Diabetic Nephropathy/ Glomerular Diseases

Question 1

What are the two major types of Renal Disease

Answer 1

Glomerular and Interstitial

Question 2

Proteinuria in Glomerular and Interstitial renal disease

Answer 2

Glomerular: >2.0 gm/day
Interstitial: <2.0 gm/day

Question 3

Urine sediment in Glomerular and Interstitial renal disease

Answer 3

Glomerular: Hematuria, RBC casts
Interstitial: Pyuria, WBC casts

Question 4

Hypertension in Glomerular and Interstitial renal disease

Answer 4

• Common in glomerular and less common in interstitial

Question 5

Edema in Glomerular and Interstitial renal disease

Answer 5

Usual in glomerular, rare in interstitial

Question 6

Quantitation of proteinuria on spot urine

Answer 6

Protein (mg/dL)/ Creatinine (mg/dL)= g protein/24 hour

Question 7

Nephrotic syndrome

Answer 7

• Proteinuria
• Hypoalbuminemia
• Edema
• Hyperlipidemia
• Lipiduria

Question 8

Most common glomerular disease in the US

Answer 8

Diabetic nephropathy- most common cause of end-stage renal disease in US.

Question 9

Microalbuminuria value

Answer 9

30-300mg/24 hrs

Question 10

Macroalbuminuria value

Answer 10

> 300 mg/24 hrs

Question 11

General history of glomerular nephropathy

Answer 11

Elevated glomerulofiltration rate and increased kidney size —–> Microalbuminuria—-> Proteinuria—-> Decreased GFR, ESRD

Question 12

With elevated GFR and increased renal size, what do you control and how would you treat

Answer 12

BP control (<130/80). ACE Inhibitor?

Question 13

With microalbuminuria, what do you control and how would you treat?

Answer 13

BP Control: ACE inhibitor, Glycemic control? (Statin)

Question 14

With proteinuria, what do you control and how?

Answer 14

BP control (<125/75): ACE inhibitor. Statin?

Question 15

Lab evaluation of glomerulonephritis

Answer 15

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

Question 16

Minimal change disease: Most common in what population? Presents how?

Answer 16

-most common in kids, presents with acute onset edema and nephrotic syndrome. Cell mediated immunity may play role in primary disease.

Question 17

How to treat minimal change disease

Answer 17

Steroids

Question 18

Most common primary glomerular disease in US blacks. Presentation from nephrotic syndrome to progressive kidney dysfunction. Can recur quickly following kidney transplant.

Answer 18

Focal and Segmental Glomerulosclerosis (FSGS)

Question 19

Treatment in Focal and Segmental Glomerulosclerosis (FSGS)

Answer 19

General: Blood pressure control, block Renin angiotensin system, Diuretics for edema, statin therapy
-Idiopathic: Immune modulation with steroids and/or cyclosporine

Question 20

Clinical presentation of what: Progressive edema related to gradual worsening proteinuria. Overt nephrotic syndrome (80%). Microscopic hematuria (

Answer 20

Membranous Nephropathy

Question 21

Etiology of Membranous Nephrology

Answer 21

• Idiopathic- most common
• Autoimmune disease (SLE)
• Drugs (Gold, NSAIDS)
• Infections (Hepatitis, syphilus)

Question 22

Membranous nephropathy treatment:

Answer 22

General: Blood pressure control, block Renin angiotensin system, Diuretics for edema, statin therapy
-Idiopathic: Immune modulation with steroids and/or cyclosporine

Question 23

Most common glomerular disease worldwide

Answer 23

IgA Nephropathy- Most primary but can be secondary

Question 24

IgA Presentation

Answer 24

Microscopic hematuria, gross hematuria (SYNpharyngenitic), proteinuria, progressive renal dysfunction

Question 25

MPGN Type I Presentation

Answer 25

Microscopic hematuria and non-nephrotic proteinuria, LOW SERUM COMPLEMENT LEVELS, Hypertension

Question 26

Serum Complement levels: Low complement causes

Answer 26

• Lupus nephritis
• MPGN
• Post infectious glomerulonephritis (Strep, endocarditis)

Question 27

Serum Complement Levels: Anti-Neutrophil Cytoplasmic Antibodies

Answer 27

Wegener, microscopic polyangiitis, churg straus

Question 28

40 yo male who has noticed a little swelling in legs and urine is weird colored: How would you approach it?

Answer 28

1) Detailed History
2) PE: Skin rashes, tenderness, BP
3) Labs: UA, Creatinine, Serum Chemistries, Complements, blood culture, ANCA, ANA

Question 29

Anti-glomerular basement membrane disease clinical presentation

Answer 29

Hematuria and proteinuria. Progressive loss of kidney function.

• Goodpasture’s Disease-when combined with lung involvement
• Autoantibody to type IV collagen

Question 30

Treatment for Anti-GBM

Answer 30

Treated with plasmapheresis, steroids, cyclophosphamide

Question 31

Glomerulonephritis and ANCA

Answer 31

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

Question 32

ANCA treatment

Answer 32

Steroids, cyclophosphamide. Plasmapheresis for severe renal disease or pulmonary hemmorrhage

Question 33

A systemic disease characterized by autoimmunity with antinuclear antibodies (ANA) and low serum complements

Answer 33

Systemic Lupus Erythematosis

Question 34

T/F: Lupus nephritis can present with multiple type of kidney lesions

Answer 34

True- immune complex glomerular disease

Question 35

Treatment of lupus nephritis

Answer 35

Steroids, cyclophosphamide, mycophenolate mofetil