Glomerular Dz + Path

Question 1

Nephritic syndrome

Answer 1

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

Question 2

Nephrotic Syndrome

Answer 2

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

Question 3

Rapidly Progressive Glomerulonephritis

Answer 3

• acute nephritis

* acute kidney injury leading to ESRD in weeks to months

Question 4

Most nephrotic

Answer 4

• Minimal change glomerulopathy
• membranous glomerulopathy
• focal segmental glomerulosclerosis

Question 5

Renal biopsy

Modalities

Answer 5

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

Question 6

Glomerular dz

Focal v Diffuse
Segmental v global

Answer 6

.

Question 7

Glomerular response to injury

Answer 7

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

Question 8

MC adult Nephrotic

Answer 8

1) Membranous Glomerulopathy

2) Focal Segmental glomerulosclerosis

Question 9

MC Peds Nephrotic

Answer 9

1) Minimal Change Dz

Question 10

Glomerular membrane

Layers

Answer 10

OUT TO IN:
BOWMAN’S SPACE

• podocyte foot projections
• Glomerular basement membrane
• Endothelium

BLOOD

Question 11

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

Answer 11

8 weeks

Question 12

Minimal change dz

Etiology

Answer 12

KIDS

• viral infection
• ALLERGY rxn
• autoimmune

Question 13

Minimal change Dz

DX

Answer 13

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

Question 14

Minimal change dz

Tx

Answer 14

Prednisone (highest responsive dz

Refractory = cyclosporin

Question 15

Focal Segmental Glomerulosclerosis

Etiology

Answer 15

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

Question 16

FSGlomerulosclerosis

Tx

Answer 16

Prednisone

50% progress to ESRD

Question 17

Membranous Nepropathy

Etiology

Answer 17

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

Question 18

Nephrotic

DX

Answer 18

• *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)

Question 19

Nephrotic

Tx

Answer 19

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

Question 20

Membranous nephropathy

DX

Answer 20

• 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

Question 21

Membranous Nephropathy

Tx

Answer 21

• Steroids + Cyclophosphamide
• Cyclosporine
• Rituximab
• ACTH

Question 22

Post-infectious Glomerulonephrits

Etiology

Answer 22

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

Question 23

Post-infectious Glomerulonephrits

DX

Answer 23

• 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

Question 24

Post-infectious Glomerulonephrits

Tx

Answer 24

Supportive

ABX

Question 25

SLE class IV diffuse proliferative Lupus Tx

Answer 25

``` ANA Anti-dsDNA C3 C4 CH50 ```

Question 26

Goodpasture’s Dz Etiology

Answer 26

*anti-GBM + lung alveoli antibodies

Question 27

Goodpasture’s Dz Dx

Answer 27

* linear IgG deposits * Kidney failure + Hemoptysis *if checking anti-GBM, check ANCA too cuz often together (b/f starting immunosupp therapy)

Question 28

Goodpasture’s Dz Tx

Answer 28

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

Question 29

Membranoproliferative/Mesangiocapillary Etiliology

Answer 29

Viral (HC/BV). SLE

Question 30

Membranoproliferative/Mesangiocapillary DX

Answer 30

* Hypocomplimentemia * cryoglobulinemia * mixed nephrotic-nephritic

Question 31

Cresentic Glomerulonephritis Tx

Answer 31

Corticosteriod + Cyclophosphamide All can become Goodpastures, Vasculitis automatically are

Question 32

Vasculitis Acute Glomerulonephritis Etiology

Answer 32

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

Question 33

Vasculitis Acute Glomerulonephritis Tx

Answer 33

Steroids Cyclophosphamide If pulm hemorrhage, severe renal failure = +plasma exchange

Question 34

Diabetic Nephropathy Tx

Answer 34

* ACEI * Glycemic control * BP control to <125/75

Question 35

Focal segmental glomerulosclerosis Dx

Answer 35

Biopsy renal * semental sclerosis * no IgM/comp deposits only in sclerosing

Question 36

SLE class 4 diffuse proliferative lupus Dx

Answer 36

Biopsy * hypercell in glomeruli, sclerosis, thickened “wire loop” capillaries * supendothelial deposits

Question 37

Vasculitis. Dx

Answer 37

Skin biopsy

Question 38

Diabetic Nephropathy Dx

Answer 38

Biopsy | *hyalinization