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Senior - GU Test 1 > 7 - Glomerular Diseases > Flashcards

7 - Glomerular Diseases Flashcards

1
Q

Oliguria

A

Urine output <400 mL/day

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2
Q

Azotemia

A

Buildup of nitrogenous waste in blood, secondary to decreased renal function

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3
Q

Crescents

A

Proliferation of cells w/in bowmans capsule

  • response to glomerular rupture
  • marker of severe glomerular injury
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4
Q

Oval fat bodies

A

Sloughed tubular epithelial cells that have reabsorbed some of the excess lipoproteins in the urine

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5
Q

Abnormalities of glomerular function cause damage to?

A

The major components of the glomerulus

  • epithelium (podocytes)
  • basement membrane
  • capillary endothelium
  • messangial cells
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6
Q

How is glomerular disease diagnosed?

A

Visualization of specific histologic patterns on biopsy

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7
Q

Glomerular disease classifications?

A

Nephritic syndrome

Nephrotic syndrome

They usually exhibit primarily nephritic or nephrotic but there is some overlap

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8
Q

Nephritic findings

A 
Ne phritic 
• Hematuria ± RBC casts 
• Mild proteinuria 
• ↓ GFR 
• Edema 
• HTN
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9
Q

Nephrotic findings

A 
Nephrotic 
• Heavy proteinuria (>3.5
g/24h) 
• Hypoalbuminemia 
• Marked Edema 
• HLP (lipiduria)

Sweet pic on slide 9

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10
Q

Slide 10

A

Look at it

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11
Q

Nephrotic vs nephritic onset?

A

Nephrotic: insidious

Nephritic: acute

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12
Q

UA findings for nephrotic vs nephritic?

A

Nephrotic: proteinuria

Nephritic: hematuria; RBC casts

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13
Q

Edema w nephrotic and nephritic?

A

Nephrotic: ++++

Nephritic: ++

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14
Q

arterial BP and Central venous pressure for nephrotic vs nephritic?

A
  • Nephrotic: normal

- nephritic: increased

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15
Q

Nephritic specturm disorders range from?

A

Glomerular hematuria —> rapidly progressive glomerulonephritis (RPGN)

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16
Q

Where on the spectrum does nephritic syndrome land?

A

Somewhere in the middle

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17
Q

Nephritic syndrome is aka?

A

Acute glomerulonephtitis

Nephritis syndrome

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18
Q

Nephritic syndrome causes ___ of the glomeruli

A

Inflammation

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19
Q

Inflammatory response of nephritic syndrome is caused by?

A
  • due to immune response triggered by infection of other diseases
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20
Q

Essentials of diagnosis for nephritic syndrome

A 
Essentials of diagnosis
– Hematuria ± red cell casts
–Edema
–Hypertension (may be normotensive initially) 
–Subnephrotic Proteinuria (< 3 g/day) 
–↑ serum creatinine
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21
Q

S/s of nephritic syndrome?

A

Dark, “cola colored” urine
• ± ↓ urine volume (oliguria)

Edema in regions of low tissue pressure
• Periorbital
• Scrotum

HTN, if present, is due to volume overload
• Due to ↓ GFR
• Check for JVD & adventitious lung sounds

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22
Q

Lab testing for nephritic syndrome?

A 
Testing:
– BUN, Creatinine, GFR
– UA:
    • Dark, “cola” colored • Hematuria:
– Dysmorphic RBCs
– RBC casts 
    • Subnephrotic proteinuria
– Renal biopsy
    • To definitively establish underlying cause
    • Not always necessary
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23
Q

With nephritic syndrome you should also order?

A

Miscellaneous serologic markers based on presentation:

– Complement levels 
– Antinuclear antibodies (ANA) 
– Cryoglobulins 
– Hepatitis serologies 
– ANCA (antineutrophil cytoplasmic antibodies) 
– Anti-glomerular basement membrane (GBM) antibodies 
– Anti-streptolysin O (ASO) titers 
– C3 nephritic factor
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24
Q

Nephritic UA and metabolic syndrome?

A

Slide 18

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25
Q

Goal of tx for nephritic syndrome?

A

Reduce the glomerular inflammation

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26
Q

Nephrtic syndrome treatment?

