CIS 1 Flashcards
- Which of the following is an accurate description of a kidney glomerulus? It is an
- Arteriole-venous shunt
- Vascular epithelial organ
- Capillary plexus
- Endothelial fenestrated structure
Vascular epithelial organ
- Erythropoeitin is exhaggerated where?
- the interstitial cells
Erythropoeitin is exhaggerated in the interstitial cells.
What is the primary site of production before birth and after birth?
- BEfore: Liver
- After: Kidney
What part of the kidneys are the major sites of production of erthryopoietin?
- peritubular capillary endothelial cells
- peritubular fibroblasts
- The term diffuse proliferative glomerulonephritis means
Inflammatory infiltration of the glomerulus
- What is the difference between acute/diffuse/focal proliferative glomerulonephritis?
- Acute and diffuse are the same
- Focal: occuring in some glomeruli, not all
Generally, the etiology of GN can be ascribed to what?
Immunologic phenomena
Benz jones proteins is seen in _____________
- Benz jones proteins is seen in plasma cell dysplasia (tubular damage)
- Localized edema => _____ syndrome
nephritic
Generalized edema => ____ syndrome
nephrotic
- Gross hematuria => _____ syndrome
nephritic
- _____ on UA => nephritic syndrome
less than 4
- membranoproliferative GN (type 2) occurs most commonly in who and is associated with what?
- Adults
- Chronic antigenemia
Patients with:
- Hep C with cryoglobinemia
- Malignancies
- Chronic immune complex disorders
are most likely to have?
Membranoproliferative GN Type 2
Membranoproliferative GN (type 2) is characteritized by what type of deposits
Dense electron deposits of C3 (not C1q or C4) in BM
What is the prognosis of MPGN Type 2?
Poor prognosis.
If we see something that looks like nephrotic syndrome, we think of 3 things
KIDS
- MCD
Adults:
- 1. FSGD (more common)
- 2. Memnranous GN
- 52 YO male has a BP of 140/84, mild periorbital edema, moderate pitting edema of the LE and significant proteinuria on dipstick testing. His CBC shows a white count of 10,000. A 24 hour urine collection shows 3.7gm of protein, primary albumin. PMH indicates that he was a previously healthy except for mild HTN for which he takes HCTZ. The protein in his urine is most likely due to
-
Glomerular disorder (nephrotic syndrome)
- Bc it is primarily albumin, we are selecting for SMALL proteins
- A 4YO M presents with a CC of sore thorast and dry cough. He has a 4gm of protein reflected in 24 hour urine collection and discernible periorbital edema. You intend to begin steroid therepy but first meet with his parents to consel them. Nased on the most likelyy diagnosis you indicate, tx and prognosis
- Nephrotic => MCD => tx with steroids => good prognosis
Hyposthenuria is what
- inability to concentrate URINE
MCD will show what on EM
- Foot process fusion
Mesangial interposition occurs in what
MPGN
Sclerotic nodules and capillary loops occurs in
DB
MPGN Type 1 shows what on IF?
IgG, C3, C1q and C4 in subendothelium d/t alternative and classical activation
In MCD, proximal tubules will most like exhibit what?
- A. Necrosis
- B. Ben Jones Proteins
- C. Regengeration
- D. Lipid deposition
D:
- The cells of the PT are typically laden with lipids, reflecting tubular reabsorption of lipoproteins (after passing through damaged glomeruli): lipoid nephrosis
When can we see regeneration of glomeruli
as long as BM is intact
- Necrosis occurs in settings of _________
acute kidney injury
- Children with MCD will have _____ renal function and is assx with ______________
- ____________ occurs in adults
- Children with MCD will have normal renal function and is assx with exposure to allergens or immunizations
- Acute renal failure occurs in adults
- A 7YO child has 3.2 grams of protein in a 24 hour urine collection and lipiduria. His serum albumin is 3.1 gm/dL. He has generalized edema and a sore throat. He fails to respond to steroid thereapy. His BP is not remarkable abut he has a temp of 100.4. Of the following, it is most likely the patient has
- RPGN type 1
- Diffuse proliferative (post-infectious) GN
- Acute Kidney Injury
- FSGS
- IgA Npehopathy
-
FSGS
- generalized edema is most likely to be nephrotic
- If we think its post-strep, what test could we run that would favor this result?
ASO titers
- IF is positive for IgM + C3. EM shoes mesengial sclerosis and foot process fusion. Best diagnosis?
FSGS
- IF shows IgM & C3 What is the diagnosis?
