General renal stuff

Question 1

Nephritis syndrome

Answer 1

Results from glomerular injury
Acute development of:
•Painless macroscopic hematuria, with dysmorphic RBC casts in urine
•Mild hypertension - from decreased GFR and RAS activation
•Oliguria
•Azotemia
•Mild proteinuria, <3.5 g/day
•Periorbital edema
Is caused by inflammatory leukoctyic infiltration and inflammatory capillary injury, causing increased permeability.

Question 2

Neophrosis syn

Answer 2

Massive proteinuria, above 3g/day

Hypoalbuminemia

Severe edema/anasarca

Hyperlipidemia

Lipiduria

Question 3

RPGN

Answer 3

Rapid loss of GFR, days/weeks/months
o Oliguria/Anuria
o Severe Azotemia, BUN, creatinine increase
o Na+ and H2O retention- periorbital edema
o Variable degrees of proteinuria

Urinary sediments
o RBC casts and dysmorphic RBCs.

Systemic symptoms
o Fever, especially Chronic fever or subfebrility.
o Signs of vasculitis, arthritis, pneumonitis/hemoptysis

Question 4

AKI

Answer 4

dominated by oliguria or anuria
recent onset azotemia

urine production, AKI staging
<0.5 ml/kg/h for 6-12 hours
<0.5ml/kg/h longer than 12 hours
<0.3 ml/kg/h for 24 hours or anuria for 12 hours

Serum creatinine AKI staging:
>0.3mg/dL increase or 1.5 times increase from baseline.
normal creatinine values are:

Question 5

CKD

Answer 5

Kidney impairment longer than 3 months.
Classified based on GFR, Albuminuria amount, and ACR

GFR: in ml/min/1.73 m2. 
>60 - only CKD if theres other evidence of kidney damage
45-60 - mild moderate CKD
30-45 - moderate severe
15-29 - severe 
< 15  - Kidney failure
CKD5d = Stage 5 plus RRT 

Albumin excretion in mg/24 hours
A1 < 30, no significant excretion
A2 30-300, microalbuminuria
A3 >300 macroalbuminuria

Albumin:Creatinine ratio
A1 < 3
A2 3-30
A3 >30

Question 6

What are the major types of GN associated with Lupus?

Answer 6

Proliferative GN and Membranous nephropathy.

Question 7

What disease is associated with linear antibody deposition in RPGN?

Answer 7

Goodpasture syndrome, anti-GBM antibodies

Question 8

What diseases are associated with granular deposition in RPGN?

Answer 8

Post-Strep GN

Diffuse proliferative glomerulonephritis, see nin SLE

Question 9

What disease cause a negative IF staining on the GBM in RPGN?

Answer 9

Wegener granulomatosis,

microscopic polyangitis

Churg-Strauss syndrome

Question 10

What is an ANCA

What is a:
c-ANCA
PR3-ANCA
p-ANCA

Answer 10

Anti-Neutrophil Cytoplasmic Antibody

cytoplasmic-ANCA
proteinase3-ANCA, the most frequent specific type of c-ANCA

perinuclear-ANCA
MPO-ANCA

Question 11

Classes of GN seen in patients with SLE

Answer 11

Class 1: No disease/normal: 5%

Class 2: Mesangial GN. 10-25%

Class 3: Focal proliferative

Class 4: Diffuse proliferative GN 35-60% - most serious and most common

Class 5: membranous GN 10-15%

Class 6: End stage renal disease

Question 12

Normal creatinine range

Answer 12

70-100 uM - oxford
40-130 uM - mayo

Higher in men (more muscle)
45-90uM women 60-110uM men
0.5-1.0 mg/dL women 0.7-1.2 mg/dL men

Question 13

Normal Urea range

Normal BUN range

Answer 13

urea 2.5-6.7 mM

BUN is typically given in mg/dL, measuring the mg of Nitrogen in Urea, basically just a conversion

BUN range: 6-20 mg/dL.

Question 14

Units for GFR

Answer 14

ml/min/1.73m2

Question 15

Describe ACR and its ranges

Answer 15

Albumin Creatinine ratio:
Ratio of the amount of albumin in urine (mg) to the concentration of creatinine in urine (mM).
Healthy <3
Microalbuminuria 3-30
Proteinuria/nephrosis >30
Severe proteinuria >70

Question 16

Normal GFR decrease with age, per year

Answer 16

loses 0.8ml/min/1.73m2 of GFR per year, per kidney

• 1.6 GFR per year.

Question 17

Markers of graft survival

Answer 17

Renal function
Proteinuria

Emergence of donor-specific antibodies in patients serum - indicate onset of antibody injury to graft.

Graft biopsy and histology for early or late rejection,

Question 18

Definition of glomerulonephritis and the diseases it includes

Answer 18

definition = glomerular disease.

Asymptomatic hematuria or proteinuria
Nephritis
Nephrosis
RPGNs - all of them
AKI
Chronic GN
End stage renal disease.