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ClinMed II Exam 5 GU/Renal > Glomerular disease > Flashcards

Glomerular disease Flashcards

1
Q

What is glomerular disease?

A

Abnormal glomerular function from damage to components of glomeruli

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2
Q

Damage to glomeruli can be caused by what?

A

Overwork (CKD), inflammation, hereditary disease

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3
Q

What is often necessary to diagnose the underlying etiology of glomerular disease?

A

Kidney biopsy

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4
Q

Exceptions to kidney biopsy being done for glomerular disease?

A

Risk>benefit (pt. refusal, definitive dx from serology, classic presentation dx)

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5
Q

Glomerular disease classifications?

A

Nephritic or Nephrotic

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6
Q

What is nephritic glomerular disease?

A

Immune mediated process causing glomerular damage

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7
Q

Is nephritic glomerular disease acute or chronic (with progressive scarring)?

A

Can be either

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8
Q

Signs of nephritic glomerular disease?

A

HTN, gross hematuria (coca-cola), RBC casts, oliguria, proteinuria (mild-mod), edema (dec. GFR –> salt/H2O retention)

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9
Q

What is nephrotic glomerular disease?

A

Glomerular damage from podocyte injury (failure of podocytes to hold protein/leakage of plasma protein)

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10
Q

Primary cause of nephrotic glomerular disease?

A

Idiopathic

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11
Q

Most common cause of secondary nephrotic glomerular disease?

A

DM

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12
Q

Signs of nephrotic glomerular disease?

A

Heavy proteinuria, hypoalbuminemia, hyperlipidemia, edema (generalized severe from loss of albumin), thrombosis (DVT/PE)

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13
Q

Function of a normal capillary in the glomerulus?

A

Keeps RBC, WBC, most proteins in blood/only lets watery fluid into urine

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14
Q

What happens when glomerular capillaries are diseased/damaged in nephritic and nephrotic syndrome?

A

Nephritic syndrome: let protein/RBCs into urine
Nephrotic syndrome: let protein into urine

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15
Q

What are the conditions on the nephritic spectrum (hematuria, proteinuria)?

A

Post-infectious GN, IgA nephropathy (Berger Disease), Henoch-Schonlein Purpura, Pauci immune GN, Anti-GBM GN, Goodpasture Syndrome, Cryoglobulin associated GN

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16
Q

What are the primary disorders on the nephrotic spectrum (proteinuria)?

A

Minimal change disease, FSGS, Membranous nephropathy

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17
Q

What are the secondary disorders on the nephrotic spectrum (proteinuria)?

A

DM (MC), Autoimmune diseases, infections, malignancy, meds

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18
Q

Glomerulonephritis is the ________ component of nephritic syndrome

A

inflammatory

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19
Q

Nephritic syndrome presentation depends on what?

A

Severity of underlying inflammation & pattern of injury

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20
Q

Symptoms of Nephritic syndrome?

A

Fever, abd/flank pain, edema, oliguria (<400mL/day), azotemia (inc. BUN/Cr), hematuria (coca-cola), HTN

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21
Q

Diagnostics for Nephritic syndrome?

A

CBC, CMP, serology testing

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22
Q

Urinalysis for Nephritic syndrome?

A

Dipstick: proteinuria (<3.5g/day), hematuria
Microscopy: RBC casts

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23
Q

Renal biopsy for Nephritic syndrome (given no C/I)?

A

Inc. WBCs, mesangial cells, immune complex disposition

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24
Q

Crescent shaped glomerulus on renal biopsy indicates what?

A

Rapidly progressing glomerulonephritis (RPGN)

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25
Q

Nephritic syndrome is treated by who?

A

Nephrologist

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26
Q

Treatment/management of nephritic syndrome?

A

Address HTN/fluid overload, immunosuppressive agents if required

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27
Q

What may be considered in treatment of nephritic syndrome in patients without AKI?

A

Antiproteinuric therapy w/ ACEi or ARB

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28
Q

What may be indicated in treatment of Nephritic syndrome w/ profound AKI?

A

Dialysis

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29
Q

Post-infectious glomerulonephritis is most often caused by what?

A

Nephritogenic group A beta-hemolytic strep (pharyngitis or impetigo)

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30
Q

Onset of post-infectious glomerulonephritis?

A

1-3 weeks after infection

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31
Q

What infections can cause infection-related glomerulonephritis (glomerular injury during active infection)?

A

Bacterial pneumonia, infectious mono, syphilis

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32
Q

S/Sx of post-infectious glomerulonephritis?

A

Hematuria (smoky/coca-cola color), proteinuria, edema, HTN, severe oliguria

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33
Q

Lab indicators of post-infectious glomerulonephritis?