A 
Admit - usually
Nephrology referral
Monitor 
- renal function
- BP
- edema
- serum albumin
- urine protein
HTN and fluid overload reduction
Corticosteroids
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27
Q

Nephritic syndrome prognosis?

A

Kids do better than adults

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28
Q

IgA nephropathy is aka?

A

Berger disease

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29
Q

IgA nephropathy is?

A

IgA deposition in the glomerular mesangium

MC form of nephritic syndrome

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30
Q

MC pax for berger?

A

Most Common: young males&raquo_space; females

Common: Asians

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31
Q

MC presentation of IgA nephropathy?

A

Painless gross hematuria

May present at any point on the nephritic spectrum
- MC less sever end of spectrum

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32
Q

With IgA you need to look for?

A

URI

- freq associated w current URI “synpharyngitic hematuria”

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33
Q

IgA nephropathy labs?

A

Renal

  • UA
  • BUN
  • Cr
  • GFR

Serum IgA
- elevated

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34
Q

Confirm IgA nephropathy diagnosis?

A

Renal biopsy

  • Focal glomerulonephritis w/ diffuse mesangial IgA deposits & mesangial cell proliferation

– Not always indicated

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35
Q

Tx of IgA nephroptathy?

A

ACE/ARB
- target BP <125/75

Corticosteroids
- if proteinuria persists > 3-6 mo

REFERRAL to nephrology

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36
Q

ACE and ARB are titrated to? (IgA nephropathy)

A

Proteinuria < 1g/day

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37
Q

Most unfavorable prognostic indicator (IgA nephropathy)

A

Proteinuria > 1g/day

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38
Q

Postinfectious glomerulonephritis is due to?

A

Infection w
- group A Beta-hemolytic streptocci

  • 7-10 days after pharyngitis/impetigo
  • get a good hx
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39
Q

S/s of postinfectious glomerulonephritis?

A
  • coffee/cola urine
  • oliguria
  • edema
  • HTN (varies)
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40
Q

Labs for postinfectious glomerulonephritis?

A 
– UA:
   • Urinary RBCs, red cell casts 
   • Mild proteinuria
– Throat culture
– ASO titers may be elevated
   • May be WNL due to antibiotic treatment
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41
Q

postinfectious glomerulonephritis tx?

A
  • tx infection
  • supportive
  • bed rest
  • anti-hypertension
  • diuretics (PRN)
  • nephrology consult
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42
Q

Prognosis for postinfectious glomerulonephritis?

A

Kids - full recover 2 months

Adults - progress to RPGN

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43
Q

IgA vs PSGN

A

Slide 29

44
Q

Henoch-schonlein purpura is?

A

HSP

Small vessel leukocytoclastic vasculitis
- mediated by IgA (vasculitis)

45
Q

HSP is not related to?

A

Unrelated to IgA nephropathy however pathophysiology and

histologic findings are the same.

46
Q

HSP is MC in?

A

Young males

Post infection

47
Q

HSP ask about?

A

Fever and hematuria

48
Q

S/s of HSP?

A 
– Palpable purpura
(most often on legs) 
– Arthralgias 
– Abdominal
symptoms (nausea, colic, melena) 
– ↓GFR 
– Hematuria
49
Q

HSP tx?

A 
– Usually self-limiting &amp; most patients recover
fully over several weeks
• Bed rest
• Hydration
• Analgesics
– +/- corticosteroids
50
Q

HSP indications for inpatient

A
  • cant maintain fluids
  • severe abd pain
  • sig gastrointestinal bleeding
  • mental status changes
  • severe joint involvement
  • renal insufficiency
51
Q

Goodpasture syndrome is?

A

Anti-Glomerular Basement Membrane (anti-GBM)

Glomerulonephritis

52
Q

Goodpasture syndrome is defined by?

A
  • glomerulonephritis

- pulmonary hemorrhage

53
Q

Goodpasture syndrome symptoms?

A
  • hemoptysis
  • tachypnea
  • malaise
  • anorexia
  • HA
  • preceding URI (poss)

Nephritic syndrome

  • HTN
  • Edema
54
Q

Goodpasture syndrome prognosis?

