Approach to Kidney Disease Flashcards
Will a patient with nephritic or nephrotic syndrome outwardly appear to be more unwell?
Nephritic syndrome
Dark brown urine can represent increased levels of these three things
Bilirubin (liver disease)
Hemoglobin
Myoglobin (rhabdomyolysis)
Method to differentiate if heme in urine is from hemoglobin or myoglobin
Microscopic analysis
Three hallmark signs of nephrotic syndrome
More than 3.5 grams of protein in the urine per day
Edema
Hypoalbuminemia
A parent with congenital polycystic kidney disease where their progressively growing renal cysts replace normal kidney tissue has this % chance of passing it on to their child
50%
ADPKD - autosomal dominant polycystic kidney disease
This condition is associated with a characteristic thickening of basement membranes of the glomerulus
Membranous nephropathy
Most common cause of nephrotic syndrome in whites and the elderly
Membranous nephropathy
Dysmorphic red blood cells seen on microscopic analysis of urine suggest this condition
Damage at the level of the kidney
RBCs misshapen from passing through glomerular basement membrane
Between which ages does anti-GBM disease most commonly occur?
Men - 20 to 40
Women - 60 to 80
This IgA nephropathy variant generally occurs in children, and has a clinical tetrad of purpuric rash on thighs, arthralgias, abdominal pain, and gross hematuria (from renal failure)
HSP (Henoch-Schonlein Purpura)
This renal condition has a classic “tram tracking” appearance on biopsy, can cause nephrotic OR nephritic syndrome, low complement levels, and a strong relationship with Hep C
MPGN (Membranoproliferative Glomerulonephritis)
(tram tracking = double inner and outer membrane)
These two signs/symptoms nearly always co-present with diabetic caused nephrotic syndrome
Peripheral nephropathy
Diabetic retinopathy
Leading cause of nephrotic syndrome in adults, especially blacks
FSGS (focal segmental glomerular syndrome)
Two causal associations for minimal change disease
NSAIDs
Hodgkin’s lymphoma
Most common glomerulonephritis worldwide
IgA nephropathy
Your patient has rapidly progressing renal failure with gross hematuria and oliguria, hemoptysis, dyspnea, and pulmonary infiltrates. What do you think they have, and how would you confirm this diagnosis?
Anti-glomerular basement membrane disease
Confirm with serology that shows Anti-GBM antibodies
Does a patient who presents with hematuria, flank pain, dysuria, or urinary frequency, but no proteinuria more likely have a renal or non-renal issue?
Non-renal source
Area where edema is first seen in cases of significant pediatric proteinuria
Periorbital edema (especially in children)
Does a patient who presents with hematuria, increased BUN and creatinine in the blood, and dysmorphic RBC casts in the urine more likely have a renal or non-renal issue?
Renal source
Gold standard for analysis of proteinuria
24 hour urine sample
Most common cause of obstructive uropathy in adults
BPH
Patients with severe and generally acute inflammatory injury to glomerulus where patients are frequently oliguric with tea colored hematuria, and hypertension have this syndrome
Nephritic syndrome
Podocyte effacement is a hallmark sign of this condition
Nephrotic syndrome
This condition causes multiple abnormalities including proteinuria which will show on 24 hour urine collection, but not on dipstick
Multiple myeloma
Patients with a first degree relative who died of a cerebral aneurysm should be screened for this renal condition
ADPKD (autosomal dominant polycystic kidney disease)
Diagnosis method for orthostatic proteinuria
Split day/night urine collection
Urine that looks foamy and bubbly suggests this …
Proteinuria
Four associated conditions with ADPKD (autosomal dominant polycystic kidney disease)
Mitral valve prolapse
Cerebral aneurysms
Diverticulitis
Ovarian cysts
Orthostatic proteinuria occurs when the patient is upright/active. Which type of patient is this condition most common in?
Adolescents
(gets better with time)
This condition is associated with massive proteinuria (>10 grams/day), rapid onset of swelling, but kidney structure looks normal on light microscopy
Minimal change disease
(need electron microscopy to see squashed podocytes)
Number one cause of end stage renal disease in the US
Diabetes
Three treatments for nephrotic syndrome
Statins
ACE/ARBs to decrease protein push through glomerulus
Treat edema with salt restriction and loop diuretic
Secondary causes (3) of membranous nephropathy
Hepatitis B/C
Lupus
Occult malignancy
Microcystic disease, renal scarring, and nephrogenic diabetes insipidus is induced by use of this medication
Lithium
(lithium induced renal disease)
In nephrotic syndrome, overcompensation as a response to albumin loss can lead to these two conditions
Hyperlipidemia
Hypercoagulable state
A child develops hypertension, swelling, and has tea-colored/red urine 10-14 days after a strep infection. Diagnose this child.
Post-streptococcal GN (glomerulonephritis)
Most common secondary cause of FSGS (focal segmental glomerular syndrome)
Obesity/OSA
Number one cause of proteinuria
Type 2 diabetes
Your patient has developed blood in their urine within 24 hours of having an upper respiratory infection/sore throat/ear infection. What condition might they have developed and how would you slow its progression?
IgA nephropathy “syn-pharyngitic nephritis”
Slow progression with ACE inhibitors
Name the classic triad associated with cholesterol emboli
Eosinophilia and eosinophiluria
Low complements
Livido reticularis
Which of these, minimal change disease or focal segmental glomerular syndrome is the most common cause of nephrotic syndrome in children?
Minimal change syndrome
Acute interstitial nephritis is usually caused by (blank) and begins (time) after exposure
Caused by medications
Occurs 7-10 days after exposure
This renal condition is more common after invasive procedures around the heart and can cause acute or chronic renal failure
Cholesterol embolitis
Which of these, minimal change disease or FSGS (focal segmental glomerular syndrome) is the more treatment resistant?
FSGS tends to be treatment resistant
Minimal change disease is very responsive to steroids, especially in children
This nephritis is associated with long term NSAID use
Chronic interstitial nephritis
