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ICM -- Nephrology > Glomerular Disease and such... > Flashcards

Glomerular Disease and such... Flashcards

1
Q

Causes of heme-negative red urine

A

Meds – Doxorubicin, Chloroquine, Ibuprofen
Dyes – Beets, Blackberries, Food Coloring
Metabolites – Bile, Melanin, Porphyrin

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2
Q

Main risk factors for urologic malignancy?

A

Age, Gross hematuria, Smoking, Env. Exposure

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3
Q

Urine dipstick for hematuria is positive…now what?

A

Microscopic exam. If over 3 RBCs/hpf with no obvious cause, refer to urologic evaluation

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4
Q

Extraglomerular source of hematuria. Color? Clots? Proteinuria? RBC Details?

A

Red/Pink
Maybe
Less than 500 mg/day
Normal RBC morphology w/out Casts

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5
Q

Glomerular source of hematuria. Color? Clots? Proteinuria? RBC Details?

A

Red, Smoky brown, or Coca-Cola
No clots
Can be over 500 mg/day
Dysmorpic possibly with Casts

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6
Q

Best way to rule out renal mass as a cause for hemato.?

A

Multiphasic CT Urography

If any indicator, move forward with cystoscopy

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7
Q

Most common renal biopsy discoveries

A

IgA nephropathy, thin BA disease, NORMAL

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8
Q

Pathogenesis of IgA Nephropathy (Bergers disease)

A

Two hit hypothesis –> abberantly glycosylated IgA1

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9
Q

Pathology of Bergers Disease

A

Mesangial Proliferative GN with IgA deposits on IF

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10
Q

Three types of proteinuria?

A

Glomerular, Tubular, Overflow

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11
Q

What is glomerular proteinuria?

A

Increased filtration of macromolecules across glomerular capillary wall

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12
Q

What is tubular proteinuria?

A

Excretion of low-molecular weight proteins (like beta2-microglobulin, Ig Light Chains, and albumin break down products).

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13
Q

What is overflow proteinuria?

A

Increased excretion of low-mol weight proteins due to Ig light chains of multiple myeloma, lysozyme of AML, or myoglobin in rhabdo

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14
Q

Nephrotic Levels of Urine Protein?

A

Over 3.5 g

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15
Q

Elevated urinary albumin excretion is defined as

A

Over 30 microgram/mg

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16
Q

Difference between microalbuminuria and macroalbuminuria?

A

Micro – 30-300mg

Macro – Over 300mg

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17
Q

Preferred method of measuring urine albumin

A

Urine Albumin/Creatinine

Helps overcome the limits of variations in urine volume

18
Q

Relationship of albuminuria and DM

A

Type 1 – Often earliest sign of diabetic nephropathy

TII – Usually present at diagnosis, can reflect CV disease or nephropahy

19
Q

Shortcoming of the urine dipstick

A

Can’t detect microalbuminuria or globin (in myeloma)

20
Q

Three symptoms common in nephrotic syndrome

A

Proteinuria over 3g per 24 hours
Edema due to hypoalbuminemia
Hyperlipidemia (increased albumin, increased LDL chol)

21
Q

Four examples of primary nephrotic syndrome

A

Membranous GN
Lipoid Nephrosis
Focal Segmental Glomerular Sclerosis
Membranoproliferative GN

22
Q

Four main examples of secondary nephrotic syndrome

A

DM
Amyloidosis
Myeloma
SLE

23
Q

Six Complications of Nephrotic syndrome (from protein loss)

A

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)

24
Q

Two main contraindications for renal biopsy

A

Solitary kidney, Marked coagulopathy

25
Q

Pathogenesis of Membranous GN

A

In situ formation about antigen-antibody complex
Usually Phospholipase A2 target antigen
Membrane width increase, sub-epithelial deposits on EM

26
Q

Clinical Presentation/Treatment of Membranous GN

A

Proteinuria or nephrotic syndrome
Increased incidence of renal vein thrombosis
Tx - ACEi to reduce proteinuria. If persistent, severe neph. syndrome, Steroids + Cyclophosphamides

27
Q

Pathogenesis of lipoid nephrosis

A

Primarily related to abnormalities in cellular immunity

Effacement of foot processes

28
Q

Clinical presentation/Treatment of Lipoid Nephrosis

A

Usually presents w/ nephrotic (most common in children)

Tx - Usually steroids, can relapse, Cyclophosphamide if dependent

29
Q

Pathogenesis of Focal Segmental Glomerular Sclerosis

A
  1. Primary - like Lipoid Nephrosis
  2. Genetic Abnormalities in structural proteins
  3. Adaptive sclerotic response to primary glomerular injury
30
Q

Clinical presentation of Focal Segmental Glomerular Sclerosis?

A

Proteinuria+Nephrotic Syndome
Much higher incidence in African Americans
Less response to steroids than Lipoid Nephrosis

31
Q

What tends to be seen with Nephritic syndrome

A

Hematuria, Oliguria, Azotemia, HTN, Edema

32
Q

Three primary types of nephritic syndrome?

A

MPGN Type I and II

C3 Glomerulopathy

33
Q

Three important infectious correlations with nephritic syndrome

A

Post streptococcal GN
Staphylococcal Infection
HIV assocaited nephropathy

34
Q

Important features in rapidly progressive glomerulonephritis

A

Acute kidney injury w/ hematuria, proteinuria, and HTN

Crecenteric glomerulonephritis on biopsy

35
Q

Three types of RPGN

A

Linear glomerular BM Deposits (Goodpastures)
Granular Immune Complexes (SLE, cryoglob)
No Immune Complexes (If only renal, Renal - pauci immune)

36
Q

RPGN associated with cANCA (PR3)?

A

Wegener’s granulomatosis

37
Q

RPGN associated with pANCA (MPA)

A

Micro-PAN

38
Q

Mutations associated with primary Thrombotic Microangiopathy

A

TTP – ADAM TS13
HUS – Shiga toxin
Can also be drug induced, from complement overactivity

39
Q

Primary treatment for TTP

A

Plasmaphoreses

40
Q

Three labs/scans that suggest chronic, rather than acute, kidney damage

A

Anemia
Very high PTH
Small kidneys

41
Q

Urine tests suggestive of a glomerular process? Suggestive of non-glomerular?

A

Glom – RBC Casts

Non – Clots in the urine

ICM -- Nephrology (9 decks)

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