Clinical Presentations of Glomerular Diseases

Question 1

What is specific to glomerular diseases?

Answer 1

Altered GBM permeability

Question 2

Generation of dysmorphic RBC

Answer 2

Compressed throughout renal system b/c leakedo ut

Question 3

Dysmorphic RBCs and acanthocytes

Answer 3

Looks like mickey mouse…comes from the glomerulus

Acanthocytes - spikey and very damaged

Question 4

Clinical presentations of glomerular dz

Answer 4

Asx hematuria and proteinuria

Nephrotic - lots of protein in urine and very swollen

Neprhitic - lots of red cells and some protein in the urine

Rapidly progressive glomeruloneprhitis…neprhitic pt with blood in urine and losing kidney function fast

Question 5

Asx hematuria

Answer 5

Detected during routine urinalysis

> 2 RBC/HPF

Dysmorphic RBCs

Might have RBC casts (Tamm-Horsfall)…localizes origin of RBC to renal parenchyma (specificially the tubule)****

Most common dx - IgA nephropathy and thin basement membrane dz

Due to small breaks in GBM

Question 6

Asx proteinuria

Answer 6

Non-nephrotic proteinura (under 3.5 g/day/1.73)

Normal protein under 150 (less than 30 albumin)

Microalbuminuria - albumin 30-300…detected by special dipsticks or by immunoassay

Most useful in ID’ing early diabetic neprhopathy and assessing CV risks in pts with HTN

Overproteinura/macroalbuminuria - positive by dipstick routine U/A (usually over 200-300 mg/d)

Question 7

HOw to correct for amount of fluid a person is consuming

Answer 7

Urine creatinine is fixed so measure urine protein/creatinine

Question 8

Overflow proteinuria
Tubular proteinuria
Glomerular proteinuria

Answer 8

Usually seen due to excessive production of light chain protein seen in MM

Due to tubulointerstitial disease…consistats of tubular protein (microglobulins) and impaired reabsorption of filtered albumin

Abnormal filtration of albumin throgu hteh GBM

Question 9

Orthostatic proteinuria

Answer 9

Children and YA

Absent in urine generated in rcumbent position (first morning specimen)

Almost always under 1 g/day

Benigng with good prognosis

Question 10

Functional proteinuria

Answer 10

Transient and benign

Fever, HF, post exercise, hyperadrenergic

Due to increased nephron flow and pressure

Question 11

Fixed non-nephrotic

Answer 11

Mild form of any glomerular dz

Decreased GFR or high BP may prompt need for kidney biopsy

At least yearly follow up

Under 3.5 g/day

Question 12

Nephrotic syndrome

Answer 12

Proteinuria over 3.5 
Hypoalbulinemia - under 3.5 g/dL
Edema
Hypercholesterolemia - liver response to decreased oncotic pressure
Lipiduria - oval fat bodies

Question 13

COmps of neprhotic syndrome

Answer 13

Edema - due to low oncotic pressure and activation of the RAS/ADH systeem…activation of Na reabsorption due to proteinuria

Malnutrition and neg nitrogen balance

Hypercoag…renal vein thrombisis

Hyperlipidemia - and accel CV dz

Infection - loss of immunoglobulins and compliments..soft tissue and fragile skin

Vit D def - loss of VD-binding protein in urine

Question 14

Evidence of inflamed glomerulus

Answer 14

Microscopic heamture and RBC cases

Non-nepehrotic proteinuria

Salt retention - HTN and edema

Often with decreased GFR (increased creatinine)

Question 15

Onset, edema, BP, JVP

itic vs otic

Answer 15

otic - insidous, lots of edema, normal BP, normal JVP

itis - abrupt, some, raised, raised

Question 16

Protinuria, hematuria, RC casts, serum albumin

Otic vs itic

Answer 16

otic - almost always, may or may not, absent, low

Itic - sometime present, almost always, present, normla or slightly reduced

Question 17

RPGN

Answer 17

GFR deteriorates in weeks or days…rapidly rising serum creatinine

Crescent in glomerulus

Neprhological emergency