A

Increased ASO titers
Urinalysis: hematuria, RBC casts, proteinuria

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34
Q

Renal biopsy for post-infectious glomerulonephritis?

A

Diffuse proliferative pattern of injury on light microscopy

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35
Q

Treatment for post-infectious glomerulonephritis?

A

-Identify/tx underlying infection
-Supportive care: control BP/fluid overload (BP meds, diuretics, salt restriction)

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36
Q

Prognosis for post-infectious glomerulonephritis?

A

Depends on severity & age
Children: usual full recovery
Adults: more prone to severe dz/CKD progression

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37
Q

What is IgA Nephropathy aka Berger Disease (nephritic)?

A

IgA deposited in glomerulus

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38
Q

Cause of IgA Nephropathy aka Berger Disease (nephritic)?

A

Unknown, possibly preceding URI

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39
Q

Primary IgA Nephropathy aka Berger Disease (nephritic) is ________

A

inherited

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40
Q

IgA Nephropathy aka Berger Disease (nephritic) can be secondary to which infections/conditions?

A

HIV, CMV, celiac, cirrhosis

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41
Q

Prevalence of IgA Nephropathy aka Berger Disease (nephritic)?

A
  • MC in children/young adults
  • Males
    -MC primary glomerular dz in western world (esp. Asia)
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42
Q

Classic presentation of IgA Nephropathy aka Berger Disease (nephritic)?

A

Gross hematuria associated w/ URI, red/smoky urine 1-2 days after onset, possible proteinuria, HTN, or other nephritic sx

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43
Q

Is there any helpful serology testing for IgA Nephropathy aka Berger Disease (nephritic)?

A

no

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44
Q

Renal biopsy for IgA Nephropathy aka Berger Disease (nephritic)?

A

Focal glomerulonephritis w/ mesangial proliferation, if rapidly progressive: crescent formation (rare)

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45
Q

Treatment approach for IgA Nephropathy aka Berger Disease (nephritic) is tailored to what?

A

Risk of progression
Low risk: no HTN, normal GFR, minimal proteinuria
High risk: proteinuria >1g/day, dec. GFR, or HTN

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46
Q

Treatment for IgA Nephropathy aka Berger Disease (nephritic) with low risk of progression?

A

Low risk of progression: Monitor annually
High risk of progression: ACEi or ARB for BP/proteinuria control

+/- corticosteroids, kidney transplant in ESRD

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47
Q

Recurrence of IgA Nephropathy aka Berger Disease (nephritic) after kidney transplant?

A

30% recurrence 5-10 years post-transplant (rarely leads to failure)

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48
Q

What amount of patients IgA Nephropathy aka Berger Disease (nephritic) have spontaneous remission?

A

1/3 of pts

49
Q

What is Henoch-Schonlein Purpura (HSP) (nephritic)?

A

Systemic small vessel leukocytoclastic vasculitis w/ IgA depositing on glomerular vessel walls
“IgA vasculitis”

50
Q

Prevalence of Henoch-Schonlein Purpura (HSP) (nephritic)?

A

MC in children, males w/ inciting infection (group A strep)

51
Q

Cause of Henoch-Schonlein Purpura (HSP) (nephritic)?

A

Preceding URI/GI infection, (?) exposure to allergen

52
Q

S/Sx of Henoch-Schonlein Purpura (HSP) (nephritic)?

A

Prodrome: headache, fever, anorexia
Sx: Arthralgia, hematuria, colicky abd pain, nausea, palpable purpura of LE (HALLMARK)

53
Q

What % of patients with Henoch-Schonlein Purpura (HSP) (nephritic) have kidney involvement?

A

20-50%

54
Q

Treatment of Henoch-Schonlein Purpura (HSP) (nephritic)?

A

Usually self-limiting, supportive care
If severe: Immunosuppressants, plasma exchange

55
Q

What may occur from severe Henoch-Schonlein Purpura (HSP) (nephritic)?

A

CKD, ESRD

56
Q

Monitoring of Henoch-Schonlein Purpura (HSP) (nephritic)?

A

Urinalysis and BP 6 months after initial presentation

57
Q

What causes Pauci-Immune Glomerulonephritis (nephritic)?

A

Various systemic ANCA-associated small vessel vasculitides or may present as primary renal lesion w/ no systemic involvement

58
Q

Pauci-Immune Glomerulonephritis (nephritic) is considered to be ______ ______

A

Rapidly progressive

59
Q

S/Sx of Pauci-Immune Glomerulonephritis (nephritic)?

A

Systemic inflammation (fever, malaise, wt. loss), hematuria, proteinuria, purpura

60
Q

Is serology used for the dx of Pauci-Immune Glomerulonephritis (nephritic)?

