Glomerular Disease Flashcards
Nephrotic syndrome
- Proteinuria > 3.5 g/day
- Hypoalbuminemia
- Edema
microalbuminuria
150-300g /day protein
overt proteinuria
over 300g/day protein
What are the complications of proteinuria
- (Mainly with nephrotic)
- edema
- progressive renal failure
- hyperlipidemia
- coagulopathy
- immune compromise
- malnutrition - Increased risk of CV disease and death
Treatment proteinuria
- Treat underlying cause
- Moderate protein diet (1g/kg/day)
- ACEi/ARB
- Edema: low sodium, stockings, furosemide
- Hyperlipids: diet, statins
- Immune: vaccinations
- Coagulopathy: DVT prophylaxis, vigilance
Overflow proteinuria
- Caused by an overwhelming amount of protein
- Ie. multiple myeloma
- Negative urine dip for albumin
- positive SPEP/UPEP for light chains
- Increased protein:cr ratio
Primary causes of nephrotic sydnrome
- Minimal change disease
- Membranous GN
- FSGS
Secondary causes of nephrotic sydnrome
- Diabetes
2. Amyloidosis
Collapsing variant of FSGS
Associated with HIV
Spikes on kidney biopsy
Membranous
Children/NSAID use
Minimal Change Disease
Causes of transient proteinuria
Fever, exercise, orthostatic, CHF
Usually less that 1 g per day
Thunderclap edema
FSGS
Kimmelstiel-Wilson nodules
Diabetic nephropathy
Linear IF stain
Anti-GBM/ goodpastures
Granular IF stain
- SLE
- IgA
- Post-Infectious
- Membranoproliferative
Pauci-Immune IF stain
ANCA vasculitis
C-ANCA
vasculitis of micro vessels
P-ANCA
vasculitis of small and medium vessels (aka Granulomatosis with polyangitis aka wegeners)
Nephritic syndrome
- Active sediment (dysmorphic RBC and protein)
- Hypertension
- Sub-acute kidney injury
Isolated hematuria ddx
IgA nephropathy
Thin basement membrane disease
Mechanism pauci immune vasculititis
Neutrophil activation
Synpharyngitic hematuria
IgA nephropathy
Active urine sediment plus nephrotic range proteinuria ddx
Membranoproliferative
Lupus
Post infective
Nephritic syndrome work up
ANCA Anti GBM C3/c4 ANA Hep b/c, HIV serology Cryoglobulins Strep titters
Causes of membranous nephropathy
NSAIDs
Lupus
Cancer
Hepatitis
Treatment of children with nephrotic syndrome
Treat empirically first
Work up nephrotic syndrome
Diabetes: fasting glucose, HBA1C Overflow: SPEP/UPEP Lupus/immune: ANA, c3/c4 Viral: hepb/c Biopsy
Minimal change disease
Hx: most common in children
Causes: lymphoma, lupus, hepatitis, HIV, NSAIDs, lithium
IX: normal histology, diffuse podocyte effacement on electron microscopy
Tx: empirical steroids
Membranous nephropathy
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
FSGS
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
Amyloid
Causes: Primary: multiple myeloma, idiopathic Secondary: RA/ chronic inflammatory diseases Px: systemic symptoms IX: SPEP, biopsy
Diabetic nephropathy
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,
Anti GBM
Hx: sick patient, rapid onset, may have lung involvement/hemoptysis
IX: shows linear immunofluorescence, anti GBM antibodies
Tx: plasmapheresis and corticosteroids
Immune complex Glomerulonnephritis
Causes: post-infective, IgA nephropathy, lupus
IX: granular immunostain
Tax: steroids
Pauci immune Glomerulonnephritis
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
Membranoproliferative Glomerulonnephritis
Causes: viral infection (hep/HIV), cancer, endocarditis
Path: complement activation, mesangial deposition
IX: tram tracks
