Glomerular Diseases

Question 1

the normal glomerulus is partitioned into

Answer 1

• Mesangium
• endothelium
• basement membrane
• epithelium

Question 2

Diagnostic clues of glomerular disease?

Answer 2

• proteinuria
• active urine sediment
• rbc, dysmorphic RBC, RBC casts

Question 3

• 80-150mg/ 24 hrs is normal
• nephrotic range proteinuria (> 3.5g/day)
• subnephrotic proteinuria (between 150mg and 3.5g/day)

Answer 3

proteinuria

Question 4

what is albuminuria? What are the normal values

Answer 4

Presence of albumin in urine

• normal < 30mg/gm
• moderately increased 30-300 mg/gm
• severely increased > 300mg/gm

Question 5

what is hematuria? what is glomerular hematuria?

Answer 5

> 3 RBCs per high power field

Glomerular hematuria = dysmorphic RBCs and casts

Question 6

what is active sediment?

Answer 6

RBC casts or dysmorphic RBCs= an inflammatory process

Question 7

what should you do if you suspect kidney failure and glomerular disease?

Answer 7

• if there is evidence of renal failure AND glomerular hematuria- STOP
• often biopsy is indicated
• you likely have an aggressive, inflammatory process that needs to be treated emergently

Question 8

classification of glomerular disease?

Answer 8

Primary

• when major problems starts in the glomerulus

Secondary

• when involvement is part of systemic disease

Question 9

nephritic syndrome looks like?

Answer 9

• hematuria (+/-RBC casts)
• HTN
• non-nephrotic range proteinuria
• edema
• azotemia, oliguria, signs of uremia

more emergent needs kidney biopsy for diagnosis

Question 10

Nephrotic syndrome looks like?

Answer 10

• Massive proteinuria (> 3.5g/day)
• edema
• hypoalbuminemia
• hyperlipidemia

Question 11

causes of nephritic syndrome?

Answer 11

• lupus nephritis
• IgA nephropathy
• ANCA vasculitis
• post infectious GN
• thin basement

Question 12

causes of nephrotic syndrome?

Answer 12

• membranous nephropathy
• focal segmental glomerulosclerosis
• minimal change disease
• Diabetic nephropathy
• amyloidosis

Question 13

• Nephritic syndrome + renal impairment

Answer 13

Can be RPGN (rapidly progressive glomerular nephritis)

• RPGN: nephritic syndrome + doubling of serum Cr or 50% decrease in GFR over < 3 months

Question 14

when should a kidney biopsy be completed?

Answer 14

• no hard and fast rule
• cause cannot be determined w/o it
• differential has different treatments
• worsening creatinine
• proteinuria > 1gm despite treatment

Question 15

therapy for glomerular disease

Answer 15

• managment of the proteinuria
• immunomodulatory therapies
• managment of systemic diseases that cause secondary glomerular injury

Question 16

ways to decrease proteinuria?

Answer 16

• Inhibition of the renin-angiotensin system (either ACEi or ARB)
• SGLT2i in both diabetics and nondiabetics
• good BP control
• good DM control
• quitting smoking
• low sodium diet (< 2000 mg of Na/day)
• weight loss (if obese)