36 Nephron Loss

Question 1

What are the different ranges of regulation for some solutes with progressive nephron loss?

Answer 1

Little or no regulation

Partial regulation

Near-complete regulation

Question 2

describe the regulation for Creatinine and Urea?

Answer 2

Little or no regulation

Creatinine & Urea
Plasma concentrations increase as nephrons are lost

Question 3

describe the regulation for HCO3-, Ca++, Pi?

Answer 3

Partial regulation

Plasma concentration
can be maintained until 50-70 % nephrons are lost

Question 4

describe the regulation for Water, Na+, K+?

Answer 4

Near-complete regulation

Plasma concentration can be maintained until 75-90% of nephrons are lost

Question 5

what is Nephrotic Syndrome?

Answer 5

defined as excretion of more than 3.5 g protein/24 hours/1.73 m2 body surface area, hypoalbuminemia, hypercholesterolemia, edema

Remember “O” in nephrotic syndrome with prOteinuria

Question 6

what are the characteristics of Nephrotic Syndrome?

Answer 6

• Most frequent cause of nephrotic syndrome in children
• Represents 10-15% cases of nephrotic syndrome in adults
• Sudden onset of severe nephrotic syndrome: with hypoalbuminemia, hyper-cholesterolemia, normal BP, normal GFR
• Urinalysis: 4+ protein, oval fat bodies, hematuria in 20% cases
• Most cases are idiopathic
• Frequently, especially in children, responds to treatment and has good prognosis

Question 7

what other medical illnesses are associated with Nephrotic Syndrome?

Answer 7

• Focal Segmental Glomerulosclerosis(FSGS)
• HIV-Associated Nephropathy
• Membranous Glomerulopathy
• Diabetic Nephropathy
• Amyloidosis
• Membranous Lupus Nephropathy

Question 8

what is Nephritic Syndrome?

Answer 8

defined as hematuria with RBC casts and proteinuria, GFR reduced due to glomerulonephritis (-itis = inflammation), reduced glomerular filtration rate (GFR) leads to salt and water retention, which causes hypertension

Associate the “I” in nephrItic syndrome with glomerulonephrItis

Question 9

what is Post Infectious GlomeruloNephritis (GN)?

Answer 9

▪ After immune system gets messed up, active antigens can sit themselves in basement membrane of kidneys and bother nephrons

Question 10

what is Membranoproliferative GN, type 1?

Answer 10

Final diagnosis is by renal biopsy

• Deposition of circulating immune complexes
• Complement activation
• Inflammatory reaction

Question 11

what are the characteristics of o Membranoproliferative GN, type 1?

Answer 11

• More common in adolescents and children; very rare in adults
• May present as nephritic syndrome and/or nephrotic syndrome
• Low levels of circulating complement
• -Frequent in children
• -Only in 50% of cases in adults.
• Can be primary (idiopathic) or secondary to a systemic condition:
• Secondary disease is associated with chronic viral diseases, especially Hepatitis B and C
• Primary disease has a poor prognosis
• Secondary disease responds to treatment of primary condition

Question 12

is acute Infectious Endocarditis Staphorreus or Strep?

Answer 12

Staphorreus

Question 13

is sub acute Infectious Endocarditis Staphorreus or Strep?

Answer 13

strep related

Question 14

what are the characteristics of acute renal failure?

Answer 14

Creatinine increases rapidly over a few days
Oliguria/anuria frequent
3 etiologies: Pre-renal, Renal, Post-renal

Question 15

what are examples of Tubulointerstitial diseases?

Answer 15

Acute tubular necrosis

Acute interstitial nephritis

Question 16

what are examples of Crescentic GN?

Answer 16

Immune complex-mediated GN
Rapidly progressive GN,
Anti-basement membrane disease (Goodpasture)

Question 17

vascular causes can lead to acute renal failure?

Answer 17

T

Question 18

what are the examples of acute renal failure?

Answer 18

Tubulointerstitial diseases
Crescentic GN
Vascular causes