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Foundations II Exam 5 (Jess) > Glomerular diseases > Flashcards

Glomerular diseases Flashcards

1
Q

What level is pathologic proteinuria?

A

150 mg or more over 24 hrs

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2
Q

Are we more likely to see microalbuminuria or proteinuria first clinically? Why?

A

microalbuminuria

because it is the smallest plasma protein= more readily filtered

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3
Q

What is the protein amount that is defined as nephrotic dz?

A

greater than or equal to 3.5 g of protein

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4
Q

What is primary vs secondary glomerular dz?

A

Primary- something wring in the glomerulus

Secondary- something outside of the glomerulus

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5
Q

Gold standard for dx of glomerular dz?

A

Biopsy

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6
Q

What do glomerular diseases cause?

A

hypoalbuminemia due to urinary loss of proteins

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7
Q

What is Nephritic syndrome?

A

inflammatory process a/w immunologic response leads to renal glomeruli damage

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8
Q

Clinical findings in Nephritic syndrome?

A 
edema
hematuria= "Coca Cola colored"
occasional WBCs
proteinuria
HTN
azotemia
elevated creatinine
oliguria
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9
Q

What is Rapidly Progressive Glomerularnephritis?

A
  • 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
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10
Q

What causes Post Infectious Glomerularnephritis?

A

Group A beta-hemolytic strep

immune mediated glomerular injury

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11
Q

Typical presentation of pt w/ Post Infectious Glomerularnephritis

A
  • oliguria
  • edematous
  • variable hypertensive
  • Coca Cola urine
  • UA w/ RBCs, red cell casts, proteinuria
  • ASO titers are high
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12
Q

How do you treat Post Infectious Glomerularnephritis?

A

Supportive:
anti-hypertensives (ACE/ARBs)
salt restriction
diuretics

No steroids

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13
Q

MC primary glomerular dz?

A

IgA Neuropathy

“Berger’s disease”

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14
Q

What happens in IgA Neuropathy

“Berger’s disease”?

A

IgA deposition in the glomerular mesangium –> inflammatory response

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15
Q

Normal hx of a pt w/ IgA Neuropathy

“Berger’s disease”? Labs?

A

usually follows a URI or GI infection
-“coca-cola colored” urine 1-3 days after illness onset

hematuria
proteinuria
increased IgA
complement levels nl

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16
Q

When do you give corticosteroids in pt w/ IgA Neuropathy-“Berger’s disease”?

A

if proteinuria 1.0-3.5 g/d

17
Q

How does Henoch-Schonlein purpura classically present?

A

Palpable purpura in the lower extremities and buttock area w/ arthralgias and abdominal sx (nausea, colic, melena)

18
Q

What are the small vessel vasculitides seen w/ Pauci-immune glomerulonephritis (ANCA-associated)

S/S of these?

A
  • Wegener granulomatosis
  • Churg-Strauss dz
  • microscopoc polyangitis

S/S= fever, malaise, weight loss, purpura

19
Q

What lab will you order for pt with probable Pauci-immune glomerulonephritis ?

A

ANCA (anti-neutrophil cytoplasmic antibodies)

20
Q

Tx of pt w/ Pauci-immune glomerulonephritis ?

A

high dose corticosteroids

DMARDS

21
Q

Another name for Anti-glomerular basement membrane glomerulonephritis?

what is it?

A

Goodpasture syndrome

glomerulonephritis + pulmonary hemorrhage
basement membrane injury from anti-GBM antibodies

22
Q

S/S of Goodpasture syndrome?

A
  • onset preceded by URI in 20-60%
  • hemoptysis & dyspnea
  • RPGN
23
Q

What do you see in labs/CXR in Goodpasture syndrome?

A
  • sputum shows hemosiderin-laden macrophages
  • anti-GBM antibodies

CXR: pulmonary infiltrates

24
Q

Tx of Goodpasture syndrome?

A
  • Plasma exchange therapy to remove antibodies

- immunosuppressive drugs to prevent new formation of antibodies

25
Q

What happens to the basement membrane in Nephrotic syndrome?

A

significantly increased basement membrane permeability

26
Q

What are essential components of dx of Nephrotic syndrome?

A
  • urine protein >3.5 in 24 hrs
  • hypoalbuminemia (< 3)
  • bland urinary sediment
  • peripheral edema
  • hyperlipidemia
27
Q

What is the hallmark finding in Nephrotic syndrome?

A

Peripheral edema

also dyspnea

28
Q

What will UA and blood show in Nephrotic syndrome?

A

UA: proteinuria, (can see oval fat bodies)

Blood: decreased albumin and total protein= characteristic
also hyperlipidemia in >50%

29
Q

What do you need to consider when treating Nephrotic Syndrome?

A
  • Protein loss
  • Edema (restrict salt, thiazide or loop)
  • Hyperlipidemia
  • Hypercoagulable state
30
Q

What is Minimal Change dz? Who is it seen in?

A
  • Increased level of glomerular permeability, foot process effacement
  • mainly in children
31
Q

How do you treat Minimal Change dz?

A

-Oral corticosteroids w/ prolonged taper

relapse is common upon discontinuation

32
Q

What is Membranous Nephropathy?

A

MC cause of primary nephrotic syndrome in adults

idiopathic immune mediated

immune complex deposition in glomerular capillary walls results in increased permeability

33
Q

Clinical presentation of pt w/ Membranous nephropathy?

A
  • asymptomatic
  • edema w/ frothy urine
  • high incidence of venous thromboembolism
34
Q

Tx of Membranous nephropathy in pt with elevated BP?

If they don’t spontaneously recover within 6 months what do you give?

A

reduce urine protein levels with ACE or ARB if BP > 125/75

Corticosteroids

35
Q

What is Focal Segmental Glomerulosclerosis? How does it occur?

A

Increase permeability due to podocyte injury

Primary: idiopathic (African descent)
Secondary: obesity, HTN, chronic urinary reflux

36
Q

Clinical presentation of pt with Focal Segmental Glomerulosclerosis?

A

Proteinuria

37
Q

Tx of pt w/ Focal Segmental Glomerulosclerosis?

A
  • diuretics for edema
  • ACE/ARB for HTN and proteinuria
  • statins for hyperlipidemia

-high dose corticosteroids for primary cause patients

Foundations II Exam 5 (Jess) (7 decks)

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