glomerular disease Flashcards
differentiate nephrotic range proteinuria & subnephrotic proteinuria
- nephrotic range: over 3.5 g/day
- subnephrotic: 150 mg to 3.5g/day
if there is evidence of renal failure + glomerular hematuria what now?
send to nephro for biopsy!! it is likely an inflammatory process that needs to be treated emergently
what are the two classifications of glomerular disease?
nephritic syndrome
nephrotic syndrome
what class of glomerular disease is this?
- hematuia
- HTN
- edema
- azotemia, oliguria, signs of uremia (high Cr, etc)
- non-nephrotic range proteinuria
nephritic syndrome (glomerulonephritis)– urgent! they have AKI
- massive proteinuria (over 3.5 g/day)
- edema
- hypoalbuminemia
- hyperlipidemia
nephrOtic syndrome– protein loss
top 3 primary causes of nephritic synrome vs nephortic syndrome
- nephritic– lupus, IgA, ANC
- nephrotic– membranous, focal segmental glomerulosclerosis, minimal change disease
most common cause of nephrotic syndrome? (hint it is a secondary disease)
diabetic nephropathy
what is this? what does biopsy show? according to PPP, how is it tx?
nephritic syndrome + doubling of serum Cr or 50% decrease in GFR over 3+ months
- RPGN– rapidly progressive glomerulophritis
- biopsy: extensive glomerular crescents in bowman’s space
- tx from PPP: steroids + cyclophosphamide
what is needed to diagnose nephritic or nephrotic syndrome?
kidney biopsy
which 4 causes of nephritic syndrome will have low serum complements?
- lupus
- post-infectious GN
- cryoglobulinemia
- hepatitis related GN
which 3 causes of nephritic syndrome will have normal serum complement levels?
- IgA nephropathy
- anti-GBM
- ANCA vasculitis
2 benefits to treating proteinuria
- sows down progression of kidney disease
- helps to normalize levels of serum proteins like albumin
4 ways to decrease proteinuria
- use ACE/ARB to inhibit RAAS
- SGLT2i
- BP control (< 130/80) and DM control
- dont smoke, low sodium, wt loss
how do ACE/ARBs reduce proteinuria? (2)
it causes efferent dilation and reduced intraglomerular pressure/ HTN which then reduces podocyte damage.
Decreased glomerular BP = decreased GFR = 25% rise in serum creatinine (transient rise in first 2-4 wks)
what class is used to treat edema in glomerular disease (1)? how about HTN (2)?
- edema: usually loop diuretics
- HTN: ACE, CCB
