Glomerular disease

Question 1

Mechanisms of Glomerular Disease

Answer 1

Immunocomplex deposition (circulate then deposit in glomerulus, activates complement resulting in neutrophil chemotaxis)

Antibodies against GBM or glomerular antigens

Cytokine production by inflammatory cells

Question 2

glomerular disease presentation

Answer 2

Loss of GFR, Hematuria, proteinuria

Question 3

Nephrotic vs nephritic

Answer 3

Nephrotic syndrome: proteinuria > 3.5 g/day
Hypoalbuminemia
Edema (loss of plasma oncotic pressure vs Na/H20 retention)
Hyperlipidemia (increased hepatic protein production)
Lipiduria
Hypercoagulability (loss of proteins C and S)

Nephritis: mild proteinuria, hematuria (RBC, RBC casts, dysmorphic RBCs), hypertension, Edema

Question 4

IgA nephropathy

Answer 4

Most common glomerulonephritis
pts between age 10-50

Hematuria is most prominent feature (50-60% episodic gross hematuria, 30% persistent microhematuria, 10% acute GN or nephrotic syndrome)

Proteinuria if present is generally mild

Many cases are subclinical

Dysuria and loin pain may accompany hematuria (frequently occurs in conjuction with an upper respiratory infection (synpharyngitic hematuria)

HTN may be present in patients with more advanced disease

Question 5

henoch-schölein purpura

Answer 5

systemic disorder characterized by IgA, depostition in multiple organs

Multiple manifestions: Skin (characteristic non blanching purpura on legs and buttocks), joints (transient arthralgias), GIT, kidney (hematuria, proteinuria, rarely progressive renal failure

Question 6

Post infectious GN

Answer 6

Post Streptococcal GN classic example

7-14 days after pharyngitis, 14-28 days after skin infection

Question 7

Anti-GBM/ goodpastures syndrome

Answer 7

Males>females
May present as a pulmonary renal syndrome

Hemoptysis, pulmonary infiltrates, GN, due to circulating anti GBM antibody

Linear IgG and C3 on kidney biopsy IF

Question 8

Pauci immune GN

Answer 8

Crescenteric GN with little deposition of immune reactancts, idiopathic or associated with Anti neutrophil cytoplasmic antibody (ANCA vasculitis)

Question 9

Nphtrotic glomerular disease

Answer 9

Primary renal disease (membranous nephropathy, focal segmental glomerulosclerosis minimal change disease, in children- 80% will have minimal change
Secondary to DM, SLE, amyloidosis, infections, drugs

Renal biopsy

treatment: acei or ARB, statins, diuretics, salt restriction to improve edema

Minimal change disease: NSAIDS, hodkinns lymphomas, infections

Question 10

membranous nephropathy

Answer 10

Most common cause of nephrotic syndrome in whites

HBC, SLE
Neoplasms
Diffuse thickening of GBM

Question 11

Focal segmental glomerulosclerosis

Answer 11

nephrotic glomerulosclerosis (FSGS)
HTn

HIV