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Renal > Glomerular Disease > Flashcards

Glomerular Disease Flashcards

1
Q

Nephrotic syndrome

A
  1. Proteinuria > 3.5 g/day
  2. Hypoalbuminemia
  3. Edema
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2
Q

microalbuminuria

A

150-300g /day protein

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3
Q

overt proteinuria

A

over 300g/day protein

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4
Q

What are the complications of proteinuria

A
  1. (Mainly with nephrotic)
    - edema
    - progressive renal failure
    - hyperlipidemia
    - coagulopathy
    - immune compromise
    - malnutrition
  2. Increased risk of CV disease and death
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5
Q

Treatment proteinuria

A
  1. Treat underlying cause
  2. Moderate protein diet (1g/kg/day)
  3. ACEi/ARB
  4. Edema: low sodium, stockings, furosemide
  5. Hyperlipids: diet, statins
  6. Immune: vaccinations
  7. Coagulopathy: DVT prophylaxis, vigilance
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6
Q

Overflow proteinuria

A
  1. Caused by an overwhelming amount of protein
  2. Ie. multiple myeloma
  3. Negative urine dip for albumin
  4. positive SPEP/UPEP for light chains
  5. Increased protein:cr ratio
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7
Q

Primary causes of nephrotic sydnrome

A
  1. Minimal change disease
  2. Membranous GN
  3. FSGS
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8
Q

Secondary causes of nephrotic sydnrome

A
  1. Diabetes

2. Amyloidosis

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9
Q

Collapsing variant of FSGS

A

Associated with HIV

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10
Q

Spikes on kidney biopsy

A

Membranous

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11
Q

Children/NSAID use

A

Minimal Change Disease

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12
Q

Causes of transient proteinuria

A

Fever, exercise, orthostatic, CHF

Usually less that 1 g per day

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13
Q

Thunderclap edema

A

FSGS

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14
Q

Kimmelstiel-Wilson nodules

A

Diabetic nephropathy

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15
Q

Linear IF stain

A

Anti-GBM/ goodpastures

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16
Q

Granular IF stain

A
  1. SLE
  2. IgA
  3. Post-Infectious
  4. Membranoproliferative
17
Q

Pauci-Immune IF stain

A

ANCA vasculitis

18
Q

C-ANCA

A

vasculitis of micro vessels

19
Q

P-ANCA

A

vasculitis of small and medium vessels (aka Granulomatosis with polyangitis aka wegeners)

20
Q

Nephritic syndrome

A
  1. Active sediment (dysmorphic RBC and protein)
  2. Hypertension
  3. Sub-acute kidney injury
21
Q

Isolated hematuria ddx

A

IgA nephropathy

Thin basement membrane disease

22
Q

Mechanism pauci immune vasculititis

A

Neutrophil activation

23
Q

Synpharyngitic hematuria

A

IgA nephropathy

24
Q

Active urine sediment plus nephrotic range proteinuria ddx

A

Membranoproliferative

Lupus

Post infective

25
Q

Nephritic syndrome work up

A 
ANCA
Anti GBM
C3/c4
ANA
Hep b/c, HIV serology
Cryoglobulins
Strep titters
26
Q

Causes of membranous nephropathy

A

NSAIDs
Lupus
Cancer
Hepatitis

27
Q

Treatment of children with nephrotic syndrome

A

Treat empirically first

28
Q

Work up nephrotic syndrome

A 
Diabetes: fasting glucose, HBA1C
Overflow: SPEP/UPEP
Lupus/immune: ANA, c3/c4
Viral: hepb/c 
Biopsy
29
Q

Minimal change disease

A

Hx: most common in children
Causes: lymphoma, lupus, hepatitis, HIV, NSAIDs, lithium
IX: normal histology, diffuse podocyte effacement on electron microscopy
Tx: empirical steroids

30
Q

Membranous nephropathy

A

Hx: most common cause in adults, hx of clotting, edema
Causes: cancer, lupus, RA, sarcoid, hep, malaria, NSAIDs
IX: spikes on biopsy, IF shows string of pearls from IgG deposition
Tx: ACEi, diuretics

31
Q

FSGS

A

EPi: young males with hypertension, African Americans
Causes:
Primary: genetic?
Secondary: hyper filtration states (obesity and pregnancy) lymphoma, sickle cell, lupus, HIV, parvovirus, bisphaosphanates, IV drugs
Hx: HTN
IX: segmental sclerosis
Tx: corticosteroids

32
Q

Amyloid

A 
Causes: 
Primary: multiple myeloma, idiopathic
Secondary: RA/ chronic inflammatory diseases
Px: systemic symptoms 
IX: SPEP, biopsy
33
Q

Diabetic nephropathy

A

Epi: MOST COMMON CAUSE
Hx: 5-25 years post diagnosis diabetes, often insidious onset
IX: shows mesangial expansion, thickened basement membranes
Tx: control diabetes, blood pressure, lipids, smoking,

34
Q

Anti GBM

A

Hx: sick patient, rapid onset, may have lung involvement/hemoptysis

IX: shows linear immunofluorescence, anti GBM antibodies

Tx: plasmapheresis and corticosteroids

35
Q

Immune complex Glomerulonnephritis

A

Causes: post-infective, IgA nephropathy, lupus

IX: granular immunostain
Tax: steroids

36
Q

Pauci immune Glomerulonnephritis

A

Causes: granulomatosis with polyangitis, micro polyarteritis, Churg-Strauss

Hx: may have pulmonary renal symptoms if Wegeners, asthma if churg Strauss

IX: c, p ANCA: dots on IF stain

37
Q

Membranoproliferative Glomerulonnephritis

A

Causes: viral infection (hep/HIV), cancer, endocarditis

Path: complement activation, mesangial deposition

IX: tram tracks

Renal (14 decks)

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