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Nephrology > 308 Glomerulolar Disease > Flashcards

308 Glomerulolar Disease Flashcards

1
Q

What test will you do to assess risk for diabetic nephropathy?

A

Urine Creatinine: protein ratio

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2
Q 
50M mine worker presents with 2 months chronic cough, purulent nasal discharge and low grade fever. Treated with co-amoxiclav, however, develops shortness of breath and hemoptysis. PE +purpura on both hands and legs and crackles  on right lower lung fields. Labs leukocytosis with neutrophilia, Creatinine 3.2 mg/dl and urinalysis  +hematuria and proteinuria. CXR shows right lung nodule and non specific infiltrates. Biopsy of the pulmonary nodule shows neutrophilic microabscesses and necrotizing granuloma. What is the most likely diagnosis?
A. Goodpasture's syndrome
B. Churg Strauss syndrome
C. Granulomatosis with polyangitis
D. Microscopic polyangitis
A

C. Granulomatosis with polyangitis

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3
Q

Glomerulonephritis that presents with gross hematuria

A

IgA nephropathy

Sickle cell disease

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4
Q

Other differentials for microscopic hematuria not necessarily GN

A 
BPH
Interstitial nephritis
Papillary necrosis
Renal stones
Cystic kidney disease
Renal vascular injury
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5
Q

Causes of transient proteinuria

A 
Fever
Exercise
Obesity
Sleep apnea
Emotional stress
CHF
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6
Q

Proteinuria only seen in upright posture

A

Orthostatic proteinuria

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7
Q

True or false. Proteinuria in adults and children with glomerular disase is selective and composed of albumin

A

False. Adults non selective. Albumin and mixture of other serum proteins

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8
Q

Most common causes of GN in the western hemisphere

A

Malari
Schistosomiasis
HIV
Hepatitis B and C

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9
Q

True or false. In chronic GN, decreased kidney size if often seen

A

True.

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10
Q

When does GN occur after a skin infection? After strep pharyngitis?

A

Skin infection: 2-6 weeks

Pharyngitis: 1-3 weeks

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11
Q

When does endocarditis associated GN typically occurs

A

Subacute bacterial endocarditis
Untreated for a long time
Negative blood cultures
Right sided endocarditis

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12
Q

When goes GB in acute bacterial endocarditis occur

A

10-14 days

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13
Q

Most common and serious complication of SLE

A

Lupus nephritis

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14
Q

Most varies course of lupus nephritis

A

Class III

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15
Q

The only reliable method of identifying morphologic variant of lupus nephritis

A

Renal biopsy

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16
Q

Complication of class V lupus nephritis

A

Renal vein thrombosjs

Other thrombotic complications

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17
Q

True or false. SLE tends to became quiescent once there is renal failure because of immunosuppressant effects of uremia

A

True

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18
Q

When can renal transplant be done in patient with lupus nephritis

A

After 6 months of inactive disease

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19
Q

What is the target epitopes for anti GBM disease

A

A3 NC1 domain of collagen IV

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20
Q

Most common Glomerulonephritis world

A

IgA nephropathy

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21
Q

Single most common cause of chronic renal failure

A

DM nephropathy

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22
Q

What is a the characteristic lesion in HIV associated nephropathy

A

FSGS

Collapsing glomerulopathy

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23
Q

plasma of water filtered by the glomerular capillaries

A

120-180 L/day

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24
Q

True or false. The glomerulus is an imperfect barrier in the case of serum albumin

A

True.

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25
Q

what is the physical radius of albumin compared to the pores in the GBM and slit pore membranes

A

albumin has a physical radius of 3.6 nm while pores in the GBM and split ore membranes have a radius of 4 nm

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26
Q

how much albumin is voided in the urine daily

A

8-10 mg of albumin in daily voided urine

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27
Q

hematuria suspicous for GN

A

3-5 RBC in the spun sediment from first voided morning urine is suspicious

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28
Q

GN which presents with gross hematuria

A

IgA nephropathy and sickle cell disease

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29
Q

differential of microscopic hematuria

A

malignancy of urinary tract, BPH, interstitial nephritis, papillary necrosis, hypercalciuria, renal stones, cystic kidney disease, or renal vascular injury

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30
Q

found in the urine sediment which points more likely to glomerulonephritis

A

RBC casts, dysmorphic RBC

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31
Q

proteinuria in microalbuminuria

A

30-300 mg in 24 hrs

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32
Q

represents frank proteinuria and more advanced renal disease

A

more than 300 mg in 24 hours

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33
Q

Urine assays for Albuminuria/Proteinuria. Normal

A

24hr urine: 8-10 mg ACR less than 30 mg/g Dipstick proteinuria none 24hr urine protein less than 150 mg in 24 hr

