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1. Internal Medicine I > 3. Differential diagnosis in nephrology > Flashcards

3. Differential diagnosis in nephrology Flashcards

1
Q

What are the main renal symptoms?

A

Most renal diseases present insidiously without pain, frequently only with laboratory abnormalities.

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2
Q

What are some urological causes of hematuria?

A
  • Renal/ uroepithelial tumor,
  • stone,
  • UTI ( eg.cystitis),
  • renal cyst rupture,
  • papillary necrosis.
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3
Q

What are some nephrological causes of hematuria?

A
  • Glomerulonephritis (!!!)
  • Alport -syndrome,
  • thin basement membrane disease,
  • acute interstitial nephritis.
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4
Q

How can microscopic urinary sediment examination help differentiate between urological and nephrological causes of hematuria?

A

Urological causes have similar RBCs (isomorphic), while nephrological causes have variable appearance of RBCs (dysmorphic)

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5
Q

What is the differential diagnosis for acute cholecystitis?

A
  • Pancreatic tumor,
  • pancreatitis,
  • colon neoplasm,
  • spleen infarct.
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6
Q

What is the normal protein excretion in urine per day?

A

Up to 200 mg/day (20 mg/mmol).

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7
Q

What is the main protein secreted in the loop of Henle?

A

Tamm-Horsfall protein (uromodulin).

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8
Q

What is the normal albuminuria per day?

A

<30mg/day (<3mg/mmol).

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9
Q

What is the normal protein/creatinine ratio in spot urine?

A

20 mg protein/mmol creatinine.

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10
Q

What is the normal albumin/mmol creatinine in spot urine?

A

3mg albumin/mmol creatinine (normoalbuminuria).

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11
Q

What is the corresponding amount of proteinuria for a spot urine protein/creatinine ratio of 100 mg/mmol?

A

1 g/day proteinuria.

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12
Q

What is the term for hematuria with normal RBC morphology?

A

Isomorphic hematuria.

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13
Q

What is the definition of “clinically significant” proteinuria?

A

> 500mg/day (>50mg/ mmol creatinine).

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14
Q

What is the treatment target for most glomerular diseases?

A

Less than 500mg/day.

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15
Q

What is the definition of albuminuria?

A

> 30mg/day (3 mg/mmol).

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16
Q

What does a urine dipstick detect mainly?

A

Albumin.

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17
Q

What is the range of “nephrotic” range proteinuria?

A

> 3-3.5g/day (0.3 -0.35 g/ mmol).

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18
Q

What is the differential diagnosis for proteinuria if it is >200mg/day or >20mg/mmol?

A
  • Spurious proteinuria (non-renal),
  • functional : fever, orthostatic
  • glomerular : glomerulonephritis,
  • tubular : tubulointerstitial disease,
  • “overflow”
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19
Q

What is a “differential diagnosis” in nephrology?

A

It is the process of distinguishing between different diseases that have similar symptoms in the kidneys.

20
Q

What are the frequently used immunological tests in the diagnosis of renal diseases?

A

ANA (anti-nuclear antibody) and ANCA (anti-neutrophil cytoplasmic antibody).

21
Q

What is Fanconi syndrome?

A

It is a condition where there is damage to the proximal tubule in the kidneys, leading to a failure to reabsorb small molecular weight proteins.

22
Q

What is Bence-Jones proteinuria?

A

It is a type of “overflow” proteinuria where there is a high amount of small molecular weight protein in the serum that overflows reabsorption, such as kappa/lambda light chains.

23
Q

What is the significance of ANA (anti-nuclear antibody)?

A

It is associated with SLE and other systemic autoimmune diseases.

24
Q

What is the significance of ANCA (anti-neutrophil cytoplasmic antibody)?

A

It is associated with small vessel vasculitis (pauci-immune crescentic GN).

25
Q

What is the significance of anti-dsDNS antibody?

A

It is associated with SLE.

26
Q

What is the significance of anti-GBM antibody?

A

It is associated with Goodpasture syndrome.

