Diabetic Nephropathy/ Glomerular Diseases Flashcards
What are the two major types of Renal Disease
Glomerular and Interstitial
Proteinuria in Glomerular and Interstitial renal disease
Glomerular: >2.0 gm/day
Interstitial: <2.0 gm/day
Urine sediment in Glomerular and Interstitial renal disease
Glomerular: Hematuria, RBC casts
Interstitial: Pyuria, WBC casts
Hypertension in Glomerular and Interstitial renal disease
- Common in glomerular and less common in interstitial
Edema in Glomerular and Interstitial renal disease
Usual in glomerular, rare in interstitial
Quantitation of proteinuria on spot urine
Protein (mg/dL)/ Creatinine (mg/dL)= g protein/24 hour
Nephrotic syndrome
- Proteinuria
- Hypoalbuminemia
- Edema
- Hyperlipidemia
- Lipiduria
Most common glomerular disease in the US
Diabetic nephropathy- most common cause of end-stage renal disease in US.
Microalbuminuria value
30-300mg/24 hrs
Macroalbuminuria value
> 300 mg/24 hrs
General history of glomerular nephropathy
Elevated glomerulofiltration rate and increased kidney size —–> Microalbuminuria—-> Proteinuria—-> Decreased GFR, ESRD
With elevated GFR and increased renal size, what do you control and how would you treat
BP control (<130/80). ACE Inhibitor?
With microalbuminuria, what do you control and how would you treat?
BP Control: ACE inhibitor, Glycemic control? (Statin)
With proteinuria, what do you control and how?
BP control (<125/75): ACE inhibitor. Statin?
Lab evaluation of glomerulonephritis
1) UA
2) Spot urine for protein and creatinine
3) Serum chemistries
4) Hgb A1c
5) ANA
6) C3, C4
7) ANCA
8) Blood culture
Minimal change disease: Most common in what population? Presents how?
-most common in kids, presents with acute onset edema and nephrotic syndrome. Cell mediated immunity may play role in primary disease.
How to treat minimal change disease
Steroids
Most common primary glomerular disease in US blacks. Presentation from nephrotic syndrome to progressive kidney dysfunction. Can recur quickly following kidney transplant.
Focal and Segmental Glomerulosclerosis (FSGS)
Treatment in Focal and Segmental Glomerulosclerosis (FSGS)
General: Blood pressure control, block Renin angiotensin system, Diuretics for edema, statin therapy
-Idiopathic: Immune modulation with steroids and/or cyclosporine
Clinical presentation of what: Progressive edema related to gradual worsening proteinuria. Overt nephrotic syndrome (80%). Microscopic hematuria (
Membranous Nephropathy
Etiology of Membranous Nephrology
- Idiopathic- most common
- Autoimmune disease (SLE)
- Drugs (Gold, NSAIDS)
- Infections (Hepatitis, syphilus)
Membranous nephropathy treatment:
General: Blood pressure control, block Renin angiotensin system, Diuretics for edema, statin therapy
-Idiopathic: Immune modulation with steroids and/or cyclosporine
Most common glomerular disease worldwide
IgA Nephropathy- Most primary but can be secondary
IgA Presentation
Microscopic hematuria, gross hematuria (SYNpharyngenitic), proteinuria, progressive renal dysfunction
MPGN Type I Presentation
Microscopic hematuria and non-nephrotic proteinuria, LOW SERUM COMPLEMENT LEVELS, Hypertension
Serum Complement levels: Low complement causes
- Lupus nephritis
- MPGN
- Post infectious glomerulonephritis (Strep, endocarditis)
Serum Complement Levels: Anti-Neutrophil Cytoplasmic Antibodies
Wegener, microscopic polyangiitis, churg straus
40 yo male who has noticed a little swelling in legs and urine is weird colored: How would you approach it?
1) Detailed History
2) PE: Skin rashes, tenderness, BP
3) Labs: UA, Creatinine, Serum Chemistries, Complements, blood culture, ANCA, ANA
Anti-glomerular basement membrane disease clinical presentation
Hematuria and proteinuria. Progressive loss of kidney function.
- Goodpasture’s Disease-when combined with lung involvement
- Autoantibody to type IV collagen
Treatment for Anti-GBM
Treated with plasmapheresis, steroids, cyclophosphamide
Glomerulonephritis and ANCA
Renal limited ANCA disease: Hematuria and proteinuria. Progressive renal dysfunction.
-As part of systemic disease (Wegener, MPA, Churg-Straus): Night sweats, wt. loss, fatigue (esp. elderly), pulmonary and Upper airway disease
ANCA treatment
Steroids, cyclophosphamide. Plasmapheresis for severe renal disease or pulmonary hemmorrhage
A systemic disease characterized by autoimmunity with antinuclear antibodies (ANA) and low serum complements
Systemic Lupus Erythematosis
T/F: Lupus nephritis can present with multiple type of kidney lesions
True- immune complex glomerular disease
Treatment of lupus nephritis
Steroids, cyclophosphamide, mycophenolate mofetil
