Clinical Glomerular Disease

Question 1

what lab should always be ordered w/ nephritic syndrome

Answer 1

complement- low complement indicates immune complex mediated diseases

Question 2

4 pulmonary renal syndromes

Answer 2

ANCA
goodpasture
SLE
cryoglobulinemia

Question 3

4 dermato renal syndromes

Answer 3

ANCA
SLE
IgA vasculitis
cryoglobulinemic

Question 4

urine protein creatinine ratio is equal to…

Answer 4

x g/g is equivalent to urine protein excretion in 24 hrs

Question 5

early intervention w/ AKI

Answer 5

ACEi to lower glomerular pressure, protect the kidneys

Question 6

normal protein excretion

Answer 6

less than 150mg per day

Question 7

normal protein-creatinine ratio

Answer 7

less than 2, correlates w/ daily excretion

Question 8

3 kinds of proteinuria

Answer 8

transient, orthostatic, (less than 500 mg/day) and fixed (denotes glomerular disease)

Question 9

complications of nephrotic syndrome (3)

Answer 9

thrombosis- loss of balance b/w anticoag and procoag, leads to DVT, CVA, etc

infections- loss of Ig

accelerated atherosclerosis- from hyperlipidemia

Question 10

etiology of most membranous nephropathy

Answer 10

autoAb against phospholipase A2

Question 11

age dependent causes of hematuria

Answer 11

kids/young adults: mostly glomerular causes

adults above 40- more commonly cancer and kidney stones

Question 12

clues for glomerular hematuria

Answer 12

brown or tea colored urine

proteinuria

dysmorphic RBCs, RBC casts

extra renal manifestaions

Question 13

main 2 clinical pres of IgA

Answer 13

episodic hematuria, asymptomatic

Question 14

pathogenesis of IgA nephropathy

Answer 14

serum IgA has reduced glycosylation at the hinge region, target for other antibodies

Question 15

define rapidly progressive GN

Answer 15

loss of over half of GFR w/i weeks

acute onset of azotemia, HTN, proteinuria, edema, oliguria

associated w/ crescentic GN

Question 16

C ANCA vs P ANCA

Answer 16

C ANCA is directed at PR3 in the cytoplasm

P ANCA is directed at MPO in the perinuclear region

Question 17

which disease is typically caused by overworked kidneys following loss of kidney mass

Answer 17

FSGS

Question 18

why compare dipstick w/ PCR and ACR

Answer 18

negative dipstick does not necessarily mean no proteinuria- w/ positive ACR means that the ACR is lower in the 30-300 range, w/ + PCR means some other kind of protein like light chains are present

positive w/ + PCR and ACR: if over half of the protein is albumin, more likely glomerular than tubulointerstitial

Question 19

two serologies for PIGN

Answer 19

ASO- post strep pharyngitis

anti Dnase B- cellulitis

Question 20

triad of alport syndrome

Answer 20

GN, hearing loss, ocular abnormalities

Question 21

etiology of alport syndrome

Answer 21

x linked abnormality of type IV collage (present in GBM)

laminated, frayed GBM on EM

Question 22

4 steps for evaluating glomerular disease

Answer 22

1. nephrotic vs nephritic
2. renal limited vs systemic
3. investigate: urine analysis, microscopy, complement, path
4. determine primary or secondary- genetic, infectious, inflammatory, etc