Glomerular Nephritis vs Nephrotic

Question 1

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

Answer 1

glomerular disease

Question 2

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

Answer 2

nephritic = basement membrane damage = leaky

nephrotic = podocyte damage = lose proteins

Question 3

what are the 7 characteristics of nephritic syndrome?

Answer 3

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

Question 4

what are the 5 characteristics of nephrotic syndrome?

Answer 4

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

Question 5

what are the 5 nephritic syndromes?

Answer 5

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)

Question 6

what is the most common nephritic disease in children?

Answer 6

post-strep glomerulonephritis

Question 7

what is the patho of post-strep glomerulonephritis?

Answer 7

antibodies and antigens go into mesangium + subendothelium = hypersensitivity reaction

Question 8

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

Answer 8

post-strep (infection related) glomerulonephritis

Question 9

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

Answer 9

cola colored/brown/smoky
proteinuria

decreased GFR
elevated BUN/Cr

Question 10

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

Answer 10

post-strep glomerulonephritis

Question 11

what is the mainstay treatment for post-strep glomerulonephritis?

Answer 11

supportive treatment

Question 12

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

Answer 12

ACEI / ARB
lasix / furosemide +/- thiazide
dialysis

Question 13

what is the most common primary glomerular disease globally?

Answer 13

IgA nephropathy (Berger Disease)

Question 14

patho of IgA nephropathy (Berger Disease)?

Answer 14

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

Question 15

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?

Answer 15

IgA nephropathy (Berger Disease)

Question 16

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

Answer 16

cola/tea urine
increase IgA

Question 17

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

Answer 17

IgA nephropathy (Berger Disease)

Question 18

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?

Answer 18

monitor yearly

Question 19

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?

Answer 19

ACI/ARB
lasix/furosemide

steroids

Question 20

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

Answer 20

cyclophosphamide + corticosteroids

Question 21

what is the most common vasculitis in children?

Answer 21

Henoch-Schonlein Purpura (IgA vasculitis)

Question 22

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?

Answer 22

henoch-schonlein purpura (IgA vasculitis)

Question 23

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

Answer 23

IgG-IgA immune complexes attach blood vessels

Question 24

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

Answer 24

kidney biopsy

mesangial proliferation like IgA nephropathy

Question 25

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

Answer 25

leukocytoclastic vasculitis

Question 26

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

Answer 26

rituximab prednisone analgesics wound care

Question 27

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

Answer 27

perinuclear-ANCA cytoplasmic -ANCA

Question 28

what are the 3 different p-ANCAs?

Answer 28

"PEM" Polyarteritis Nodosa Eosinophilic granulomatosis with polyangiitis (Churg Strauss) Microscopic polyangiitis

Question 29

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

Answer 29

polyarteritis nodosa (PAN)

Question 30

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

Answer 30

eosinophilic granulomatosis w/ polyangiitis (Churg Strauss)

Question 31

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

Answer 31

microscopic polyangiitis

Question 32

what is a type of c-ANCA?

Answer 32

granulomatosis with polyangiitis (Wegener granulomatosis)

Question 33

granulomatous inflammation involving the respiratory tract and renal necrotizing vasculitis

Answer 33

granulomatosis with polyangiitis (Wegener granulomatosis)

Question 34

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

Answer 34

pauci-immune necrotizing GN

Question 35

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

Answer 35

p-ANCAs

Question 36

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

Answer 36

c-ANCAs

Question 37

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

Answer 37

ANCA serology for anti-MPO or anti-PR3

Question 38

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

Answer 38

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

Question 39

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

Answer 39

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

Question 40

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

Answer 40

anti-glomerular BM GN (goodpasture's disease)

Question 41

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

Answer 41

elevated anti-GBM antibodies negative ANCAs

Question 42

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

Answer 42

crescent formation linear deposition of IgG + GBM

Question 43

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

Answer 43

intensive plasmapheresis prednisone cyclophosphamide

Question 44

what is the patho of lupus nephritis?

Answer 44

ANA attacks antigens = immune complexes = hypersensitivity reaction

Question 45

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

Answer 45

lupus nephritis

Question 46

identify the class: minimal mesangial lupus nephritis

Answer 46

class 1

Question 47

identify the class: mesangial proliferative lupus nephritis

Answer 47

class 2

Question 48

identify the class: focal lupus nephritis

Answer 48

class 3

Question 49

identify the class: diffuse lupus nephritis

Answer 49

class 4

Question 50

identify the class: membranous nephropathy

Answer 50

class 5

Question 51

identify the class: advanced sclerosing lupus nephritis

Answer 51

class 6

Question 52

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

Answer 52

classes 3 + 4 (focal + diffuse)

Question 53

what is the treatment for class 1 and 2 LN?

