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Renal-Genitourinary > Glomerular Nephritis vs Nephrotic > Flashcards

Glomerular Nephritis vs Nephrotic Flashcards

1
Q

what is the most common cause of end-stage-renal disease worldwide?

A

glomerular disease

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2
Q

what is the difference between the nephritic spectrum and nephrotic spectrum?

A

nephritic = basement membrane damage = leaky

nephrotic = podocyte damage = lose proteins

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3
Q

what are the 7 characteristics of nephritic syndrome?

A

hematuria (smoky/cola)
< 3.5 g/day proteinuria
hypertention
oliguria
general edema
decreased GFR
elevated BUN/SCr

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4
Q

what are the 5 characteristics of nephrotic syndrome?

A

severe proteinuria > 3.5 g/day
hyperlipidemia
generalized edema
hypercoag
osteomalacia

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5
Q

what are the 5 nephritic syndromes?

A

poststreptococcal GN

IgA nephropathy (Berger disease)

Henoch-Schonlein Purpura (IgA vasculopathy)

Lupus Nephritis

Pauci-immune Necrotizing GN
Anti-glomerular basement membrane GN (Goodpasture’s disease)

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6
Q

what is the most common nephritic disease in children?

A

post-strep glomerulonephritis

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7
Q

what is the patho of post-strep glomerulonephritis?

A

antibodies and antigens go into mesangium + subendothelium = hypersensitivity reaction

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8
Q

a patient presents with a history of an infection 2 weeks ago. on physical exam, they are hypertensive, report hematuria, and have edema. Dx?

A

post-strep (infection related) glomerulonephritis

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9
Q

what will be present in UA in post-step glomerulonephritis? (2)
GFR and BUN/Cr?

A

cola colored/brown/smoky
proteinuria

decreased GFR
elevated BUN/Cr

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10
Q

electron microscope shows large, dense subepithelial deposits or “humps” and immunofluorescent shows a “starry sky appearance”. Dx?

A

post-strep glomerulonephritis

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11
Q

what is the mainstay treatment for post-strep glomerulonephritis?

A

supportive treatment

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12
Q

what to give for HTN and proteinuria in PSGN? edema? what if it develops rapidly progressive glomerulonephritis?

A

ACEI / ARB
lasix / furosemide +/- thiazide
dialysis

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13
Q

what is the most common primary glomerular disease globally?

A

IgA nephropathy (Berger Disease)

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14
Q

patho of IgA nephropathy (Berger Disease)?

A

IgG attached to abnormal IgA = immune complexes deposit into mesangium = hypersensitivity reaction

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15
Q

a patient presents with a history of a URI/cough/sore throat. they report hematuria, hypertension, edema to hands and feet, flank pain, fever, and malaise. Dx?

A

IgA nephropathy (Berger Disease)

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16
Q

what will be present in UA and labs for IgA nephropathy?

A

cola/tea urine
increase IgA

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17
Q

light microscopy shows focal mesangial proliferation, immunofluorescent shows diffuse mesangial IgA and C3 deposits. Dx?

A

IgA nephropathy (Berger Disease)

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18
Q

what is the management for IgA nephropathy (Berger) in a patient that is low risk w/ minimal hematuria and proteinuria, no hypertension, and normal GFR?

A

monitor yearly

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19
Q

what is the management for IgA nephropathy (Berger) in a patient that is high risk w/ gross hematuria, protein >1g/day, hypertension, and decreased GFR?

what should be added to treatment if protein remains elevated after 3-6 mo and GFR >30?

A

ACI/ARB
lasix/furosemide

steroids

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20
Q

what is the treatment for IgA nephropathy (Berger) that progressed to rapidly progressive GN? (2)

A

cyclophosphamide + corticosteroids

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21
Q

what is the most common vasculitis in children?

A

Henoch-Schonlein Purpura (IgA vasculitis)

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22
Q

a patient presents with a history of a URI or drug exposure, they have a palpable purpura rash to LE and buttocks, abdominal pain, and arthalgias. Dx?

A

henoch-schonlein purpura (IgA vasculitis)

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23
Q

what is the patho of henoch-schonlein purpura (IgA vasculitis)?

A

IgG-IgA immune complexes attach blood vessels

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24
Q

what is the diagnostic of choice for henoch-schonlein purpura (IgA vasculitis)? what will it show?

A

kidney biopsy

mesangial proliferation like IgA nephropathy

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25
Q

what does skin biopsy show in henoch-schonlein purpura (IgA vasculitis)?

A

leukocytoclastic vasculitis

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26
Q

what is the treatment for henoch-schonlein purpura (IgA vasculitis)? (4)

A

rituximab
prednisone
analgesics
wound care

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27
Q

what are the 2 different types of Pauci-immune necrotizing glomerulonephritis?