27
Q

What is the significance of anti-streptolysin antibody?

A

It is associated with poststreptococcal glomerulonephritis.

28
Q

What is the significance of complement 3 and 4 decrease?

A

It is associated with SLE and cryoglobulinemia.

29
Q

What is the significance of phospholipase A2 receptor antibody?

A

It is associated with membranous nephropathy.

30
Q

What are the defining characteristics of nephrotic syndrome?

A
  • Proteinuria (usually > 3.5g/day),
  • hypalbuminemia,
  • edema,
  • hyperlipoproteinemia,
  • thromboembolic events,
  • GFR may be normal.
31
Q

What are the primary renal diseases that can cause nephrotic syndrome?

A
  • Primary membranous glomerulopathy (usually anti-PLA2 receptor antibody positive),
  • minimal change nephropathy,
  • focal segmental glomerulosclerosis.
32
Q

What are the systemic diseases that can cause renal manifestation of nephrotic syndrome?

A
  • Diabetic nephropathy,
  • amyloidosis,
  • secondary FSGS (HIV, extreme obesity),
  • secondary membranous glomerulopathy (lupus nephritis, mixed cryoglobulinemia).
33
Q

What is the further differentiation process for nephrotic syndrome?

A

It involves immunoserology and kidney biopsy.

34
Q

What are the possible causes of secondary membranous glomerulopathy?

A

Lupus nephritis, malignancy, drugs, hepatitis B/C, syphilis, NSAIs, TNF-inhibitors.

35
Q

What are the possible causes of proliferative glomerulonephritis?

A
  • Immune complex and/or complement disregulation mechanisms,
  • poststreptococcalis glomerulonephritis,
  • postinfectiosus glomerulonephritis,
  • membranoproliferative glomerulonephritis.
36
Q

What are the symptoms of nephritic syndrome?

A
  • Hematuria
  • Urinary casts
  • Hypertension
  • Edema
  • Oliguria
  • Decreased GFR
37
Q

What are some symptoms of Rapidly Progressive Glomerulonephritis Syndrome (RPGN)?

A
  • Rapid worsening of kidney function,
  • nephritic urinary findings,
  • frequent systemic symptoms such as vasculitis, pulmonary bleeding, arthritis, fever, and neuropathy.
38
Q

What is the prognosis for untreated RPGN?

A

The prognosis for untreated RPGN is dismal.

39
Q

What is the typical finding in light microscopy for RPGN?

A

Light microscopy usually shows crescents with parietal cell proliferation (extracapillary proliferation).

40
Q

What are some contraindications to renal biopsy?

A

Uncooperative patient, single kidney, multiple renal cysts, renal neoplasm, acute pyelonephritis, uncontrolled bleeding diathesis, and uncontrolled blood pressure (BP > 160/95 mmHg).

41
Q

What are the different patterns observed in immunofluorescent microscopy in the evaluation of a biopsy sample in nephrology?

A

Granular pattern, Linear pattern, Pauci-immune pattern.

42
Q

What is an asymptomatic urinary abnormality in nephrology?

A

Non-nephrotic proteinuria and/or hematuria without nephritic syndrome, usually 0.5-2g/day

43
Q

What are some causes of asymptomatic proteinuria?

A
  • early diabetic nephropathy,
  • secondary FSGS,
  • hypertensive nephropathy
44
Q

What are some causes of asymptomatic hematuria?

A

glomerular diseases such as
- IgA nephropathy
- Alport syndrome,
- thin-basement membrane abnormality

45
Q

What are some signs and symptoms of chronic kidney disease?

A
  • decreased GFR,
  • usually small kidneys with echogenic parenchyma,
  • variable urinary abnormalities,
  • complications according to the stages of CKD such as hypertension, electrolyte-acid base alterations, anemia, and cardiovascular diseases.
46
Q

What should be done in cases of slow progression of chronic kidney disease?

A

In cases of slow progression of chronic kidney disease, preparation for renal replacement therapy and prevention of complications should be done.

1. Internal Medicine I (20 decks)

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