Glomerular disease Flashcards
What causes acute interstitial nephritis
What is another name for this disorder
obstruction
vesicoureteral reflux
analgesic neuropathy
heavy metals
myeloma kidney
acute tubulointerstitial nephritis (ATIN)
What is the #1 cause of ATIN
What are the meds
Meds
RSVP
- Rifampin
- sulfa drugs
- 5 (v) Ps: PPIs, pain killers, pee pills, penicillin, phenytoin
What is the classic presentation triad for ATIN
Fever
rash
arthralgias
*often with oligouria
What will be seen on labs with ATIN
What is the definitive diagnostic test
WBC casts
eosinophilia
Kidney bx
How do you treat ATIN
Stop offending agent
supportive
+/- some steroids if persistent
What is the prognosis with ATIN
Recovery in 6-8 weeks
risk of CKD progression
worse with NSAID induced AIN
What is the hallmark for golmerular damage
How is it classified
Proteinuria
Nephritic (<3g/day) & nephrotic (>3g/day)
What are some urine characteristics with nephrostic syndrome
fatty casts in urine or frothy urine
What are the dependent areas that edema will be seen first with glomerular disease
periorbital
scrotal
LE pitting edema
How do you confirm proteinuria range in nephritic / nephrotic syndrome
24 hour protein collection
or
spot urine protein: creatinin ratio
What is the best and definitive diagnostic test for glomerular disease
kidney biopsy
*nephrotic is only done if its needed for management or dx is unclear
What is the most common idiopathic GN
IgA nephropathy
What is Henoch Schonlein purpura
What patient population is it generally seen in
What is generally the cause
Acute, immune related IgA, small vessel vasculitis
kids < 10y/o
Most have preceding URI or GABHS infection
What is the classic triad for Henoch Schonlein Purpura
Palpable purpura
arthritis
abdominal pain
renal disease
What is the treatment for nephritic syndrome
*mostly self limiting
- diuresis if necessary
- patients w/o AKI get ACEi or ARB
- Patients w/ AKI get dialysis
- if inflammatory origin consider steroids
What is the top cause of nephrotic syndrome in kids
What is it associated with
How do you treat it
minimal change disease
Viral URI, Hodgkins, lithium use, NSAID, Bee sting allergies
Steroids until proteinuria resolves
What is the number 1 cause of nephrotic syndrome in adults
What is it associated with
What are they at high risk for developing
Focal and segmental glomerulosclerosis
*AA / hispanic at highest risk
Heroid, HIV, sickle cell, obesity, interferon use, CMT syndrome
ESRD -> likely to fail steroid treatment
What is the overall treatment for nephrotic syndrome
Sodium restriction
fluid restriction
diuresis (oral loop)
What are complications with glomerular disease most commonly associated with
What is the most important complication
the unselevtive loss of proteins
VTE (DVT or renal artery thrombosis)
What are common complications of glomerular disease
Hyperlipidemia
increased infection risk
Anemia
AKI/CKD