A

Rapidly progressive and fatal

55
Q

Labs for Goodpasture syndrome ?

A

– Gross or microscopic hematuria
– Proteinuria
– ↑ BUN/Creatinine
– Anti-GBM antibodies

56
Q

Goodpasture syndrome radiographs?

A

Pulmonary infiltrates due to pulmonary hemorrhage

57
Q

Tx for Goodpasture syndrome ?

A

– ADMIT
– Plasmapheresis → remove circulating anti GBM antibodies
– Medications → inhibit formation of new antibodies:
• Cortiocsteroids (i.e., Prednisone)
• Cyclophosphamide

58
Q

Nephrotic syndrome is characterized by?

A 
– Heavy proteinuria
– Hypoalbuminemia
– Edema
– Hyperlipidemia
• Oval fat bodies in urine
59
Q

Uncommon With nephrotic syndrome

A

HTN
Hematuria

Adults (usually its kids)

60
Q

Essentials of diagnosis for nephrotic syndrome

A

– Urine protein > 3.5 g 24h
– Hypoalbuminemia (albumin < 3 g/dL)
– Rapid onset of peripheral edema
• Typical presenting symptom

61
Q

S/s of nephrotic syndrome?

A

Massive peripheral edema
• When serum albumin is < 3 g/dL
–> Due to loss of plasma oncotic pressure
• Facial edema usually presenting symptom in children

Dyspnea due to pulmonary edema, pleural effusions, and/or diaphragmatic compromise w/ ascites
• Due to massive third spacing of fluid

Pic on 41

62
Q

Lab findings for nephrotic syndrome?

A

Heavy proteinuria (3+/4+)
Hyperlipidemia (TG)
- oval fat bodies in urine
L serum albumin (<3g/dl)

63
Q

Nephrotic syndrome cause profound?

A

Hypoalbuminemia
- risk of VTE

<2g/dL

64
Q

What happens when the serum albumin is <2g/dL?

A
  • H hepatic synthesis of clotting factors
  • h platelet activation
  • H serum viscosity (oncotic pressure)
  • L circulating
    —>antithrombin III,
    —>protein C/S
65
Q

nephrotic syndrome definitive diagnosis?

A

Renal biopsy

  • adults: get one
  • kids: not usually done
66
Q

Tx for nephrotic syndrome?

A

Based on symptoms

Protein loss
- ACE/ARB
Edema
- Na restriction
- loop diuretic 
Hyperlipidemia
- exercise/diet
- statins 
Pt education on H infection risk
67
Q

nephrotic syndrome infection risk?

A

Increased pneumonia and peritonitis etc

68
Q

Tx for nephrotic syndrome specific to serum albumin <2g/dL?

A

IV albumin
Long term anticoagulation therapy
- warfarin

69
Q

nephrotic syndrome admit if?

A
  • renal failure
  • refractory edema
  • complications
70
Q

nephrotic syndrome complications that lead to admission?

A 
Sepsis
Peritonitis
Pneumonia
Thromboembolic problem
Failure to thrive
71
Q

What causes adults to get nephrotic syndrome?

A

1/3 comes from systemic disease

  • DM
  • amyloidosis
  • SLE

The rest have primary renal disease

72
Q

MC primary nephrotic syndromes?

A
  1. Minimal change disease
  2. Membranous nephropathy
  3. Focal segmental glomerulosclerosis
73
Q

MC cause of primary nephrotic syndrome in kids?

A

Minimal change disease

80%

74
Q

Most minimal change disease is?

A

Idiopathic

Can also be

  • S/P viral URI
  • Tumors - hodgkins
  • meds (lithium)
  • hypersensitivity reactions (NSAIDS, bee)
75
Q

Minimal change s/s?

A

Sudden swelling in child

Nephrotic syndrome manifestations

76
Q

Biopsy for mcd?

A

Reserved for steroid tx failures

- electron microscopy shows effacement of podocyte foot process

77
Q

MCD tx?

A

Prednisone (90% respond)

  • 4-8 wks in kids
  • 16 wks in adults

Continue several weeks after remission

78
Q

Prognosis for MCD?

