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Foundations of Clinical Practice II > Glomerular Disease (Mcleod) > Flashcards

Glomerular Disease (Mcleod) Flashcards

1
Q

Pathologic proteinuria is equal to _____ or more in 24 hours

A

150mg

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2
Q

What is the smallest plasma protein

A

Albumin

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3
Q

Microalbuminuria

A

30-300mg/day of albumin excreted

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4
Q

Macro albuminuria

A

> 300mg/day of albumin excreted

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5
Q

Daily excretion fo more than ______ of protein is termed nephrotic range proteinuria

A

3.5g

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6
Q

What is the gold standard for definitive diagnosis of nephrotic versus nephritic syndrome

A

biopsy

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7
Q

Common Nephritic Syndrome characteristics

A
  1. Hematuria
  2. RBC casts/dysmorphic RBCs
  3. Occasional WBCs
  4. proteinuria <3.5g/day
  5. Azotemia
  6. Oliguria
  7. Edema
  8. Gradual increase in creatinine
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8
Q

Name the 5 Nephritic Syndromes

A
  1. Post Infectious Glomerulonephritis
  2. IgA nephropathy
  3. Henoch- Schonlein purpura
  4. Pauci-immune glomerulonephritis (ANCA-associated)
  5. Anti-Glomerular Basement Membrane Glomerulonephritis (Goodpasture Syndrome)
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9
Q

What causes Post infectious Glomerulonephritis?

A

Group A beta hemolytic streptococci

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10
Q

What damages the glomerulus in Post Infectious Glomerulonephritis?

A

Immune complexes with streptococcal antigen components

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11
Q

How long after the initial strep infection does the glomerulonephritis occur?

A

1-3 weeks

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12
Q

Describe the UAof Post infectious glomerulonephritis

A

UA: cola colored urine, RBC casts, proteinuria

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13
Q

What is the classic blood test to identify post infectious glomerulonephritis

A

ASO titer

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14
Q

Treatment for Post infectious glomerulonephritis

A
  • *Treatment is supportive
    1. ACE or ARB
    2. Salt restrict
    3. Diuretics

Steroids don’t improve outcome

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15
Q

What is the most common primary glomerular disease worldwide?

A

IgA nephropathy (Berger’s Disease)

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16
Q

When does IgA nephropathy present after a URI or GI infection?

A

cola colored urine 1-3 days after illness onset

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17
Q

What are the 4 labs you would expect to see in IgA nephropathy?

A
  1. Hematuria
  2. Proteinuria
  3. Increased IgA levels**
  4. Complement normal
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18
Q

What is the most unfavorable prognostic indicator for IgA nephropathy?

A

proteinuria <1g/day

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19
Q

Treatment for IgA nephropathy

A
  1. Corticosteroids if milder proteinuria 1-3.5g/day
  2. ACE or ARBs if severe proteinuria
  3. Target BP <130/80
20
Q

Henoch-Schonlein purpura: etiology

A

systemic small-vessel vasculitis associated with IgA deposition in vessel walls

21
Q

What do Henoch-Schonlein purpura and Post infectious glomerulonephritis have in common?

A

Both brought on by group A strep

22
Q

What is the classical presentation for Henoch-Schonlein purpura? (3)

A
  • palpable purpura in the LE and buttock areas
  • arthraligas
  • ABD symptoms (nausea, melena)
23
Q

What are the signs and symptoms of Pauci-immune glomerulonephritis

A
  • *like a systemic inflammatory disease
  • Fever
  • Malaise
  • Weight loss
  • Purpura
24
Q

What is the characteristic lab associated with Pauci-immune glomerulonephritis

A

ANCA (+)

[anti-neutrophil cytoplasmic antibodies]

25
Q

What is the treatment for Pauci-immune glomerulonephritis?

A

HIGH dose corticosteroids

DMARDs

26
Q

What is the etiology of Goodpasture syndrome?

A

Antibodies attack the glomerular basement membrane

27
Q

What other damage is caused in Good pasture syndrome?

A

Pulmonary hemorrhage

28
Q

What are the signs and symptoms of Anti-Glomerular Basement Membrane Glomerulonephritis (Goodpasture Syndrome)?

A
  1. 20-60% are preceeded by URI
  2. Hemoptysis and dyspnea**
  3. RPGN (rapidly progessing glomerulonephritis)
29
Q

What are 3 important diagnosic findings in Goodpasture syndrome?

A
  1. Sputum has hemosiderin-laden macrophages
  2. Anti-GBM antibodies in blood
  3. CXR - pulmonary infiltrates
30
Q

Good pasture Syndrome: Treatment

A
  1. Plasmaphoresis
  2. Corticosteroids
  3. DMARDs
31
Q

Name 3 Nephrotic Syndromes

A
  1. Minimal Change Disease
  2. Membranous nephropathy
  3. Focal Segmental Glomerulosclerosis (FSGS)
32
Q

What are the key features of nephrotic disease

A
  1. > 3.5 g/day of protein in the urine
  2. Hypoalbuminemia (<3 g/dL)
  3. Peripheral edema
  4. Hyperlipidemia
  5. Bland urinary sediment (oval fat bodies)
  6. Dyspnea (pulmonary edema)
33
Q

At what point does peripheral edema occur in nephrotic syndrome?

A

when serum albumin is <2g/dL

34
Q

What is the initial test to look for proteinuria?

A

dipstick (tests for albumin only)

35
Q

What do oval fat bodies in the urine indicate?

A

marked hyperlipidemia, a compensatory mechanism by the liver to replace serum protein and decreased clearance of VLDL

36
Q

What are the two characteristic findings in the blood chemistry for nephrotic syndrome?

A
  1. Decreased serum albumin (<3g/dL)

2. Total serum protein <6g/dL

37
Q

What three minerals/vitamins can also be deficient in nephrotic syndrome?

A
  1. Vitamin D
  2. Zinc
  3. Copper

(due to loss of binding proteins)

38
Q

What other state can occur when a patient’s serum albumin decreases <2g/dL?

A

Hypercoagulable state**

  • venous thromboemboli
  • PE
  • renal ven thrombosis

(may need indefinite anticoagulation)

39
Q

Which nephrotic disorder is due to foot process effacement of the podocytes?

A

Minimal Change Disease

40
Q

What is the most common cause of proteinuria in children?

A

Minimal Change Disease

41
Q

Minimal Change Disease: Treatment

A

Oral corticosteroids

42
Q

What is the most common primary nephrotic syndrome in adults?

A

Membranous Nephropathy

43
Q

Membranous nephropathy: etiology

A

immune complex deposition in glomerular capillary walls causing increased permeability

44
Q

What disease would you suspect with a “frothy” urine sample?

A

Membranous nephropathy

45
Q

Membranous Nephropathy: Treatment

A

Initial (conservative treatment): ACE or ARB (if BP is >125/75)

if not improving after 6 months –>corticosteroids

46
Q

Which disease is due to increased permeability due to podocyte injury especially in those of african descent?

A

Focal Segmental Glomerulosclerosis (FSGS)

47
Q

Focal Segmental Glomerulosclerosis: Treatment

A
  1. Corticosteroids (60mg for 16 weeks)
  2. Diuretic for edema
  3. ACE or ARB to reduce proteinuria and HTN
  4. Statin for hyperlipidemia

Foundations of Clinical Practice II (25 decks)

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