Glomerular Disease (Mcleod) Flashcards
Pathologic proteinuria is equal to _____ or more in 24 hours
150mg
What is the smallest plasma protein
Albumin
Microalbuminuria
30-300mg/day of albumin excreted
Macro albuminuria
> 300mg/day of albumin excreted
Daily excretion fo more than ______ of protein is termed nephrotic range proteinuria
3.5g
What is the gold standard for definitive diagnosis of nephrotic versus nephritic syndrome
biopsy
Common Nephritic Syndrome characteristics
- Hematuria
- RBC casts/dysmorphic RBCs
- Occasional WBCs
- proteinuria <3.5g/day
- Azotemia
- Oliguria
- Edema
- Gradual increase in creatinine
Name the 5 Nephritic Syndromes
- Post Infectious Glomerulonephritis
- IgA nephropathy
- Henoch- Schonlein purpura
- Pauci-immune glomerulonephritis (ANCA-associated)
- Anti-Glomerular Basement Membrane Glomerulonephritis (Goodpasture Syndrome)
What causes Post infectious Glomerulonephritis?
Group A beta hemolytic streptococci
What damages the glomerulus in Post Infectious Glomerulonephritis?
Immune complexes with streptococcal antigen components
How long after the initial strep infection does the glomerulonephritis occur?
1-3 weeks
Describe the UAof Post infectious glomerulonephritis
UA: cola colored urine, RBC casts, proteinuria
What is the classic blood test to identify post infectious glomerulonephritis
ASO titer
Treatment for Post infectious glomerulonephritis
- *Treatment is supportive
1. ACE or ARB
2. Salt restrict
3. Diuretics
Steroids don’t improve outcome
What is the most common primary glomerular disease worldwide?
IgA nephropathy (Berger’s Disease)
When does IgA nephropathy present after a URI or GI infection?
cola colored urine 1-3 days after illness onset
What are the 4 labs you would expect to see in IgA nephropathy?
- Hematuria
- Proteinuria
- Increased IgA levels**
- Complement normal
What is the most unfavorable prognostic indicator for IgA nephropathy?
proteinuria <1g/day
Treatment for IgA nephropathy
- Corticosteroids if milder proteinuria 1-3.5g/day
- ACE or ARBs if severe proteinuria
- Target BP <130/80
Henoch-Schonlein purpura: etiology
systemic small-vessel vasculitis associated with IgA deposition in vessel walls
What do Henoch-Schonlein purpura and Post infectious glomerulonephritis have in common?
Both brought on by group A strep
What is the classical presentation for Henoch-Schonlein purpura? (3)
- palpable purpura in the LE and buttock areas
- arthraligas
- ABD symptoms (nausea, melena)
What are the signs and symptoms of Pauci-immune glomerulonephritis
- *like a systemic inflammatory disease
- Fever
- Malaise
- Weight loss
- Purpura
What is the characteristic lab associated with Pauci-immune glomerulonephritis
ANCA (+)
[anti-neutrophil cytoplasmic antibodies]
What is the treatment for Pauci-immune glomerulonephritis?
HIGH dose corticosteroids
DMARDs
What is the etiology of Goodpasture syndrome?
Antibodies attack the glomerular basement membrane
What other damage is caused in Good pasture syndrome?
Pulmonary hemorrhage
What are the signs and symptoms of Anti-Glomerular Basement Membrane Glomerulonephritis (Goodpasture Syndrome)?
- 20-60% are preceeded by URI
- Hemoptysis and dyspnea**
- RPGN (rapidly progessing glomerulonephritis)
What are 3 important diagnosic findings in Goodpasture syndrome?
- Sputum has hemosiderin-laden macrophages
- Anti-GBM antibodies in blood
- CXR - pulmonary infiltrates
Good pasture Syndrome: Treatment
- Plasmaphoresis
- Corticosteroids
- DMARDs
Name 3 Nephrotic Syndromes
- Minimal Change Disease
- Membranous nephropathy
- Focal Segmental Glomerulosclerosis (FSGS)
What are the key features of nephrotic disease
- > 3.5 g/day of protein in the urine
- Hypoalbuminemia (<3 g/dL)
- Peripheral edema
- Hyperlipidemia
- Bland urinary sediment (oval fat bodies)
- Dyspnea (pulmonary edema)
At what point does peripheral edema occur in nephrotic syndrome?
when serum albumin is <2g/dL
What is the initial test to look for proteinuria?
dipstick (tests for albumin only)
What do oval fat bodies in the urine indicate?
marked hyperlipidemia, a compensatory mechanism by the liver to replace serum protein and decreased clearance of VLDL
What are the two characteristic findings in the blood chemistry for nephrotic syndrome?
- Decreased serum albumin (<3g/dL)
2. Total serum protein <6g/dL
What three minerals/vitamins can also be deficient in nephrotic syndrome?
- Vitamin D
- Zinc
- Copper
(due to loss of binding proteins)
What other state can occur when a patient’s serum albumin decreases <2g/dL?
Hypercoagulable state**
- venous thromboemboli
- PE
- renal ven thrombosis
(may need indefinite anticoagulation)
Which nephrotic disorder is due to foot process effacement of the podocytes?
Minimal Change Disease
What is the most common cause of proteinuria in children?
Minimal Change Disease
Minimal Change Disease: Treatment
Oral corticosteroids
What is the most common primary nephrotic syndrome in adults?
Membranous Nephropathy
Membranous nephropathy: etiology
immune complex deposition in glomerular capillary walls causing increased permeability
What disease would you suspect with a “frothy” urine sample?
Membranous nephropathy
Membranous Nephropathy: Treatment
Initial (conservative treatment): ACE or ARB (if BP is >125/75)
if not improving after 6 months –>corticosteroids
Which disease is due to increased permeability due to podocyte injury especially in those of african descent?
Focal Segmental Glomerulosclerosis (FSGS)
Focal Segmental Glomerulosclerosis: Treatment
- Corticosteroids (60mg for 16 weeks)
- Diuretic for edema
- ACE or ARB to reduce proteinuria and HTN
- Statin for hyperlipidemia
