Glomerular diseases Flashcards
What level is pathologic proteinuria?
150 mg or more over 24 hrs
Are we more likely to see microalbuminuria or proteinuria first clinically? Why?
microalbuminuria
because it is the smallest plasma protein= more readily filtered
What is the protein amount that is defined as nephrotic dz?
greater than or equal to 3.5 g of protein
What is primary vs secondary glomerular dz?
Primary- something wring in the glomerulus
Secondary- something outside of the glomerulus
Gold standard for dx of glomerular dz?
Biopsy
What do glomerular diseases cause?
hypoalbuminemia due to urinary loss of proteins
What is Nephritic syndrome?
inflammatory process a/w immunologic response leads to renal glomeruli damage
Clinical findings in Nephritic syndrome?
edema hematuria= "Coca Cola colored" occasional WBCs proteinuria HTN azotemia elevated creatinine oliguria
What is Rapidly Progressive Glomerularnephritis?
- Severe injury to the glomerular capillary wall, GBM, and bowman’s capsule
- most severe and clinically urgent end of the nephritic spectrum
- leads to renal failure
What causes Post Infectious Glomerularnephritis?
Group A beta-hemolytic strep
immune mediated glomerular injury
Typical presentation of pt w/ Post Infectious Glomerularnephritis
- oliguria
- edematous
- variable hypertensive
- Coca Cola urine
- UA w/ RBCs, red cell casts, proteinuria
- ASO titers are high
How do you treat Post Infectious Glomerularnephritis?
Supportive:
anti-hypertensives (ACE/ARBs)
salt restriction
diuretics
No steroids
MC primary glomerular dz?
IgA Neuropathy
“Berger’s disease”
What happens in IgA Neuropathy
“Berger’s disease”?
IgA deposition in the glomerular mesangium –> inflammatory response
Normal hx of a pt w/ IgA Neuropathy
“Berger’s disease”? Labs?
usually follows a URI or GI infection
-“coca-cola colored” urine 1-3 days after illness onset
hematuria
proteinuria
increased IgA
complement levels nl
When do you give corticosteroids in pt w/ IgA Neuropathy-“Berger’s disease”?
if proteinuria 1.0-3.5 g/d
How does Henoch-Schonlein purpura classically present?
Palpable purpura in the lower extremities and buttock area w/ arthralgias and abdominal sx (nausea, colic, melena)
What are the small vessel vasculitides seen w/ Pauci-immune glomerulonephritis (ANCA-associated)
S/S of these?
- Wegener granulomatosis
- Churg-Strauss dz
- microscopoc polyangitis
S/S= fever, malaise, weight loss, purpura
What lab will you order for pt with probable Pauci-immune glomerulonephritis ?
ANCA (anti-neutrophil cytoplasmic antibodies)
Tx of pt w/ Pauci-immune glomerulonephritis ?
high dose corticosteroids
DMARDS
Another name for Anti-glomerular basement membrane glomerulonephritis?
what is it?
Goodpasture syndrome
glomerulonephritis + pulmonary hemorrhage
basement membrane injury from anti-GBM antibodies
S/S of Goodpasture syndrome?
- onset preceded by URI in 20-60%
- hemoptysis & dyspnea
- RPGN
What do you see in labs/CXR in Goodpasture syndrome?
- sputum shows hemosiderin-laden macrophages
- anti-GBM antibodies
CXR: pulmonary infiltrates
Tx of Goodpasture syndrome?
- Plasma exchange therapy to remove antibodies
- immunosuppressive drugs to prevent new formation of antibodies
What happens to the basement membrane in Nephrotic syndrome?
significantly increased basement membrane permeability
What are essential components of dx of Nephrotic syndrome?
- urine protein >3.5 in 24 hrs
- hypoalbuminemia (< 3)
- bland urinary sediment
- peripheral edema
- hyperlipidemia
What is the hallmark finding in Nephrotic syndrome?
Peripheral edema
also dyspnea
What will UA and blood show in Nephrotic syndrome?
UA: proteinuria, (can see oval fat bodies)
Blood: decreased albumin and total protein= characteristic
also hyperlipidemia in >50%
What do you need to consider when treating Nephrotic Syndrome?
- Protein loss
- Edema (restrict salt, thiazide or loop)
- Hyperlipidemia
- Hypercoagulable state
What is Minimal Change dz? Who is it seen in?
- Increased level of glomerular permeability, foot process effacement
- mainly in children
How do you treat Minimal Change dz?
-Oral corticosteroids w/ prolonged taper
relapse is common upon discontinuation
What is Membranous Nephropathy?
MC cause of primary nephrotic syndrome in adults
idiopathic immune mediated
immune complex deposition in glomerular capillary walls results in increased permeability
Clinical presentation of pt w/ Membranous nephropathy?
- asymptomatic
- edema w/ frothy urine
- high incidence of venous thromboembolism
Tx of Membranous nephropathy in pt with elevated BP?
If they don’t spontaneously recover within 6 months what do you give?
reduce urine protein levels with ACE or ARB if BP > 125/75
Corticosteroids
What is Focal Segmental Glomerulosclerosis? How does it occur?
Increase permeability due to podocyte injury
Primary: idiopathic (African descent)
Secondary: obesity, HTN, chronic urinary reflux
Clinical presentation of pt with Focal Segmental Glomerulosclerosis?
Proteinuria
Tx of pt w/ Focal Segmental Glomerulosclerosis?
- diuretics for edema
- ACE/ARB for HTN and proteinuria
- statins for hyperlipidemia
-high dose corticosteroids for primary cause patients