A

Often used

61
Q

Biopsy for Pauci-Immune Glomerulonephritis (nephritic) is required and should to be done when?

A

ASAP

62
Q

Biopsy results for Pauci-Immune Glomerulonephritis (nephritic)?

A

Necrotizing lesions and crescents on light microscopy, lack of antibody deposition

63
Q

Treatment of Pauci-Immune Glomerulonephritis (nephritic)?

A

High dose steroids & cytotoxic agents

64
Q

Prognosis of Pauci-Immune Glomerulonephritis (nephritic)?

A

Extremely poor if not treated, complete remission in 75% if aggressively treated

65
Q

Antiglomerular basement membrane GN and Goodpasture Syndrome (nephritic) are considered to be ______ _________

A

Rapidly progressive

66
Q

What happens in Antiglomerular basement membrane GN (nephritic)?

A

Autoantibodies are directed against the glomerular BM causing GN

67
Q

What causes Goodpasture Syndrome (nephritic)?

A

Concomitant immune attack on alveolar BM results in pulmonary hemorrhage as well as GN from Antiglomerular basement membrane

(GN + pulmonary hemorrhage)

68
Q

The onset of Antiglomerular basement membrane GN and Goodpasture Syndrome (nephritic) is often preceded by what?

A

URI

69
Q

S/Sx of Antiglomerular basement membrane GN and Goodpasture Syndrome (nephritic)?

A

Hemoptysis, dyspnea, possible respiratory failure, hematuria, proteinuria

70
Q

CXR for Antiglomerular basement membrane GN and Goodpasture Syndrome (nephritic) may show what?

A

Pulmonary infiltrates if pulm hemorrhage present

71
Q

Are serology & urinalysis helpful in the dx of Antiglomerular basement membrane GN and Goodpasture Syndrome (nephritic)?

A

Yes (+anti-GBM antibodies serology)
Urinalysis helpful

72
Q

Renal Biopsy for Antiglomerular basement membrane GN and Goodpasture Syndrome (nephritic)?

A

Crescent formation on light microscopy

73
Q

Treatment for Antiglomerular basement membrane GN and Goodpasture Syndrome (nephritic)?

A

*Emergent tx if pulm hemorrhage & strong suspicion for Goodpastures
Plasma exchange & corticosteroids

74
Q

What med has been used for refractory cases of Antiglomerular basement membrane GN and Goodpasture Syndrome (nephritic)?

A

Rituximab

75
Q

Prognosis of Antiglomerular basement membrane GN and Goodpasture Syndrome (nephritic)?

A

If oliguric AKI or require dialysis: poor

76
Q

What is Cryoglobulin-Associated GN (nephritic)?

A

Vasculitis caused by cold-precipitable immunoglobulins (cryoglobulins) –> Immune complexes deposit in vessels/cause inflammation

77
Q

Most common underlying infection in Cryoglobulin-Associated GN (nephritic)?

A

HCV

78
Q

S/Sx of Cryoglobulin-Associated GN (nephritic)?

A

Purpuric necrotizing skin lesions in dependent areas, fever, hepatosplenomegaly, arthralgias

79
Q

What would be elevated in Cryoglobulin-Associated GN (nephritic)?

A

Rheumatoid factor & cryoglobulin (+)

80
Q

Treatment for Cryoglobulin-Associated GN (nephritic)?

A

Tx underlying cause (ex. viral suppression)

81
Q

What is Nephrotic Syndrome characterized by?

A

Proteinuria, hypoalbuminemia, hyperlipidemia, edema

82
Q

Primary causes of Nephrotic Syndrome?

A

Minimal change disease, Focal segmental glomerulosclerosis (FSGS), Membranous neuropathy

83
Q

Secondary causes of Nephrotic Syndrome?

A

DM (MC), autoimmune disease, infections, malignancy, meds

84
Q

S/Sx of Nephrotic Syndrome?

A

Edema (peripheral or generalized, periorbital), proteinuria (>3.5g/day), Frothy urine, DVT, dyspnea

85
Q

Diagnostics for Nephrotic Syndrome?

A

CBC, CMP, lipid panel, serology, Urinalysis, Renal bx

86
Q

Urinalysis for Nephrotic Syndrome?

A

Spot urine protein:Cr ratio or 24hr protein excretion (>3.5g/day), Proteinuria (foamy), often bland microscopy (few elements, fatty casts, oval fat bodies in HLD)

87
Q

Treatment for Nephrotic Syndrome?

A

Address: protein, edema, hyperlipidemia, hypercoagulable states (Low serum albumin <2g/dL)
Often includes immunosuppressive therapy (steroids)

88
Q

Nephrotic syndrome requires immediate referral to where?

