Belz

Question 1

Glomerulonephritis

Answer 1

• inflammation of the glomerulus
• Symtpoms
  
  • Edema
  • gross hematuria
• differentiation of glomerular versus non-glomerular sources via RED BLOOD CELL CAST
  
  • dysmorphic red blood cells
• SIGNS
  
  • lipiduria
  • PROTEINURIA (correlates with glomerular damage)
• Renal failure can occur and can be rapidly progressive

Question 2

Asymptomatic hematuria

Answer 2

• glomerular disease in patient with NO PROTEINURIA (less than 10% of pop)
• Hematuria
• proteinuria less than 1g/day (close to normal)
• serume creatinine less than 1.5 mg/dl
• three major findings on biopsy (not generally performed)
  
  • normal
  • thin basement membrane nephropathy
  • IgA nephropathy

Question 3

IgA nephropathy

Answer 3

• asymptomatic hematuria with proteinuria
• Macroscopic hematuria associated with upper respiratory infection
• this can be ass with HenochSchonlein purpura

Question 4

Rapidly progressive Glomerulonephritis***

Answer 4

• Characteristics
  
  • renal failure
  • oliguria
  • edema
  • HTN
  • proteinuria
  • Hematuria - active sediment
• MEDICAL EMERGENCY
• PRESENCE OF CELLULAR CRESCENTS (proliferation of parietal epithelial cells)

Question 5

causes of rapidly progressive glomerulonephritis

Answer 5

ANCA positive

• direct immunoglobulin attack
  
  • Anti-GBM disease (linear deposits of IgG in glomerular basement membrane)
• immune complex deposition
  
  • granular pattern of immune complex deposition (post infection ect)
• pauci-immune
  
  • lack of immune complex
    
    • granulomatosis with polyangiitis
    • eosinophilic granulomatosis with polyangiitis
    • microscopic polyangiitis

Question 6

Post infectious glomerulonephritis

Answer 6

• In Situ immune complex formation due to glomerular deposition of streptococcal nephritogenic antigens (or any infection)
• CLINICAL
  
  • antecedent history of GROUP A Strep infection
  • Latent period is weeks
  • EDEMA
  • GROSS HEMATURIA
  • HYPERTENSION
• LABS
  
  • hematuria with and without red blood casts
  • Proteinuria
  • depressed C3 and CH50 complement activity
    
    • return to normal within 4-8 weeks
  • ELEVATED antibody titers to extracellular streptococcal antigens

Question 7

Nephrotic Syndrome

Answer 7

• Characterized by:
  
  • MASSIVE proteinuria (>3.5g/24hrs)
  • hypoproteinemia/hypoalbuminemia (albumin less tahn 3g/dl)
  • Edema
  • hyperlipidemia
  • thrombotic disease
  • lipiduria

Question 8

Complications of Nephrotic syndrome

Answer 8

• Thrombosis secondary to loss of hemostasis control proteins
• infections secondary to loss of immunoglobulins
• accelerated atherosclerosis from hyperlipidemia
• protein malnutrition
• iron-resistant microcytic hypchromic anemia due to transferrin loss
• hypocalcemia and secondary hyperparathyroidism (vitamin D deficiency

Question 9

Nephrotic syndromes

Answer 9

• primary
  
  • minimal change disease
  • focal segmental glomerulosclerosis
  • membranous glomerulopathy
• Secondary nephrotic syndrome
  
  • diabetic glomerulopathy
  • amyloidosis

Question 10

Diabetic glomerular disease

Answer 10

• Kimmelstiel-Wilson nodules - nodular mesangial expansion
• first sign = microalbuminuria
• overtime develop gross hematuria

Question 11

diabetic nephropathy –> nonimmunologic injury

Answer 11

• diabetic nephropathy
  
  • glomerular HTN
  • hyperglycemia
  • Advanged glycosylation end products
  • growth factor expression (GH, IGF1, angiotension II)
  • Cytokines (TGF-beta)

Question 12

glomerular HTN

Answer 12

• Intraglomerular pressure is a stimulus for mesangial matrix production and glomerulosclerosis
• blockade of the renin-angiotension-aldosterone system (ACEI, renin inhibitors, ARB blockers etc) is important in alleviating this type of injury.