Glomerular disease

Question 1

What causes acute interstitial nephritis

What is another name for this disorder

Answer 1

obstruction
vesicoureteral reflux
analgesic neuropathy
heavy metals
myeloma kidney

acute tubulointerstitial nephritis (ATIN)

Question 2

What is the #1 cause of ATIN

What are the meds

Answer 2

Meds
RSVP
- Rifampin
- sulfa drugs
- 5 (v) Ps: PPIs, pain killers, pee pills, penicillin, phenytoin

Question 3

What is the classic presentation triad for ATIN

Answer 3

Fever
rash
arthralgias
*often with oligouria

Question 4

What will be seen on labs with ATIN

What is the definitive diagnostic test

Answer 4

WBC casts
eosinophilia

Kidney bx

Question 5

How do you treat ATIN

Answer 5

Stop offending agent
supportive
+/- some steroids if persistent

Question 6

What is the prognosis with ATIN

Answer 6

Recovery in 6-8 weeks
risk of CKD progression
worse with NSAID induced AIN

Question 7

What is the hallmark for golmerular damage

How is it classified

Answer 7

Proteinuria

Nephritic (<3g/day) & nephrotic (>3g/day)

Question 8

What are some urine characteristics with nephrostic syndrome

Answer 8

fatty casts in urine or frothy urine

Question 9

What are the dependent areas that edema will be seen first with glomerular disease

Answer 9

periorbital
scrotal
LE pitting edema

Question 10

How do you confirm proteinuria range in nephritic / nephrotic syndrome

Answer 10

24 hour protein collection
or
spot urine protein: creatinin ratio

Question 11

What is the best and definitive diagnostic test for glomerular disease

Answer 11

kidney biopsy

*nephrotic is only done if its needed for management or dx is unclear

Question 12

What is the most common idiopathic GN

Answer 12

IgA nephropathy

Question 13

What is Henoch Schonlein purpura

What patient population is it generally seen in

What is generally the cause

Answer 13

Acute, immune related IgA, small vessel vasculitis

kids < 10y/o

Most have preceding URI or GABHS infection

Question 14

What is the classic triad for Henoch Schonlein Purpura

Answer 14

Palpable purpura
arthritis
abdominal pain
renal disease

Question 15

What is the treatment for nephritic syndrome

Answer 15

*mostly self limiting
- diuresis if necessary
- patients w/o AKI get ACEi or ARB
- Patients w/ AKI get dialysis
- if inflammatory origin consider steroids

Question 16

What is the top cause of nephrotic syndrome in kids

What is it associated with

How do you treat it

Answer 16

minimal change disease

Viral URI, Hodgkins, lithium use, NSAID, Bee sting allergies

Steroids until proteinuria resolves

Question 17

What is the number 1 cause of nephrotic syndrome in adults

What is it associated with

What are they at high risk for developing

Answer 17

Focal and segmental glomerulosclerosis
*AA / hispanic at highest risk

Heroid, HIV, sickle cell, obesity, interferon use, CMT syndrome

ESRD -> likely to fail steroid treatment

Question 18

What is the overall treatment for nephrotic syndrome

Answer 18

Sodium restriction
fluid restriction
diuresis (oral loop)

Question 19

What are complications with glomerular disease most commonly associated with

What is the most important complication

Answer 19

the unselevtive loss of proteins

VTE (DVT or renal artery thrombosis)

Question 20

What are common complications of glomerular disease

Answer 20

Hyperlipidemia
increased infection risk
Anemia
AKI/CKD