Glomerular Disease and such... Flashcards
Causes of heme-negative red urine
Meds – Doxorubicin, Chloroquine, Ibuprofen
Dyes – Beets, Blackberries, Food Coloring
Metabolites – Bile, Melanin, Porphyrin
Main risk factors for urologic malignancy?
Age, Gross hematuria, Smoking, Env. Exposure
Urine dipstick for hematuria is positive…now what?
Microscopic exam. If over 3 RBCs/hpf with no obvious cause, refer to urologic evaluation
Extraglomerular source of hematuria. Color? Clots? Proteinuria? RBC Details?
Red/Pink
Maybe
Less than 500 mg/day
Normal RBC morphology w/out Casts
Glomerular source of hematuria. Color? Clots? Proteinuria? RBC Details?
Red, Smoky brown, or Coca-Cola
No clots
Can be over 500 mg/day
Dysmorpic possibly with Casts
Best way to rule out renal mass as a cause for hemato.?
Multiphasic CT Urography
If any indicator, move forward with cystoscopy
Most common renal biopsy discoveries
IgA nephropathy, thin BA disease, NORMAL
Pathogenesis of IgA Nephropathy (Bergers disease)
Two hit hypothesis –> abberantly glycosylated IgA1
Pathology of Bergers Disease
Mesangial Proliferative GN with IgA deposits on IF
Three types of proteinuria?
Glomerular, Tubular, Overflow
What is glomerular proteinuria?
Increased filtration of macromolecules across glomerular capillary wall
What is tubular proteinuria?
Excretion of low-molecular weight proteins (like beta2-microglobulin, Ig Light Chains, and albumin break down products).
What is overflow proteinuria?
Increased excretion of low-mol weight proteins due to Ig light chains of multiple myeloma, lysozyme of AML, or myoglobin in rhabdo
Nephrotic Levels of Urine Protein?
Over 3.5 g
Elevated urinary albumin excretion is defined as
Over 30 microgram/mg
Difference between microalbuminuria and macroalbuminuria?
Micro – 30-300mg
Macro – Over 300mg
Preferred method of measuring urine albumin
Urine Albumin/Creatinine
Helps overcome the limits of variations in urine volume
Relationship of albuminuria and DM
Type 1 – Often earliest sign of diabetic nephropathy
TII – Usually present at diagnosis, can reflect CV disease or nephropahy
Shortcoming of the urine dipstick
Can’t detect microalbuminuria or globin (in myeloma)
Three symptoms common in nephrotic syndrome
Proteinuria over 3g per 24 hours
Edema due to hypoalbuminemia
Hyperlipidemia (increased albumin, increased LDL chol)
Four examples of primary nephrotic syndrome
Membranous GN
Lipoid Nephrosis
Focal Segmental Glomerular Sclerosis
Membranoproliferative GN
Four main examples of secondary nephrotic syndrome
DM
Amyloidosis
Myeloma
SLE
Six Complications of Nephrotic syndrome (from protein loss)
Hypercoagulation (Loss of Anti-thrombin, proteinC,S)
Infections, esp. G+ (Loss of IgG, Complement)
Anemia (EPO)
Malnutrition (Albumin)
Hypothyroidism (Thyroid Binding Globulin)
Vit D Deficiency (VitD Binding Protein)
Two main contraindications for renal biopsy
Solitary kidney, Marked coagulopathy
Pathogenesis of Membranous GN
In situ formation about antigen-antibody complex
Usually Phospholipase A2 target antigen
Membrane width increase, sub-epithelial deposits on EM
Clinical Presentation/Treatment of Membranous GN
Proteinuria or nephrotic syndrome
Increased incidence of renal vein thrombosis
Tx - ACEi to reduce proteinuria. If persistent, severe neph. syndrome, Steroids + Cyclophosphamides
Pathogenesis of lipoid nephrosis
Primarily related to abnormalities in cellular immunity
Effacement of foot processes
Clinical presentation/Treatment of Lipoid Nephrosis
Usually presents w/ nephrotic (most common in children)
Tx - Usually steroids, can relapse, Cyclophosphamide if dependent
Pathogenesis of Focal Segmental Glomerular Sclerosis
- Primary - like Lipoid Nephrosis
- Genetic Abnormalities in structural proteins
- Adaptive sclerotic response to primary glomerular injury
Clinical presentation of Focal Segmental Glomerular Sclerosis?
Proteinuria+Nephrotic Syndome
Much higher incidence in African Americans
Less response to steroids than Lipoid Nephrosis
What tends to be seen with Nephritic syndrome
Hematuria, Oliguria, Azotemia, HTN, Edema
Three primary types of nephritic syndrome?
MPGN Type I and II
C3 Glomerulopathy
Three important infectious correlations with nephritic syndrome
Post streptococcal GN
Staphylococcal Infection
HIV assocaited nephropathy
Important features in rapidly progressive glomerulonephritis
Acute kidney injury w/ hematuria, proteinuria, and HTN
Crecenteric glomerulonephritis on biopsy
Three types of RPGN
Linear glomerular BM Deposits (Goodpastures)
Granular Immune Complexes (SLE, cryoglob)
No Immune Complexes (If only renal, Renal - pauci immune)
RPGN associated with cANCA (PR3)?
Wegener’s granulomatosis
RPGN associated with pANCA (MPA)
Micro-PAN
Mutations associated with primary Thrombotic Microangiopathy
TTP – ADAM TS13
HUS – Shiga toxin
Can also be drug induced, from complement overactivity
Primary treatment for TTP
Plasmaphoreses
Three labs/scans that suggest chronic, rather than acute, kidney damage
Anemia
Very high PTH
Small kidneys
Urine tests suggestive of a glomerular process? Suggestive of non-glomerular?
Glom – RBC Casts
Non – Clots in the urine