Answer 53

ACEI / ARB

Question 54

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

Answer 54

corticosteroids + mycophenolate mofetil OR cyclophosphamide

Question 55

what is the treatment for class 5 LN?

Answer 55

calcineurin inhibitors

Question 56

what is the treatment for class 6 LN?

Answer 56

dialysis + transplant

Question 57

what is 3 supportive therapies for LN?

Answer 57

ACEI / ARB statin antiplatelet

Question 58

what is the patho of nephrotic syndrome?

Answer 58

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

Question 59

what is the most common complication of nephrotic syndrome?

Answer 59

spontaneous blood clot

Question 60

what will LM and IF show in nephrotic syndrome?

Answer 60

LM = oval fat bodies IF = maltese cross pattern

Question 61

what will be present in labs in nephrotic syndrome?

Answer 61

microcytic, hypochromic anemia

Question 62

what does renal biopsy show in nephrotic syndrome?

Answer 62

podocyte effacement

Question 63

what is the mainstay of nephrotic syndrome treatment?

Answer 63

treat underlying cause

Question 64

how to treat proteinuria in nephrotic syndrome?

Answer 64

ACEI / ARB

Question 65

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

Answer 65

#1: loop diuretic / lasix #2: thiazide #3: IV albumin

Question 66

how to treat dyslipidemia in nephrotic syndrome? (2)

Answer 66

statins exercise

Question 67

how to treat hypercoagulability in nephrotic syndrome?

Answer 67

warfarin 3-6 months

Question 68

what should be done with patients with nephrotic syndrome?

Answer 68

refer to nephrology

Question 69

what are the 3 types of primary glomerulonephrosis?

Answer 69

minimal change disease focal segmental glomerulosclerosis membranous GN

Question 70

what are the 2 types of secondary glomerulonephrosis?

Answer 70

diabetic nephropathy amyloidosis

Question 71

what are the type of hereditary glomerulonephrosis?

Answer 71

thin basement membrane

Question 72

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

Answer 72

minimal change disease

Question 73

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?

Answer 73

minimal change disease

Question 74

what is the treatment for minimal change disease?

Answer 74

high-dose prednisone

Question 75

what is the patho of focal segmental glomerulosclerosis?

Answer 75

podocyte detachment / cell death = spreads to adjacent podocytes

Question 76

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

Answer 76

focal segmental glomerulosclerosis

Question 77

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

Answer 77

focal segmental glomerulosclerosis

Question 78

what is the treatment for primary focal segmental glomerulosclerosis?

Answer 78

prednisone +/- cyclosporine / tacrolimus if resistant

Question 79

what is the treatment for secondary focal segmental glomerulosclerosis?

Answer 79

treat cause

Question 80

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

Answer 80

membranous nephropathy

Question 81

what is the patho in membranous nephropathy?

Answer 81

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

Question 82

what is secondary membranous nephropathy associated with?

Answer 82

cancer

Question 83

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?

Answer 83

membranous nephropathy

Question 84

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

Answer 84

ACEI / ARB lasix anticoagulants

Question 85

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

Answer 85

rituximab OR corticosteroids + cyclophosphamide

Question 86

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

Answer 86

diabetic nephropathy

Question 87

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

Answer 87

diabetic nephropathy

Question 88

what is a pathognomonic finding in diabetic nephropathy?

Answer 88

Kimmelstiel-Wilson nodules

Question 89

what is the treatment for diabetic nephropathy? (5)

Answer 89

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

Question 90

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

Answer 90

renal amyloid

Question 91

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?

Answer 91

renal amyloid

Question 92

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

Answer 92

melphalan + stem cell transplant

Question 93

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

Answer 93

melphalan high-dose steroids bortezomib

Question 94

what are 3 treatment options for secondary renal amyloid?

Answer 94

antibiotics eprodisate renal transplant

Question 95

what is the most common cause of asymptomatic hematuria?

Answer 95

thin basement membrane nephropathy

Question 96

what is the treatment for thin basement membrane nephropathy?

Answer 96

trial with ACEI to reduce hematuria