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Genitourinary > Glomerular Dz + Path > Flashcards

Glomerular Dz + Path Flashcards

1
Q

Nephritic syndrome

A

HEMATURIA, AZOTEMIA, DEPENDENT EDEMA (PROTEINURIA)

  • hematuria w/ dysmorphic red cells
  • Variable proteinuria (<1.5g/day usually)
  • RBC casts, granular casts, pyuria
  • Edema, HTN, renal insufficiency, oliguria
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2
Q

Nephrotic Syndrome

A
  • proteinuria > 3.5 gm/day
  • Hypoalbuminemia
  • Hyperlipidemia, Lipiduria = liver tries to replace albumin
  • Edema
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3
Q

Rapidly Progressive Glomerulonephritis

A
  • acute nephritis

* acute kidney injury leading to ESRD in weeks to months

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4
Q

Most nephrotic

A
  • Minimal change glomerulopathy
  • membranous glomerulopathy
  • focal segmental glomerulosclerosis
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5
Q

Renal biopsy

Modalities

A
  • light microscopy w/ H+E + Silver stains
  • Immunofluorescence
  • electron microscopy
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6
Q

Glomerular dz

Focal v Diffuse
Segmental v global

A

.

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7
Q

Glomerular response to injury

A
  • Hypercellularity (mesangial endothelial inflammatory) w/ possible crescents
  • Foot process swelling and effacement
  • Basement membrane thickening
  • Hyalinosis/sclerosis = capillary walls
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8
Q

MC adult Nephrotic

A

1) Membranous Glomerulopathy

2) Focal Segmental glomerulosclerosis

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9
Q

MC Peds Nephrotic

A

1) Minimal Change Dz

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10
Q

Glomerular membrane

Layers

A

OUT TO IN:
BOWMAN’S SPACE

  • podocyte foot projections
  • Glomerular basement membrane
  • Endothelium

BLOOD

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11
Q

How many weeks of tx to say peds is steroid -resistant?

A

8 weeks

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12
Q

Minimal change dz

Etiology

A

KIDS

  • viral infection
  • ALLERGY rxn
  • autoimmune
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13
Q

Minimal change Dz

DX

A
  • simple light microscopy -nothing seen
  • electron microscope - podocyte foot damage
  • lose (-) charge, proteins slip through
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14
Q

Minimal change dz

Tx

A

Prednisone (highest responsive dz

Refractory = cyclosporin

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15
Q

Focal Segmental Glomerulosclerosis

Etiology

A
  • HTN , AA,
  • Reflux nephropathy
  • HIV
  • Morbid obesity
  • Sickle cell
  • Pamidronate
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16
Q

FSGlomerulosclerosis

Tx

A

Prednisone

50% progress to ESRD

17
Q

Membranous Nepropathy

Etiology

A

*Thickened BM, Immune complexes
*virus hepatitis, Rx,
Caucasian males >40

18
Q

Nephrotic

DX

A
  • *24-hour urine protein collection >3.5g/day
  • UA: proteinuria 3-4+
  • Oval fat bodies “maltese cross-shaped”
  • hypoablbuminemia, hyperlipid
  • Renal biospy (NO in minimal change)
19
Q

Nephrotic

Tx

A
  • Steroids = fsg , minimal change
  • Edema reduction = diuretic (thiazide/loop)
  • Proteinuria reduction = ACEI/ARB
  • Hyperlipid reduction= lifestyle, statin
20
Q

Membranous nephropathy

DX

A
  • Biopsy = GMS stain, spikes, diffuse IgM/comp in BM
  • PLA2R phosphodiesterase antibody = ID 1ary

Prognosis: rule of 3rds
1/3 risk ESRD, 1/3 remission, 1/3 stable

21
Q

Membranous Nephropathy

Tx

A
  • Steroids + Cyclophosphamide
  • Cyclosporine
  • Rituximab
  • ACTH
22
Q

Post-infectious Glomerulonephrits

Etiology

A

*after GABH STREP
*any infxn , 2 weeks after skin impetigo
*

23
Q

Post-infectious Glomerulonephrits

DX

A
  • facial edema
  • scanty, coca-cola urine
  • UP antistreptolysin titers, DOWN complement
  • Biopsy = hypercell (mono/lympho/neutro), Ig/C deposits, IgM/comp immunofluor = starry sky/humps
24
Q

Post-infectious Glomerulonephrits

Tx

A

Supportive

ABX

25
Q

SLE class IV diffuse proliferative Lupus

Tx

A 
ANA
Anti-dsDNA
C3
C4
CH50
26
Q

Goodpasture’s Dz

Etiology

A

*anti-GBM + lung alveoli antibodies

27
Q

Goodpasture’s Dz

Dx

A
  • linear IgG deposits
  • Kidney failure + Hemoptysis

*if checking anti-GBM, check ANCA too cuz often together (b/f starting immunosupp therapy)

28
Q

Goodpasture’s Dz

Tx

A

*Corticosteriods (high dose) + Cyclophosphamide + Plasmapheresis (while waiting for Rx to work)

29
Q

Membranoproliferative/Mesangiocapillary

Etiliology

A

Viral (HC/BV). SLE

30
Q

Membranoproliferative/Mesangiocapillary

DX

A
  • Hypocomplimentemia
  • cryoglobulinemia
  • mixed nephrotic-nephritic
31
Q

Cresentic Glomerulonephritis

Tx

A

Corticosteriod + Cyclophosphamide

All can become
Goodpastures, Vasculitis automatically are

32
Q

Vasculitis Acute Glomerulonephritis

Etiology

A
  • lack of immune deposits
  • ANCA antibodies
  • Microscopic polyangitis (small renal vessels) = P-ANCA
  • Granulocytosis w/ polyangiitis (wegner’s necrotizing vasculitis) = C-ANCA
33
Q

Vasculitis Acute Glomerulonephritis

Tx

A

Steroids
Cyclophosphamide

If pulm hemorrhage, severe renal failure = +plasma exchange

34
Q

Diabetic Nephropathy

Tx

A
  • ACEI
  • Glycemic control
  • BP control to <125/75
35
Q

Focal segmental glomerulosclerosis

Dx

A

Biopsy renal

  • semental sclerosis
  • no IgM/comp deposits only in sclerosing
36
Q

SLE class 4 diffuse proliferative lupus

Dx

A

Biopsy

  • hypercell in glomeruli, sclerosis, thickened “wire loop” capillaries
  • supendothelial deposits
37
Q

Vasculitis.

Dx

A

Skin biopsy

38
Q

Diabetic Nephropathy

Dx

A

Biopsy

*hyalinization

Genitourinary (9 decks)

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