A

perinuclear-ANCA
cytoplasmic -ANCA

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28
Q

what are the 3 different p-ANCAs?

A

“PEM”

Polyarteritis Nodosa

Eosinophilic granulomatosis with polyangiitis (Churg Strauss)

Microscopic polyangiitis

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29
Q

affects small and medium arteries of the abdomen and kidneys resulting in aneurysms

A

polyarteritis nodosa (PAN)

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30
Q

allergic reaction with asthma and eosinophilia affecting the respiratory tract and kidneys

A

eosinophilic granulomatosis w/ polyangiitis (Churg Strauss)

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31
Q

necrotizing vasculitis primarily affecting the kidneys, but can affect pulmonary capillaries

A

microscopic polyangiitis

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32
Q

what is a type of c-ANCA?

A

granulomatosis with polyangiitis (Wegener granulomatosis)

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33
Q

granulomatous inflammation involving the respiratory tract and renal necrotizing vasculitis

A

granulomatosis with polyangiitis (Wegener granulomatosis)

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34
Q

a patient presents with oliguria-anuria, hypertension, edema, hematuria, hemoptysis, fever, malaise, weight loss, and purpura. Dx?

A

pauci-immune necrotizing GN

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35
Q

which pauci-immune necrotizing GN targets myeloperoxidase antigens (anti-MPO)?

A

p-ANCAs

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36
Q

which pauci-immune necrotizing GN targets proteinase 3 (PR3) antigens?

A

c-ANCAs

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37
Q

what will help diagnose the specific type of pauci-immune necrotizing GN?

A

ANCA serology for anti-MPO or anti-PR3

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38
Q

what is the treatment for pauci-immune necrotizing GN? (5)

A

high-dose steroids x 3 days
+/- plasmapheresis
cyclophosphamide
azathioprine
prophylactic bactrim (pneumo. jirovecii)

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39
Q

what is the patho of anti-glomerular basement membrane GN (goodpasture’s disease)?

A

autoantibodies target basement membrane in kidneys and lungs = glomerular crescents + pulmonary hemorrhage

40
Q

a patient presents with rapid decline in renal function, +/- pulmonary hemorrhage, cough, SOB, DOE, and hemoptysis. Dx?

A

anti-glomerular BM GN (goodpasture’s disease)

41
Q

what will be seen in anti-glomerular BM GN (goodpasture’s disease)? (2)

A

elevated anti-GBM antibodies
negative ANCAs

42
Q

what does biopsy of anti-glomerular BM GN (goodpasture’s disease) show of LM and IF (2)?

A

crescent formation
linear deposition of IgG + GBM

43
Q

what is the treatment for anti-glomerular BM GN (goodpasture’s disease)? (3)

A

intensive plasmapheresis
prednisone
cyclophosphamide

44
Q

what is the patho of lupus nephritis?

A

ANA attacks antigens = immune complexes = hypersensitivity reaction

45
Q

a patient presents with fever, edema, hypertension, butterfly rash/malar rash, alopecia, joint/muscle pain, frothy urine. Dx?

A

lupus nephritis

46
Q

identify the class: minimal mesangial lupus nephritis

A

class 1

47
Q

identify the class: mesangial proliferative lupus nephritis

A

class 2

48
Q

identify the class: focal lupus nephritis

A

class 3

49
Q

identify the class: diffuse lupus nephritis

A

class 4

50
Q

identify the class: membranous nephropathy

A

class 5

51
Q

identify the class: advanced sclerosing lupus nephritis

A

class 6

52
Q

which 2 classes of lupus nephritis are the most active and are further classified as acute or chronic and MUST be treated?

A

classes 3 + 4 (focal + diffuse)

53
Q

what is the treatment for class 1 and 2 LN?

A

ACEI / ARB

54
Q

what are 2 treatment options for class 3 and 4 LN?

A

corticosteroids + mycophenolate mofetil
OR
cyclophosphamide

55
Q

what is the treatment for class 5 LN?

A

calcineurin inhibitors

56
Q

what is the treatment for class 6 LN?

A

dialysis + transplant

57
Q

what is 3 supportive therapies for LN?

A

ACEI / ARB
statin
antiplatelet

58
Q

what is the patho of nephrotic syndrome?

A

glomerular damage allows albumin into filtrate = decreased oncotic pressure = edema = RAAS = more cholesterol by liver = excess lipids in urine

59
Q

what is the most common complication of nephrotic syndrome?

A

spontaneous blood clot

60
Q

what will LM and IF show in nephrotic syndrome?

A

LM = oval fat bodies
IF = maltese cross pattern

61
Q

what will be present in labs in nephrotic syndrome?

