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PEDIATRIE > Glomerulonefrite > Flashcards

Glomerulonefrite Flashcards

1
Q

ce inseamna sd nefritic acut? 6

A
  1. edeme
  2. hematurie macroscopica
  3. proteinurie - mai mica decat in nefrotic
    4.HTA
    5.scade RFG
  4. retentie azotata
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2
Q

de ce apare retentia azotata?

A

scade RFG

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3
Q

ce sunt glomerulonefritele acute?

A

grup de afectiuni glomerulare caracterizate:
1. clinic
2. histopat
3. evolutie

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4
Q

cum se carac HP GNAc?

A

lezare glomerulara
1. difuza
2. segmentala
3. focala

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5
Q

in functie de ce variaza evolutia in GNAc?

A

factorul etiologic

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6
Q

etiologie GNAc? 2

A
  1. primare
  2. secundare
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7
Q

GNAc primare - clasificare - 3

A
  1. postinfectioase
  2. noninfectioase/mec imun/toxico-alergic
  3. primitive
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8
Q

care este cea mai frecv GNAc postinfectioasa?

A

poststreptococica - 80%

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9
Q

tipuri de GNAc postinfectioase? - 5

A
  1. poststreptococica
  2. sec altor infectii bacteriene
  3. sec infectii virale
  4. sec infectii parazitare
  5. sec infectii fungice
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10
Q

GNAC cu alte infectii bact? - 7

A
  1. strept viridans
  2. strept pneumoniae
  3. staf aureu
  4. staf epidermitis
  5. mycoplasma pneumoniae
  6. e coli
  7. salmonella
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11
Q

GNAC infectii virale? - 4

A
  1. EBV
  2. CMV
  3. VHB
  4. VHC
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12
Q

GNAC inf parazitare? - 3

A
  1. toxoplasma
  2. ricketsiae
  3. pneumocystis carinii
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13
Q

GNAC infectii fungice? - 2

A
  1. candida
  2. aspergillus
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14
Q

GNAC noninfectioase? -3

A
  1. maladia serului
  2. post adm medicamente
  3. nefrite de sunt
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15
Q

ce insemna GNAC primitive si cat la % reprez?

A

25%, nu au f etiologic

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16
Q

GNAC sec altor boli? - 4

A
  1. purpura HENOCH-SCHONLEIN
  2. SHU
  3. colagenoze
  4. sd Goodpasture
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17
Q

cea mai frecv colagenoza in GNAC?

A

LES

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18
Q

CE Ac avem in sd GOODPASTUR?

A

ANTI MB BAZALA GLOMERULARA

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19
Q

care este cea mai frecv GNAC la copil?

A

poststreptococica

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20
Q

GNAC POSTSTR clinic - 6

A

sd nefritic acut:
1. edeme
2. hematurie macroscopica
3. proteinurie - mai mica decat in nefrotic
4.HTA
5.scade RFG
6. retentie azotata

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21
Q

debut GNACPOSTSTRETP

A

infectie amigdaliana = 1-2 sapt
infectie piele = 6 sapt

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22
Q

GNAC STREPTO - factor etiologic

A

streptococ beta-hemolitic grp A

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23
Q

patogenie GNACSTREPT

A

CIC

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24
Q

anatopat GNACSTREPTO

A

lez acuta glomerulara
-proliferativ-exsudativ
-endocapilara predominant

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25
Q

evol GNACSTREPTO

A

frecv buna - vindecare restitutio ad integrum
rar cronicizare - bcr

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26
Q

teste inflam GNACSTR

A

pozitive

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27
Q

ASLO GNACSTR

A

crescut sau normal

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28
Q

ret azotata GNACSTR

A

inconstant

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29
Q

complemetul GNACSTR

A

scazut - fractiunea C3

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30
Q

ce Ac pot sa apara chiar daca nu s specifici in GNACSTR

A

ANA si ANCA

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31
Q

tulb coag GNACSTR?

A

da, PDF crescuut

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32
Q

sd urinar GNACSTR?

A
  1. hemturie + cilindrii hematici
  2. proteinurie -moderata sub prag nefrotic
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33
Q

dg poz GNACSTR? 4

A
  1. anamneza: ep infectios si interval liber(timpul de la infectie la manif)
  2. clinic
  3. biologic
  4. histo - se face PBR doar daca pac nu evol spre vindecare
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34
Q

ce dd avem la GNACSTR? 5

A

1.gn ac alte infectii
2. gn ac sec
3. gn cr puseu acut
4. SHU
5. alte hematurii

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35
Q

alte hematurii dd pt gnacstr? 3

A
  1. litiaza
  2. malformatii
  3. traumatisme
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36
Q

def shu - 3

A
  1. anemie hemolitica
  2. trombocitopenie
  3. ira
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37
Q

GNACSTR - forme clinice simpt - 5

A
  1. f comuna
  2. f frusta =doar semne urinare
  3. f oligosimpt
  4. f cu sd nefrotic
  5. f anurica
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38
Q

GNACSTR - f clinice varsta - 3

A
  1. sugar
  2. copil=5-12 ani
  3. adolescent
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39
Q

ce este specific la gnacstr sugar? rara

A

lipsesc:
1. edemele
2. hematuria macro

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40
Q

cea mai frecv GNAC dupa varsta?