A

Many relapse and require subsequent steroid tx

Progression to ESRD is rare (adults > kids)

79
Q

MC cause of primary nephrotic syndrome in adults?

A

Membranous nephropathy

- adults 40s or 50s

80
Q

Membranous nephropathy is sometimes secondary to?

A

Carcinoma

Infections (HBV, HCV, syphilis)

Autoimmune disease

81
Q

Menbranous nephropathy s/s?

A

Nephrotic syndrome manifestations

VTE (high incidence)

  • renal vein thrombosis
  • high PE risk
82
Q

Membranous nephropathy tx?

A

R/o secondary causes
Tx renal progression
Biopsy (maybe)

Meds:

  • ace/arb
  • statin
  • immunosuppression (steroids/cytotoxic)

Renal transplant

83
Q

Focal segment glomerulosclerosis is associated with?

A

Renal inj
- podocyte damage
Nephrotic syndrome manifestations
- proteinuria

84
Q

Focal segment glomerulosclerosis diagnosis?

A

Biopsy

- fusion of epithelia foot processes

85
Q

Focal segment glomerulosclerosis tx?

A

Steroids
Ace/arb
Statins

86
Q

Systemic diseases that adversly affect the glomeruli?

A

Secondary renal disease

  • DM (DM nephropathy)
  • Hep C
  • SLE
  • SCD
  • HIV (HIV associated nephropathy)
  • renal amyloidosis
  • alport syndrome (hereditary nephritis)
87
Q

MC cause of ESRD in US?

A

The big DM

- type 1 more likely to develop ESRD

88
Q

Why does DM1 get more ESRD?

A

DM1 lives longer so they can develop ESRD,

- DM2 folks die faster

89
Q

When does diabetic nephropathy present?

A

10 yrs after DM onset

- may be at diagnosis for DM2

90
Q

MC lesion in diabetic nephropathy?

A

Diffuse glomerulosclerosis

91
Q

Diabetic nephropathy pathogenesis?

A

Glomerular HTN -> glomerular hyperfiltration -> sclerosis

92
Q

DM pts must be screened for?

A

Microalbuminuria

- earliest detector

93
Q

Diabetic nephropathy tx?

A

Strict glycemic control
Aggressive HTN control
- ACE/ARB
PT education

Avoid contrast material - acute renal failure

94
Q

Hep C nephritic and nephrotic features?

A

– Membranoproliferative glomerulonephritis

– Cryoglobulinemic glomerulonephritis

– Membranous nephropathy

95
Q

Hep c glomerular disease typically has?

A

Hematuria
Proteinuria
HTN
Anemia

96
Q

SLE pts need?

A

Routine UA

  • hematuria
  • proteinuria
97
Q

SLE has what glomerular lesions?

A

Wide spectrum of lesions

- 6 lupus nephritis classification based on biopsy results

98
Q

SLE renal is?

A

Aggressive

- 50% + greater loss of renal function w/in weeks/months

99
Q

SCD renal problems?

A

RBC sickling

  • renal medula
  • renal dysfunction

Hematuria and flank pain

Congestion and stasis

  • hemorrhage
  • interstitial inflammation
  • papillary infarcts

Glomerular involvement
- proteinuria and progressive GFR disease

100
Q

SCD nephropathy leads to?

A

ESRD

101
Q

HIV pts get?

A

Nephrotic syndrome w/ decreased GFR

Leads to secondary focal segmental glomerulosceroisis
- sever tubulointerstitial damage may present

102
Q

Renal amyloidosis leads to?

A

Extracelular amyloid deposition

Glomeruli are filled w/ amorphous deposits

103
Q

Primary emyloidosis leads to?

A

ESRD in 2-3 yrs

104
Q

Alport syndrome is aka?

A

Hereditary nephritis

- X linked

105
Q

Alport syndrome is?

A

Type IV coallegen defects of kidneys, ears and eyes

  • microscopic hematuria (birth)
  • progressive proteinuria
  • nephritic syndrome
  • hearing loss
106
Q

Alport syndrome leads to?

A

Progressive glomerulosclerosis and interstitial scarring develop -> ESRD

107
Q

What do testicles and prostates have in common?

A

Not much, there is a vas deference between them

Senior - GU Test 1 (13 decks)

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