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34
Q

24hr urine: 8-10 mg ACR less than 30 mg/g Dipstick proteinuria none 24hr urine protein less than 150 mg in 24 hr

A

24hr urine 30-300 mg ACR 30-300 mg/g Dipstick proteinuria trace to 1+ 24hr urine protein none

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35
Q

Urine assays for Albuminuria/Proteinuria. Proteinuria

A

24hr urine more than 300 mg ACR more than 300 Dipstick proteinuria 3+ 24hr urine protein more than 150

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36
Q

defined sustained proteinuria

A

more than 1-2 g/ 24 hrs

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37
Q

define benign proteinuria

A

less than 1 g/ 24 hrs

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38
Q

examples of functional or transient proteinuria

A

fever, exercise, obesity, sleep apnea, emotional stress, and CHF

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39
Q

True or false. Proteinuria in adults is nonselective containing albumin and other serum proteins whereas in children it is selective

A

True,

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40
Q

Patterns of clinical glomerulonephritis (6)

A

acute nephritic syndromes, pulmonary renal syndromes, nephrotic syndromes, basement membrane syndromes, glomerular vascular syndromes, infectious disease associated syndromes

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41
Q

stain used in renal biopsy to enhance basement membrane structure

A

Jones methenamine silver

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42
Q

stain used in renal biopsy to identify collagen deposition and assess the degree of glomerulosclerosis and interstitial fibrosis

A

Masson’s trichrome

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43
Q

When do you say that the lesion is focal

A

less than 50% glomeruli involved

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44
Q

When do you say that the lesion is diffuse

A

more than 50% glomeruli involved

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45
Q

injury involving most of the glomerulus

A

global

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46
Q

injury involving portion of the tuft

A

segmental

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47
Q

refers to glomeruli showing increased cellularity

A

proliferative

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48
Q

refers to cellularity in the capillary tuft

A

endocapillary

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49
Q

when cellular proliferation extends into the Bowman’s space

A

extracapillary

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50
Q

formed when epithelial podocytes attach to Bowman’s capsule in setting of glomerular injury

A

synechiae

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51
Q

extension of the synechiae when fibrocellular fibrin collections fills all or part of Bowman’s space

A

?

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52
Q

acellular, amorphous accumulations of proteinaceous material throughout the tuft with loss of capillaries and normal mesangium

A

sclerotic glomeruli

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53
Q

Examples of acute nephritic syndromes

A

Post strep GN, Subacute bacterial endocarditis, lupus nephritis, anti GBM disease, IgA nephropathy, Henoch Schonlein purpura etc

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54
Q

prototypical for acute endocapillary proliferative glomerulonephritis

A

postreptococcal glomerulonephritis

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55
Q

strain of streptococci which antedate glomerular disease in poststrep GN

A

M types of streptococci

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56
Q

M types streptococci seen in impetigo

A

47, 49, 55, 2, 60, 57 = higher number impetigo

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57
Q

M types streptococci seen in pharyngitis

A

1,2,3,4, 25,49, 12 = lower number pharyngitis

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58
Q

how many weeks does post strep GN develop after pharyngitis

A

1-3 weeks

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59
Q

how many weeks does post strep GN develop after impetigo

A

2-6 weeks

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60
Q

associated with subendothelial deposits or humps

A

post strep GN

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61
Q

nephritogenic antigen demonstrated inside the subepithelial humps on renal biopsy on poststrep GN

A

streptococcal pyrogenic exotoxin B (SPEB)

62
Q

treatment of poststrep GN

A

supportive

63
Q

What is the prognosis of poststrep GN

A

good in adulthood; worse in elderly with 60% progressing to ESRD

64
Q

when does complete resolution of hematuria occurs in patients with poststrep GN

A

Within 3-6 week of the onset of nephritis

65
Q

True or false. Endocarditis associated glomerulonephritis is a complication of SBE particularly in patients who remain untreated for a long time, have negative blood cultures or have right sided endocarditis

A

True.

66
Q

why is glomerunephritis unusual in acute bacterial endocarditis

A

because it takes 10-14 days for immune complex mediated injury

67
Q

what is the gross appearance of the kidneys in patients with endocarditis- associated glomerulonephritis

A

subcapsular hemorrhages with a flea beaten appearance

68
Q

what is the primary treatment of endocarditis associated glomerulonephritis

A

4-6 weeks of antibiotics

69
Q

what is the prognosis of SBE glomerulonephritis

A

guarded

70
Q

common and serious complication of SLE

A

lupus nephritis

71
Q

most common clinical sign of renal disease in SLE

A

proteinuria

72
Q

antibodies that correlated best with presence of acute lupus nephritis

A

anti dsDNA

73
Q

Class of lupus nephritis with most varied course

A

Class III

74
Q

Class of lupus nephritis. Normal glomerular histoloy

A

Class I

75
Q

Class of lupus nephritis. Mesangial immune complexes with mesangial proliferation

A

Class II

76
Q

Class of lupus nephritis. Focal lesions with scarring.