A

copii - 5-12 ani

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41
Q

complicatii GNACSTR? -4

A
  1. ira
  2. IC - EPA
  3. EDEM CEREBRAL
  4. HEMORAGII CEREBRALE
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42
Q

cum se manif edemul cerebral? - 5

A
  1. cefalee
  2. ameteli
  3. varsaturi
  4. amauroza
  5. convulsii
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43
Q

indicatii PBR in GNACSTR? - 3(6-3-6)

A
  1. retentie azotata PESTE 6 SAPT
  2. C3 scazut - PESTE 3 LUNI
  3. proteinurie - peste 6 luni
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44
Q

trat gnacstr? - 4

A
  1. regim igienodietetic
    2.etiologic
  2. patogenic
  3. simptomatic = DE BAZA
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45
Q

regim igienodietetic GNACSTR?

A
  1. repaus la pat sau relativ in camera pana dispar edeme si apoi evitare efort fizic 3-6 luni
  2. aport hidric - diureza : v lichide = diureza ieri + 20-30 ml/kgc
  3. reg alim NORMOCALORIC + HIPOSODAT
  4. restrictie prot - daca are retentie azotata - 0,5-1g/kgc
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46
Q

trat etiologic GNACSTR - 3

A
  1. penicilina
  2. eritromicina
    apoi
  3. moldamin - 3-6 luni

eradicareainf strepto

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47
Q

trat patogenic GNACSTR- 2

A
  1. imunosupresie
  2. antiagreg si anticoag
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48
Q

cu ce se face imunosupresia in GNACSTR? - 3

A
  1. corticoterapie - CONTROVRSE
  2. azathioprina = IMURAN
  3. ciclofosfamida
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49
Q

trat simpt GNACSTR? - 3

A
  1. med capilarotrof - vit C
  2. diuretice - furosemid
  3. trat HTA - ieca, nifedipin, betablocante
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50
Q

evolutia GNACSTR? 3 cazuri

A
  1. vindecare - cel mai frecv
  2. cronicizare
  3. deces prin complicatii
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51
Q

fazele vindecarii GNACSTR? 2

A
  1. rapida - 2-6 sapt
  2. lenta - luni - 1 an
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52
Q

criterii vindecare - GNACSTR - 6

A

dispar:
1. edeme
2. HTA
3. sd urinar:proteinurie si hematurie macro

devin normale
1. C3
2. RFG
3. aspect HP

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53
Q

cum se mai num azatioprina?

A

imuran

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54
Q

ce aspect are hematuria in GNACSTR?

A

zeama de carne sau coca-cola

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55
Q

cu ce se compara proteinuria din GNACSTR?

A

cu urina care face spuma

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56
Q

GNCR def - 4

A
  • caracter difuz si bilateral
  • etiologie cunoscuta sau neprecizata
  • evolutie indelungata
    in timp: BCR
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57
Q

tipuri GNCR -2

A
  1. primare
  2. secundare
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58
Q

GNCR primare - tipuri - 2

A
  1. dobandite
  2. familiale
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59
Q

GNCR primare familiale -1

A

SD ALPORT

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60
Q

GNCR primare dobandite - 2

A
  1. GNCR postinfectioasa
    2.GNCR la care nu poate fi det f etiologic
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61
Q

cum se petrec GNCR postinfect?

A

prin cronicizarea unei GNAC

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62
Q

GNCR sec - 4

A
  1. DZ
  2. AMILOIDOZA
  3. COLAGENOZE
  4. PURPURA HS
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63
Q

ce fel de GN pot da colagenozele si purupra HS?

A

atat acute cat si cronice

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64
Q

cum e dimensiunea rinichiului in GNCR?

A

micsorata

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65
Q

cum e corticala rinichiului in GNCR?

A

ingustata - 1 mm

66
Q

macroscopic GNCR - 2

A
  1. dimens scazute
  2. corticala ingustata - 1 mm
67
Q

ce leziuni mai pot fi asociate in gncr? 3

A

interstitale si vasculare si atrofii tubulare

68
Q

cum se instaleaza tabloul clinic in GNCR?

A

insidios

69
Q

este precedat tabloul clinic al unei GNCR de cel al unei GNAC?

A

poate fi

70
Q

cine domina simptomatologia in GN secundare?

A

semnele clinice ale bolii de baza

71
Q

gncr clinic - 4

A
  1. semne generale
  2. edeme
  3. HTA
  4. sd urinar
72
Q

sd urinar in GNCR? - 3

A
  1. hematurie
  2. proteinurie
  3. cilindrii hematici
73
Q

cum e hematuria in gnac?

A

macro

74
Q

cum e hemtauria in gncr?

A

micro sau macro

75
Q

cum e proteinuria in gnac?

