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
What is the treatment for Pauci-immune glomerulonephritis?
HIGH dose corticosteroids | DMARDs
26
What is the etiology of Goodpasture syndrome?
Antibodies attack the glomerular basement membrane
27
What other damage is caused in Good pasture syndrome?
Pulmonary hemorrhage
28
What are the signs and symptoms of Anti-Glomerular Basement Membrane Glomerulonephritis (Goodpasture Syndrome)?
1. 20-60% are preceeded by URI 2. Hemoptysis and dyspnea** 3. RPGN (rapidly progessing glomerulonephritis)
29
What are 3 important diagnosic findings in Goodpasture syndrome?
1. Sputum has hemosiderin-laden macrophages 2. Anti-GBM antibodies in blood 3. CXR - pulmonary infiltrates
30
Good pasture Syndrome: Treatment
1. Plasmaphoresis 2. Corticosteroids 3. DMARDs
31
Name 3 Nephrotic Syndromes
1. Minimal Change Disease 2. Membranous nephropathy 3. Focal Segmental Glomerulosclerosis (FSGS)
32
What are the key features of nephrotic disease
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
At what point does peripheral edema occur in nephrotic syndrome?
when serum albumin is <2g/dL
34
What is the initial test to look for proteinuria?
dipstick (tests for albumin only)
35
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
36
What are the two characteristic findings in the blood chemistry for nephrotic syndrome?
1. Decreased serum albumin (<3g/dL) | 2. Total serum protein <6g/dL
37
What three minerals/vitamins can also be deficient in nephrotic syndrome?
1. Vitamin D 2. Zinc 3. Copper (due to loss of binding proteins)
38
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)
39
Which nephrotic disorder is due to foot process effacement of the podocytes?
Minimal Change Disease
40
What is the most common cause of proteinuria in children?
Minimal Change Disease
41
Minimal Change Disease: Treatment
Oral corticosteroids
42
What is the most common primary nephrotic syndrome in adults?
Membranous Nephropathy
43
Membranous nephropathy: etiology
immune complex deposition in glomerular capillary walls causing increased permeability
44
What disease would you suspect with a "frothy" urine sample?
Membranous nephropathy
45
Membranous Nephropathy: Treatment
Initial (conservative treatment): ACE or ARB (if BP is >125/75) if not improving after 6 months -->corticosteroids
46
Which disease is due to increased permeability due to podocyte injury especially in those of african descent?
Focal Segmental Glomerulosclerosis (FSGS)
47
Focal Segmental Glomerulosclerosis: Treatment
1. Corticosteroids (60mg for 16 weeks) 2. Diuretic for edema 3. ACE or ARB to reduce proteinuria and HTN 4. Statin for hyperlipidemia