FSGS
- A 35 YO HIV+ male presents to your San Fran Clinic with nephrotic sundrome and microscopic hematuria. His T4 count is >500. What is the most likely glomerular disease pattern is most constistnt with
- FSGS
What are the secondary causes of FSGS?
- 1. HIV
- 2. Heroine
- 3. SS Disease
- 4. Massive obesity
- A 47YO white male presents to aspen clinic/spa complaing of apainful subpurn across his upper face. He reutls 48 hours with periorgbital edema and grossly discernible hematuria. Sent for evalualtion in Denver, his dx progress and he is diagnosed with nephrotic syndrome. Mostly likely dx is?
- SLE
- FSGS
- MCD
- MPGN, Type II
- DM
FSGS: This is the most common nephrotic syndrome in adults in the US
- Most nephrotic syndromes are PRIMARY or SECONDARY?
PRIMARY
- A 49 YO male presents with lower extremity pitting edema and oliguria. He has 3.8 gm of proteins on a 24 hour urine collection. His BP is 145/90 mmHg and oral temp of 99.5F. UA is positive for (1/4) for microscopic red cells. PMH is unremakle. Upon biopsy, which is most common?
- Membranous GN
- A 52 YO previously well white male presents to your Ohio clinic with nephrotic syndrome. A renal biopsy is perfomed and has membrananous GN. What is the pt most at risk for?
- Renal vein thrombosis
- Acute kidney injury
- RPGN
- Renal vein thrombosis
- _______ infections are more likely at increased risk infection and coagulation
NEPHROTIC
- A 7YO white girl presents to the ED with a fever and gross hematuria. She has distinct periorbital edema nad pitting edema of the forehead. Her mother indicates she has had a facial rash recently. Folloywing adimission a 24 hour urine collection is positive for 1.4 gm of protrein- most of which is albumin. There are fragmented red cells and RBC casts in the urine. She is oliguric. Most likey dx?
- Lupus nephritis
- Acute proliferative GN
- RPGN
- FSGS
- Interstitial nephritis
- Acute proliferative GN
Why wasnt the last answer NOT lupus nephritis?
- We will typically not make a dx of lupus, based on a renal biopsy.
- Acute proliferative GN is treated with what?
fluid and electrolyte management (95% recovery)
- 34 YO F is an insulin dependent DB first diagnosed at 5 years of age. She now presents with confusion, increased BUN, creased creating clearance, fibrinous pericarditis , anemia and oliguria. If the patient was subjected to renal biopsy, which glomerular findings are most likely?
- Uremia bc chronic renal failure
- 24 hour urine collection shows 150mg of albumin. What is her urine consistency?
- Albuminemia
Microalbuminuria is defined as?
urinary excretion of 30-300mg/24 hours of albumin in urine
Microalbuminema is a early sign of what?
- renal damage in DM
Pt has a GFR of 5mL/min.
What stage of renal dysfunction is the patient in
ESRD because 5% of normal GFR (100mL/min)
- What can be treated with plasmaprhoresis + immunosuppressive therapy?
RPGN Type 1;
NOT 2
- 37 YO male presents with HTN, gross hematuria, high fever, N, oliguria, and azotemia. His GFR continues to deteriorate rapidly. Pattern?
- RPGN
RPGN is most likely that this pt will evolve into?
- Chronic glomerulosclerosis
- NL urine volume is _______
- NL urine volume is 800-2000mL
- 52YO AA has a long history of insulin dependent DM (well controlled) and diff to control essential HTN. +3 edema of LE and SOB. His BP is 155/110. Anemia and chronic kidney disease. There is significant proteinuria and urinary volume of 220 ml on 24 hour collection. Imaging shows an increased cardiac silhouette consistent with concentric L ventricular hypertrophy. Other studies indicate several small renal cortical cysts bilaterally. Most likely dx?
- Npehrotic syndrome
- Adult polycystic kidnery disease
- Cystic, sporadic renal cell carcinoma
- Ischemic cardio/renal vascular disease
- Primary glomerulopathy
- Ischemic cardio/renal vascular disease
- 47YO white female has a BMI of 29. Alopecia, increased TSH and painless, symmetric and enlargement of thyroid gland. Autoab is consistent with hashimoto throidisits. Lab reports small quantities of intract RBC and 4.2 grams of protein in 24 hour urine collection. Urine protein constituency is due to? Most likely diagnosis?
- Secondary glomerular disease
- –> membranous glomerulopathy
HLA DRB1 is assx with what?
RPGN Type 1
HLA DQA1 is associated with what?
Primary Membranous Glomerupathy
If someone has solid tumor, hep C, lymphoma and develop glomerulopathies, what is the MCC?
- Membranous glomerulonephropathy
- MPGN Type 1 - secondary