A

Class III

77
Q

Class of lupus nephritis. Diffuse proliferation

A

Class IV

78
Q

Class of lupus nephritis. Thickened basement membrane

A

Class V

79
Q

Class of lupus nephritis. Global sclerosis

A

Class VI

80
Q

aggressive lesion in lupus nephritis has the worst renal prognosis

A

crescents on biopsy

81
Q

define remission in lupus nephritis

A

near normal renal function and proteinuria less than 330 mg/dL per day

82
Q

Lupus nephritis class predisposed to renal vein thrombosis and other thrombotic complications

A

lupus nephritis class V

83
Q

when can patient with lupus nephritis have renal transplantation

A

After 6 months of inactive disease

84
Q

targets epitopes for anti GBM disease

A

quaternary structure of a3 NC1 domain of collagen IV

85
Q

True or false. Goodpasture’s syndrome in younger age groups are usually explosive

A

True.

86
Q

What is the prognosis of anti GBM glomerulonephritis

A

good prognosis with treatment

87
Q

what is the treatment of anti GBM disease

A

plasmapharesis, oral prednisone and cyclophosphamide

88
Q

one of the most common forms of glomerulonephritis worldwide

A

IgA nephropathy

89
Q

Differential IgA with Henoch Schonlein purpura

A

HSP has prominent systemic symptoms, younger age, preceding infection and abdominal complaints

90
Q

two most common presentations of IgA nephropathy

A

recurrent episodes of macroscopic hematuria during or immediately following an upper respiratory infection often accompanied by proteinuria or persistent asymptomatic microscopic heamturia

91
Q

True or false. IgA nephropathy is a benign disease. Renal faillure seen only 25-30% over 20-25 years

A

True,

92
Q

True or false. A group of patients with small vessel vasculitis and glomerulonephritis have serum ANCA

A

True.

93
Q

two types of antibodies in ANCA small vessel vaculitis

A

anti proteinase (PR3) and anti myeloperoxidase (MPO)

94
Q

ANCA positive vasculitis

A

granulamotosis with polynagiitis, microscopic polyangitis, Churg- Strauss syndrome

95
Q

what is the induction therapy for ANCA small vessel disease

A

glucocorticoids and either cyclophosphamide or rituximab

96
Q

given to induce remission in ANCA associated vasculitis

A

monthly pulse IV cyclophasphamide

97
Q

patients with this disease present with fever, purulent rhinorrhea, nasal ulcers, sinus pain, polyarthrias/arthritis, cough, hemoptysis, shortness of breath, microscopic hematuria

A

granulomatosis with polyangitis

98
Q

patients with this disease present with peripheral eosinophilia, cutaneous purpura, mononeuritis, asthma, and allergic rhinitis

A

Churg Strauss Syndrome

99
Q

defined morphologically with dense deposits forming ribbons in the GBM

A

Dense Deposit Disease (DDD)

100
Q

Formerly called MPGN type II

A

Dense Deposit Disease (DDD)

101
Q

Recent disease classification that is defined by the glomerular accumulation of C3 with little or no immunoglobulin and encompasses dense deposit disease

A

C3 glomerulopathy

102
Q

what is the prognosis of C3 glomerulopathy

A

poor with 50% progressing to ESRD

103
Q

immune mediated glomerulonephritis characterized by thickening of the GBM with mesangioproliferative changes

A

MPGN or mesangiocapillary glomerulonephritis

104
Q

Type of MPGN assocaitred with persistent hepatitis C infections, autoimmune disease like lupus

A

type I

105
Q

most proliferative type of MPGN

A

type I

106
Q

associated with tram tracking on renal biopsy

A

Type I MPGN

107
Q

Characterized MPGN type II

A

low serum C3, dense thickening of the GBM containing ribbons of dense deposits and C3

108
Q

MPGN characterized by focal proliferation with widened segments of the GBM that appear laminated and disrupted

A

Type III MPGN

109
Q

True or false. Fifty percent of patients with MPGN develop ESRD 10 years after diagnosis and 90% have renal insufficiency after 20 years

A

True,

110
Q

glomerulonephritis associated with plasmodium falciparum

A

mesangioproliferative glomerulonephritis

111
Q

characterized by expansion of the mesangium, sometimes assocaited with mesangial hypercellularity, single contoured capillary walls and mesangial immune deposits

A

mesangioproliferative glomerulonephritis

112
Q

classic presentation of nephrotic syndrome

A

heavy proteinuria, minimal hematuria, hypoalbuminemia, hypercholesterolemia, edema and hypertension

113
Q

True or false. All patients with hypercholesterolemia secondary to nephrotic syndrome should be treated with lipid lowering agents because they are at increased risk for cardiovascular disease

A

True.