A

Nephrology

89
Q

When to admit pts w/ Nephrotic Syndrome?

A

Refractory edema and rapidly worsening kidney function

90
Q

How to address protein in Nephrotic Syndrome treatment?

A

Limit in mild dz, replace in severe dz, ACEi or ARBs lower urine protein excretion
Monitor for: AKI & hyperkalemia (do not use both meds together d/t risk of hyperkalemia)

91
Q

How to address edema in Nephrotic Syndrome treatment?

A

Dietary salt restriction, diuretics

92
Q

How to address hyperlipidemia in Nephrotic Syndrome treatment?

A

Diet & exercise, pharmacotherapy

93
Q

What causes hypercoagulable states (Low serum albumin <2g/dL) in Nephrotic Syndrome treatment?

A

Urinary loss of anti-thrombin proteins c & s —> increased platelet activation

94
Q

Management of hypercoagulable states (Low serum albumin <2g/dL) in Nephrotic Syndrome treatment?

A

Warfarin for at least 3-6 months if evidence of thrombosis
If PE, renal vein thrombosis, recurrent thromboemboli: may require indefinite anticoagulation

95
Q

What is the most common cause of proteinuric renal disease in children (80%)?

A

Minimal change disease

96
Q

S/Sx of Minimal change disease (nephrotic)?

A

Full nephrotic syndrome sx

97
Q

Is serology helpful in the dx of Minimal change disease (nephrotic)?

A

No

98
Q

Bx for Minimal change disease (nephrotic) is reserved for which patients?

A

refractory disease or unusual presentation (systemic sx)
*usually appears normal on microscopy

99
Q

Treatment of Minimal change disease (nephrotic)?

A

Empiric tx and often has remission in 4-8wks w/ oral corticosteroids

100
Q

Is relapse with Minimal change disease (nephrotic) common?

A

Yes (but progression to ESRD is rare)

101
Q

Complications of Minimal change disease (nephrotic) are usually related to what?

A

Prolonged corticosteroid use

102
Q

What is Focal segmental glomerulosclerosis (FSGS) (nephrotic)?

A

Renal injury from damage to podocytes: primary (inherited) or secondary (obesity, HTN, HIV, renal overwork)

103
Q

S/Sx of Focal segmental glomerulosclerosis (FSGS) (nephrotic)?

A

Proteinuria, dec. GFR, nephrotic sx in primary dz

104
Q

Is serology helpful in dx of Focal segmental glomerulosclerosis (FSGS) (nephrotic)?

A

No

105
Q

Dx of Focal segmental glomerulosclerosis (FSGS) (nephrotic) requires what?

A

Renal bx

106
Q

Treatment for all forms of Focal segmental glomerulosclerosis (FSGS) (nephrotic)?

A

Diuretics (edema), ACEi or ARB (HTN, proteinuria), Statin or Niacin (hyperlipidemia)

107
Q

Reserve what meds for primary Focal segmental glomerulosclerosis (FSGS) (nephrotic)?

A

Immunosuppressants (steroids)

108
Q

Treatment for secondary Focal segmental glomerulosclerosis (FSGS) (nephrotic)?

A

Tx underlying cause (obesity, HTN, etc.)

109
Q

Most common cause of primary nephrotic syndrome in adults?

A

Membranous nephropathy

110
Q

Causes of Membranous nephropathy (nephrotic)?

A

Autoimmune (complex deposited in glomerular capillary walls)
Secondary causes: Cancer, Hep B/C, Syphilis, SLE, NSAIDs

111
Q

S/Sx of Membranous nephropathy (nephrotic)?

A

May be asx or have edema, frothy urine, DVT (may be initial sign)

112
Q

Diagnostics for Membranous nephropathy (nephrotic)?

A

Serology (for underlying illness), cancer screening

113
Q

Treatment for Membranous nephropathy (nephrotic)?

A

Tx underlying illness/cause
Conservative tx - (ACEi, ARBs for antiproteinuric)

114
Q

Immunosuppressant tx is reserved for what patients with Membranous nephropathy (nephrotic)?

A

Those w/ increased risk of progression to ESRD or refractory to conservative treatment

115
Q

Disease course of Membranous nephropathy (nephrotic)?

A

Vairable: 50% progress to ESRD, some spontaneously resolve
*excellent transplant candidates

116
Q

Renal biopsy for Minimal change disease (nephrotic)?

A

Normal light microscopy
Loss of podocytes on electron microscopy

117
Q

Renal biopsy for FSGS (nephrotic)?

A

Sclerosis of some glomeruli segments on light microscopy

118
Q

Renal biopsy for Membranous nephropathy (nephrotic)?

A

Thick basement membrane

ClinMed II Exam 5 GU/Renal (4 decks)

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