A

microcytic, hypochromic anemia

62
Q

what does renal biopsy show in nephrotic syndrome?

A

podocyte effacement

63
Q

what is the mainstay of nephrotic syndrome treatment?

A

treat underlying cause

64
Q

how to treat proteinuria in nephrotic syndrome?

A

ACEI / ARB

65
Q

how to treat edema in nephrotic syndrome? (3 line treatments)

A

1: loop diuretic / lasix

#2: thiazide
#3: IV albumin

66
Q

how to treat dyslipidemia in nephrotic syndrome? (2)

A

statins
exercise

67
Q

how to treat hypercoagulability in nephrotic syndrome?

A

warfarin 3-6 months

68
Q

what should be done with patients with nephrotic syndrome?

A

refer to nephrology

69
Q

what are the 3 types of primary glomerulonephrosis?

A

minimal change disease
focal segmental glomerulosclerosis
membranous GN

70
Q

what are the 2 types of secondary glomerulonephrosis?

A

diabetic nephropathy
amyloidosis

71
Q

what are the type of hereditary glomerulonephrosis?

A

thin basement membrane

72
Q

what is the most common cause of nephrosis in children and the 3rd most common cause of nephrosis in adults?

A

minimal change disease

73
Q

a patient presents with an abrupt onset of generalized swelling, massive proteinuria > 6g/day, hypoalbuminemia, albuminuria, and lipiduria. EM shows widespread effacement of podocytes. Dx?

A

minimal change disease

74
Q

what is the treatment for minimal change disease?

A

high-dose prednisone

75
Q

what is the patho of focal segmental glomerulosclerosis?

A

podocyte detachment / cell death = spreads to adjacent podocytes

76
Q

a patient could have asymptomatic proteinuria or nephrotic syndrome. Dx?

A

focal segmental glomerulosclerosis

77
Q

biopsy LM shows segmental sclerosis and IF shows trapped IgG and C3, and EM shows podocyte effacement. Dx?

A

focal segmental glomerulosclerosis

78
Q

what is the treatment for primary focal segmental glomerulosclerosis?

A

prednisone
+/- cyclosporine / tacrolimus if resistant

79
Q

what is the treatment for secondary focal segmental glomerulosclerosis?

A

treat cause

80
Q

what is the most common cause of primary nephropathy in nondiabetic adults?

A

membranous nephropathy

81
Q

what is the patho in membranous nephropathy?

A

immune complex deposit attacks podocyte = GBM thickens and expands = causes spike and dome

82
Q

what is secondary membranous nephropathy associated with?

A

cancer

83
Q

a patient presents with progressive weight gain over weeks, an unprovoked blood clot. UA show albuminuria and lipiduria. labs show a phospholipase A2 receptor antibody and LM shows “spike and dome pattern”. Dx?

A

membranous nephropathy

84
Q

what is the treatment for mild primary membranous nephropathy? (3)

A

ACEI / ARB
lasix
anticoagulants

85
Q

what is the treatment for moderate primary membranous nephropathy? (3)

A

rituximab
OR
corticosteroids + cyclophosphamide

86
Q

what is the most common cause of end-stage renal disease in the US and western societies?

A

diabetic nephropathy

87
Q

a patient presents with hypertension, heavy proteinuria, and retinopathy. Dx?

A

diabetic nephropathy

88
Q

what is a pathognomonic finding in diabetic nephropathy?

A

Kimmelstiel-Wilson nodules

89
Q

what is the treatment for diabetic nephropathy? (5)

A

Na + fluid restriction
strict glycemic control (SGLT2 inhibitor)
statin (HLD)
ACEI / ARB
+/- diuretics

90
Q

group of rare diseases caused by extracellular deposits of insoluble fibrils within tissues

A

renal amyloid

91
Q

a patient presents with nephrosis with significant proteinuria . 20g/day, and swelling in face/ankle/tongue/legs. labs show a monoclonal spike and biopsy shows a congo red stain. LM natural light appears pink and LM polarized light appears apple green. Dx?

A

renal amyloid

92
Q

what is the treatment for primary renal amyloid in less severe disease?

A

melphalan + stem cell transplant

93
Q

what is the treatment for primary renal amyloid in severe disease?

A

melphalan
high-dose steroids
bortezomib

94
Q

what are 3 treatment options for secondary renal amyloid?

A

antibiotics
eprodisate
renal transplant

95
Q

what is the most common cause of asymptomatic hematuria?

A

thin basement membrane nephropathy

96
Q

what is the treatment for thin basement membrane nephropathy?

A

trial with ACEI to reduce hematuria

Renal-Genitourinary (7 decks)

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