114
Q

Causes 70-90% of nephrotic syndrome in children

A

Minimal change disease or nil lesions

115
Q

how many percent does MCD cause nephrotic syndrome in adults

A

10-15%

116
Q

characteristic of MCD

A

effacement of foot process on electron microscopy

117
Q

who are called primary responders in patient with minimal change disease

A

remission or less than 0.2 mg/24h of proteinuria after single course of prednisone

118
Q

who are called frequent relapser

A

two or more relapses in 6 months after taper

119
Q

when an adult patient with MCD called steroid resistant

A

no response after 4 months of therapy

120
Q

how long can adults have a remission in MCD

A

after a course of 20-24 weeks

121
Q

what is the prognosis of MCD in adult

A

less favorable when acute renal failure or steroid resistance occurs

122
Q

refers to a pattern of renal injury characterized by segmental glomerular scars that involve some but not all glomeruli

A

focal segmental glomerulosclerosis FSGS

123
Q

the pathologic changes of FSGN are most prominent where

A

prominent in glomeruli located at the corticomedullary junction

124
Q

most common cause of nephrotic syndrome in the elderly

A

membranous glomerulonephritis

125
Q

what is the characteristic of membranous glomerulonephritis

A

uniform thickening of the basement membrane along the peripheral capillary loops

126
Q

true or false. 20-30% of membranous glomerulonephritis is associated with malignancy

A

True,

127
Q

has the highest reported incidences of renal vein thrombosis, pulmonary embolism, and deep vein thrombosis

A

membranous glomerulonephritis

128
Q

sensitive indicator for the presence of diabetes but correlates poorly with the presence or absence of clinically significant nephropathy

A

thickening of the GBM

129
Q

nodules associated with diabetic nephropathy

A

nodular glomerulosclerosis or Kimmelstiel- Wilson nodules

130
Q

True or false. Renal biopsies from patients with types 1 and 2 diabetes are largely indistinguishable

A

True.

131
Q

earliest manifestation of diabetic nephropathy

A

microalbuminuria or albuminura range of 30- 300 mg/24 hr

132
Q

differential light chain deposition disease from cast nephropathy

A

light chain deposition disease cause nephrotic syndrome with renal failure; produce kappa light chains that do not have the biochemical features necessary to form amyloid fibrils

133
Q

rare glomerulopathy characterized by glomerular accumulation of non branching randomly arranged fibrils

A

Fibrillary Glomerulonephritis

134
Q

characteristic of renal amyloidosis

A

deposition of beta pleated sheets of serum amyloid protein

135
Q

deficiency in Fabry’s disease

A

deficient lysosomal alpha galactosidase

136
Q

what is the effect of Fabry’s disease

A

excess deposition of globotriaosylceramide

137
Q

glomerulopathy what revels enlarged visceral epithelial cells packed with small clear vacuoles

A

Fabry’s disease

138
Q

chronic glomerulosclerosis leading to renal failure associated with sensorineural deafness

A

Alport’s syndrome

139
Q

some patients with this disease develop lenticonus of the anterior lens capsule, dot and fleck retinopathy

A

Alport’s syndrome

140
Q

True or false. Thin basement membrane disease have a benign course

A

True,

141
Q

characterized by persistent or recurrent hematuria but no associated proteinuria, hypertension or loss of renal function or extrarenal disease

A

thin membrane disease TMD

142
Q

what the renal biopsy picture of patient with HIV associated nephropathy

A

FSGS revealing a collapsing glomerulopathy

143
Q

viral infection that can cuase endocapillary proliferative glomerulonephritis

A

dengue hemorrhagic fever and measles

144
Q

viral infection that cause mesangial proliferative glomerulonephritis

A

Hanta virus, parvovirus, mumps, EBV,

145
Q

viral infection that cuase focal glomerulonephritis or DPGN

A

coxsackie virus

146
Q

schistosoma associated with clinical renal disease

A

schistosoma mansoni

147
Q

glomerular lesson in Class I nephritis from schistosoma

A

Class I mesangioproliferative

148
Q

glomerular lesson in Class II nephritis from schistosoma

A

extracapillar proliferative

149
Q

glomerular lesson in Class III nephritis from schistosoma

A

membranoproliferative

150
Q

glomerular lesson in Class IV nephritis from schistosoma

A

focal segmental glomerulonephritis

151
Q

glomerular lesson in Class V nephritis from schistosoma

A

amyloidosis

152
Q

classes of schistosoma nephritis associated with IgA immune deposits and progress despite antiparasitic or immunosuppressive therapy

A

Class III and IV

Nephrology (6 decks)

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