19-20

Question 1

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

Answer 1

Membranous glomerulopathy

Question 2

Membranous glomerulopathy is most common in what populations?

Answer 2

Middle aged males

Question 3

Most pts with membranous glomerulopathy present with Cr that is ___

Answer 3

Normal to slightly elevated

Question 4

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

Answer 4

Membranous glomerulopathy

• renal vein thrombosis
• PE
• DVT

Question 5

Hallmark lab findings for membranous glomerulopathy is ___

*what else can you find

Answer 5

Nephrotic proteinuria

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

Question 6

Staging of membranous glomerulopathy

Answer 6

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

Question 7

Tx for membranous glomerulopathy

Answer 7

Alternating courses of steroids and chlorambucil

Question 8

___ 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

Answer 8

Membranoproliferative Glomerulonephritis

Question 9

Type I vs Type II membranoproliferative GN

Answer 9

I- hep C

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

Question 10

___ is a characteristic feature of all types of membranoproliferative GN

Answer 10

Low complement levels

Question 11

Tx for membranoproliferative GN

Answer 11

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

Question 12

Rapidly progressive GN is also called ___

Answer 12

Crescentic GN

Question 13

Tx for Rapidly progressive GN

Answer 13

SoluMedrol IV for 3 days
Cytoxan and prednisone
*treat aggressively

Question 14

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

Answer 14

Berger disease

Aka IgA nephropathy

Question 15

Lab tests for dx of IgA nephropathy

Answer 15

None

Question 16

Deposits are where in IgA nephropathy?

Answer 16

Mesangium

Question 17

Tx for IgA nephropathy?

Answer 17

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

Question 18

Chrug Strauss disease:

Answer 18

Eosinophils
Resp tract
Necrotizing vasculitis

Question 19

Wegeners disease:

Answer 19

Necrotizing vasculitis

Resp. tract

Question 20

Microscopic polyangitis:

Answer 20

Necrotizing vasculitis

Question 21

cANCA is most prominent in ___ disease.

Answer 21

Wegeners

Question 22

Treatment for wegeners disease

Answer 22

Prednisone
Cytoxan
Plasmapharesis
Rituxan

Question 23

Goodpastures syndrome is associated with ____ GN and ___

Answer 23

Crescenteric
Alveolar hemorrhage
Linear IgA deposits

Question 24

Goodpasture syndrome may present like wegeners, but differences include:

Answer 24

pANCA instead of cANCA

Question 25

Treatment of goodpasture syndrome

Answer 25

Plasma exchange Steroids Cyclophosphamide

Question 26

Primary vs secondary glomerular disease

Answer 26

1. Involves only kidney | 2. Systemic disorder

Question 27

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

Answer 27

HMW proteins in the urine (ex IgG)

Question 28

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 =

Answer 28

1. <3 2. 3-30 3. >30 1. <30 2. 30-300 3. >300

Question 29

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

Answer 29

1. Overflow/overproduction (myeloma, negative dipstick) 2. Tubular dysfunction (Fanconi's syndrome) 3. Glomerular dysfunction

Question 30

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

Answer 30

Glomerular syndromes - Fever - exercise - CHF * benign

Question 31

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

Answer 31

``` Orthostatic proteinuria (<1gm/day) Children and adolescents ```

Question 32

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

Answer 32

1. Monitor 2. Biopsy or just monitor 3. Def biopsy

Question 33

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

Answer 33

Glomerular hematuria

Question 34

The most common causes of asymptomatic hematuria are ___

Answer 34

IgA nephropathy and | Thin Basement Membrane Nephropathy

Question 35

Nephrotic syndrome is characterized by ___ | *most common causes?

Answer 35

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

Question 36

Nephritic syndrome

Answer 36

<3 g/day protein Hematuria Oliguria Abrupt onset

Question 37

Most common causes of nephritic syndrome are ___

Answer 37

Crescenteric GN Endocapillary Proliferative GN IgA nephropathy

Question 38

List of primary glomerular diseases

Answer 38

``` Minimal change disease Focal segmental glomerulosclerosis Membranous nephropathy Membranoproliferative GN Rapidly progressive GN IgA nephropathy ```

Question 39

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.

Answer 39

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

Question 40

___ is the major structural correlate of nephrotic proteinuria.

Answer 40

Minimal change disease | Podocytyopathy

Question 41

Clinical symptoms of minimal change disease

Answer 41

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

Question 42

Treatment for minimal change disease | Also tx for Focal segmental glomerulosclerosis

Answer 42

Prednisone Glucocorticoids Cyclosporin if steroid-resistant

Question 43

What is the most common lesion associated with Nephrotic syndrome?

Answer 43

Focal segmental glomerulosclerosis

Question 44

What is the most common GN leading to ESRD?

Answer 44

Focal segmental glomerulosclerosis

Question 45

Pathogenesis of Focal segmental glomerulosclerosis

Answer 45

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

Question 46

Hallmark feature of Focal segmental glomerulosclerosis is ___

Answer 46

Proteinuria Nephrotic syndrome A lot have hematuria