Glomerular Diseases - AMS

Question 1

What are the cells of the JG Apparatus and what is their role?

Answer 1

1) Macula Densa cells: NaCl sensor; local secretion of vasopressor
2) Granular cells: secrete renin in responose to macula densa cells
3) mesangial cells: anchor granular cells

Question 2

What glomerular diseases are not caused by immune processes?

Answer 2

• DM
• HTN nephrosclerosis
• Amyloidosis
• Hereditary nephropathies (i.e. alport’s syndrome)

Question 3

Does antibiotic treatment prevent glomerular disease after a GABHS infection?

Answer 3

Antibiotic Tx does NOT prevent glomerular disease.

Question 4

What are the S/S of Post-GABHS Glomerular disease?

Answer 4

• Hematuria (100%)
• Oliguria (52%)
• Edema (85%)
• HTN (82%)
• Hypocomplementemia (83%)

Question 5

What labs would be ordered for a suspected GABHS glomerular disease?

Answer 5

• U/A
• Streptozyme
• ASO titer

Question 6

What is the Tx of post-GABHS glomerulonephritis?

Answer 6

• Supportive (↓ BP & volume overload)
• ↓ salt until edema & HTN clear
• ↓ Fluids until diuresis
• Control HTN with diuretics
• Dialysis for unresponsive hyperkalemia, acidosis, or pulmonary edema

Question 7

What is the most common cause of glomerular hematuria?

Answer 7

IgA nephropathy (Berger's Disease)
-Attacks of hematuria following a nonspecific viral illness

Question 8

What is the clinical presentation of IgA nephropathy?

Answer 8

• Gross hematuria
• Mild proteinuria
• ↑ urine IgG excretion
• ↑ serum IgA level

Question 9

What is the Tx of IgA nephropathy?

Answer 9

• Supportive
• ACEI
• Steroids if progressive

Question 10

What is the hallmark of Rapid Progressive Glomerulonephritis (RPGN)?

Answer 10

Loss of renal function > 50% over a period of 3 months with renal crescents on biopsy.

Question 11

What are the clinical presentations of Goodpasture’s Disease?

Answer 11

• Glomerulonephritis associated with pulmonary hemorrhage & circulating antibodies against basement membrane antigens
• hemoptysis
• pulmonary infiltrates
• dyspnea

Question 12

What is the most common form of nephrotic syndrome in kids?

Answer 12

Minimal Change Disease (75-80%) of all cases

Question 13

What is the hallmark of MCD?

Answer 13

• Albuminuria (> 6 gm/day)
• Globules of cholesterol esters in the tubular epithelium of the kidney
• Transient symptoms

Question 14

Focal Segmental Glomerulosclerosis is more common among which poplulations?

Answer 14

• African Americans
• HIV patients
• IV heroin abusers
• Sickle cell disease

Question 15

What is the most common primary cause of nephrotic syndrome in adults?

Answer 15

Membranous Glomerular Disease (50%) of cases

Question 16

What is the clinical presentation of Membranoproliferative Glomerulonephritis (MPGN)?

Answer 16

1) Acute glomerulonephritis
2) nephrotic syndrome
3) hematuria
4) HTN
5) ↓ GFR
6) ↑ mesangial cellularity

Question 17

What is the most common cause of end stage renal disease in the US?

Answer 17

Diabetes (“The sugars” - AMS)

Question 18

What is the hallmark change seen in the cellular anatomy of the kidney during a glomerular disease process?

Answer 18

Mesangial matrix explosion → if nodular in appearance = Kimmelsteil-Wilson lesion

Question 19

What is the triad associated with the clinical presentation of Acute Interstitial Nephritis (AIN)?

Answer 19

1) Fever
2) Skin rash
3) Peripheral Eosinophilia

(50% may present with eosinophilia alone)
NO HTN/Edema/Massive Proteinuria like in glomerulonephritis

Question 20

What kind of casts will be seen in a U/A of a patient with AIN?

Answer 20

Clear casts

Question 21

What are the hallmarks of chronic tubulointerstitial nephropathy?

Answer 21

1) Hyperchloremic metabolic acidosis
2) Hyperkalemia
3) ↓ maximal urinary concentrating ability

Question 22

What syndrome is associated with chronic tubulointerstitial nephropathy and what does it result in?

Answer 22

Partial or complete Fanconi’s syndrome = inability to reabsorb electrolytes at the PCT (phosphate, bicarb, AA, uric acid, glucose)

Question 23

What are some causes of Chronic Interstitial Nephropathy?

Answer 23

• Polycystic Kidney Dz
• Hypercalcemia
• Hypokalemia
• Analgesics
• Lead
• Lithium
• SLE
• Sickle Cell