure
Find- crescents (proliferation)
yes - self limiting disease
Yes
s/s =
Massive proteinuria (>3.5 g/24 hours)*** Hypoproteinemia/hypoalbuminemia (albumin less than 3 g/dl) Edema Hyperlipidemia Thrombotic disease Lipiduria
Nephrotic Syndrome
complications:
- Thrombosis secondary to loss of hemostasis control proteins
- Infections secondary to loss of immunoglobulins
- Accelerated atherosclerosis from hyperlipidemia
- Protein malnutrition
- Iron-resistant microcytic hypochromic anemia due to transferrin loss
- Hypocalcemia and secondary hyperparathyroidism (Vitamin D deficiency due to urinary excretion of cholecalciferol-binding proteins)
- Depressed thyroxine levels due to loss of thyroxine-binding globulins
maltese crosses
nephrotic syndrome
primary v. seconday nephrotic syndrome
primary - only kidney
Minimal change disease
Focal Segmental Glomerulosclerosis
Membranous glomerulopathy
secondary - systemic
Diabetic glomerulopathy
Amyloidosis
