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Renal Medi > 19-20 > Flashcards

19-20 Flashcards

1
Q

What is the most frequent lesion associated with carcinoma? It is also the most common cause of nephrotic syndrome in elderly and adults..

A

Membranous glomerulopathy

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2
Q

Membranous glomerulopathy is most common in what populations?

A

Middle aged males

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3
Q

Most pts with membranous glomerulopathy present with Cr that is ___

A

Normal to slightly elevated

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4
Q

Spontaneous vascular thrombosis is most common with ____. Which 3 kinds of vascular thrombosis are common?

A

Membranous glomerulopathy

  • renal vein thrombosis
  • PE
  • DVT
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5
Q

Hallmark lab findings for membranous glomerulopathy is ___

*what else can you find

A

Nephrotic proteinuria

*complement levels normal, elevated LDL and VLDL, enhanced hyoercoagulable state

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6
Q

Staging of membranous glomerulopathy

A
  1. Subepithelial deposits
  2. Basement membrane starts to project between deposits
  3. Basement membrane envelops deposits
  4. Thickened BM with irregular lucent zones
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7
Q

Tx for membranous glomerulopathy

A

Alternating courses of steroids and chlorambucil

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8
Q

___ is characterized by persistent antigenemia and circulating immune complexes with glomerular depositions.

  • lesions in mesangium and capillary wall
  • widening of capillary loops with double contour
  • in older adults it is associated with hep c
A

Membranoproliferative Glomerulonephritis

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9
Q

Type I vs Type II membranoproliferative GN

A

I- hep C

II- dense deposit disease, rare, poor prognosis, C3 NeF

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10
Q

___ is a characteristic feature of all types of membranoproliferative GN

A

Low complement levels

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11
Q

Tx for membranoproliferative GN

A
  • Type I- treat underlying disease (cytoxan of MMF plus prednisone for 6 months)
  • Type II-good therapy is lacking
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12
Q

Rapidly progressive GN is also called ___

A

Crescentic GN

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13
Q

Tx for Rapidly progressive GN

A

SoluMedrol IV for 3 days
Cytoxan and prednisone
*treat aggressively

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14
Q

___ is the most common GN in the world. Common symptoms are hematuria. Much more common in males

A

Berger disease

Aka IgA nephropathy

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15
Q

Lab tests for dx of IgA nephropathy

A

None

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16
Q

Deposits are where in IgA nephropathy?

A

Mesangium

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17
Q

Tx for IgA nephropathy?

A
  • ACEI and ARB for mild disease
  • steroids or fish oil if at least proteinuria 1g/day
  • cytotoxic agents for progressive disease
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18
Q

Chrug Strauss disease:

A

Eosinophils
Resp tract
Necrotizing vasculitis

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19
Q

Wegeners disease:

A

Necrotizing vasculitis

Resp. tract

20
Q

Microscopic polyangitis:

A

Necrotizing vasculitis

21
Q

cANCA is most prominent in ___ disease.

A

Wegeners

22
Q

Treatment for wegeners disease

A

Prednisone
Cytoxan
Plasmapharesis
Rituxan

23
Q

Goodpastures syndrome is associated with ____ GN and ___

A

Crescenteric
Alveolar hemorrhage
Linear IgA deposits

24
Q

Goodpasture syndrome may present like wegeners, but differences include:

A

pANCA instead of cANCA

25
Q

Treatment of goodpasture syndrome

A

Plasma exchange
Steroids
Cyclophosphamide

26
Q

Primary vs secondary glomerular disease

A
  1. Involves only kidney

2. Systemic disorder

27
Q

The more severe the damage to the GBM, the more ___

A

HMW proteins in the urine (ex IgG)

28
Q

Albumin:Cr ratio (ACR) in mg/mmol

  1. Mild increase =
  2. Moderate =
  3. Severe =

Albumin:Cr ratio (ACR) in mg/g

  1. Mild increase =
  2. Moderate =
  3. Severe =
A
  1. <3
  2. 3-30
  3. > 30
  4. <30
  5. 30-300
  6. > 300
29
Q

Isolated proteinuria can be caused by:
1.
2.
3.

A
  1. Overflow/overproduction (myeloma, negative dipstick)
  2. Tubular dysfunction (Fanconi’s syndrome)
  3. Glomerular dysfunction
30
Q

Mild isolated proteinuria (<1gm/day)
Also called Functional Proteinuria
Type of syndrome?
Causes?

A

Glomerular syndromes

  • Fever
  • exercise
  • CHF
  • benign
31
Q

___ is when proteinuria is absent in recumbent position. It is more common in ___. This is a glomerular syndrome

A 
Orthostatic proteinuria (<1gm/day)
Children and adolescents
32
Q

For fixed non-nephrotic proteinuria, what do you do when:

  1. Proteinuria is <1 g/day
  2. Proteinuria is 1-2 g/day
  3. Proteinuria is >3 g/day
A
  1. Monitor
  2. Biopsy or just monitor
  3. Def biopsy
33
Q

___ is characterized by microscopic RBCs distorted by osmotic/chemical stress as they pass through the nephron

A

Glomerular hematuria

34
Q

The most common causes of asymptomatic hematuria are ___

A

IgA nephropathy and

Thin Basement Membrane Nephropathy

35
Q

Nephrotic syndrome is characterized by ___

*most common causes?

A

3.5 g/day protein
Hypoalbuminemia
*membranous nephropathy and focal segmental glomerulosclerosis

36
Q

Nephritic syndrome

A

<3 g/day protein
Hematuria
Oliguria
Abrupt onset

37
Q

Most common causes of nephritic syndrome are ___

A

Crescenteric GN
Endocapillary Proliferative GN
IgA nephropathy

38
Q

List of primary glomerular diseases

A 
Minimal change disease
Focal segmental glomerulosclerosis
Membranous nephropathy 
Membranoproliferative GN
Rapidly progressive GN
IgA nephropathy
39
Q

Minimal change disease is most common in ____. It is most likely a consequence of ___. It is a ____, injury leads to changes in actin cytoskeleton that causes effacement of podocytes.

A
  1. Children less than 10
  2. T-cell abnormalities which increase glomerular permeability
  3. Podocytyopathy
40
Q

___ is the major structural correlate of nephrotic proteinuria.

A

Minimal change disease

Podocytyopathy

41
Q

Clinical symptoms of minimal change disease

A 
Abrupt onset of nephrotic syndrome 
Avg proteinuria 10g/day
HTN in elderly 
Increased sed rate, lipids
Normal renal function
42
Q

Treatment for minimal change disease

Also tx for Focal segmental glomerulosclerosis

A

Prednisone
Glucocorticoids
Cyclosporin if steroid-resistant

43
Q

What is the most common lesion associated with Nephrotic syndrome?

A

Focal segmental glomerulosclerosis

44
Q

What is the most common GN leading to ESRD?

A

Focal segmental glomerulosclerosis

45
Q

Pathogenesis of Focal segmental glomerulosclerosis

A

Podocytyopathy that is NOT reversible with steroids.
Viral-HIV
Drugs-interferon

46
Q

Hallmark feature of Focal segmental glomerulosclerosis is ___

A

Proteinuria
Nephrotic syndrome
A lot have hematuria

Renal Medi (11 decks)

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