A

sub rangul nefrotic

76
Q

cum e hematuria in gncr?

A

uneori de rang nefrotic

77
Q

cum pot fi edemele in gncr?

A

masive sau discrete sau absente

78
Q

este mereu prezenta HTA in gncr?

A

nu

79
Q

biologic - gncr - 6

A
  1. teste inflam poz
  2. scaderea complemetului
  3. tulb coag - pdf poz
  4. retentie azotata
  5. suferinta tubulara : scade capac de conc urina si acidoza matab
  6. modif specif etio
80
Q

cum sunt testele inflam in gncr?

A

poz

81
Q

ce face complementul in gncr?

A

scade

82
Q

avem retentie azotata in gncr?

A

da

83
Q

avem suferinta tubuara in gncr?

A

da

84
Q

ce insemna suferinta tubulara din gncr ? - 2

A
  1. scaderea capac de conc urina
  2. acidoza metabolica
85
Q

apar modifi biologice specif etiologiei in gncr?

A

da

86
Q

dg poz in gncr? - 5

A
  1. anamneza
  2. semne gen
  3. sd urinar
  4. alterarea fct renale
  5. lez HP PBR!!!!!!!!!!!!!!
87
Q

taratamen gncr - 5

A
  1. mas profilactice
  2. trat curativ
  3. trat patogenic
  4. trat bolii de baza
  5. trat simpt anti HTA
88
Q

trat antiHTA in gncr

A
  1. nifedipin
  2. ieca
89
Q

evol gncr

A

bcr - substitutia fct renale

90
Q

prin ce metode se face substitutia fct renale? 3

A
  1. hemodializa
  2. dializa peritoneala
  3. transplant renal
91
Q

trat patogenic gncr? 2

A
  1. imunosupresie
  2. antiagreg si anticoag
92
Q

trat imunosupresie gncr? 3

A
  1. corticoterapie
  2. azathioprina
  3. ciclofosfamida
93
Q

trat curativ in gncr- 4

A

= masuri igieno-dietetice
1. se evita efort fizic intens
2. repaus la pat zilnic
3. orientare scolara si profes
4. regim alimentar

94
Q

cum trebuie sa fie regimul alimentar in gncr?

A
  1. hiposodat
  2. aport hidric adecvat
  3. restrictie proteica - in caz de retentie azotata
95
Q

ce inseamna aport hidric adecvat in gnac si gncr?

A

diureza zilei precedente + 20-30 ml/kgc/zi

96
Q

boli ereditare nefropatice? - 2

A
  1. nefropatia cu mb subtiri
  2. sd alport
97
Q

ce se petrece in sd alport?

A

mutatii gene din sinteza colagenului tip 4

98
Q

ce tip de colagen e afecat in sd alport?

A

tip 4

99
Q

ce manif clin asoc sd alport? - 2

A
  1. surditate
  2. afectare oculara
100
Q

ce tratament avem in bolile ereditare?

A
  1. renoprotectie
  2. sfatul genetic
  3. epurarea extrarenala prin dializa sau transpalntul renal in BCR STADIU FINAL
101
Q

cand se recurge la transplant in bolile genetice renale?

A

in bcr stadiu final

102
Q

ce folosim pt renoprotectie in bolile genetice renale? 2

A
  1. ieca
  2. omega 3
103
Q

ce masuri profilactice avem in gncr? 5

A
  1. prevenim si tratam corect INFECTIILE STREPTO
  2. asanam FOCARE INFECTIOASE
  3. respectam ind si CI VACCINARE
  4. evitam MED TOXICO-ALERGICE
  5. tratam corect AFECT CARE POT DA GN SEC
104
Q

care e dg de certitudin ein nefropatia cu IgA?

A

PBR - depozite IgA mezangiale

105
Q

la ce varsta si sex predom nefropatia cu IGA?

A

-toate varstele
-sex M

106
Q

tratament nefropatia cu IGa? 3

A
  1. renoprotectei
  2. corticoterapie
  3. asanarea focarelor infect - amigdalectomie
107
Q

cand se face amigdalectomie?

A

nefropatia cu iga

108
Q

cand se da corticoterapie in nefropatia cu IGa?

A

cand proteinuria e severa

109
Q

care sun manif clinice din nefropatia cu IgA? 3

A
  1. hematurie macro recurenta in inf resp
  2. hematurie micro
  3. proteinurie uneori
  4. iga crescut NUOBLUGATORIU
110
Q

este iga crescut obligatoriu in nefropatia cu iga?

A

nu

111
Q

care este intervalul liber in nefropatia cu iga? dar in gnacstr?

A

iga: 1-2 zile
gnacstr: 2 sapt

112
Q

purpura henoch schonlein - clinic: 4

A
  1. durere articulara/artrita
  2. rash cutanat hemoragic - periart, mai ales mb inf
  3. manif abd
  4. manif renale
113
Q

manifestari abd - purpura HS -5

A
  1. durere colicativa
  2. hematemeza
  3. melena
  4. invaginatie intestinala
  5. perforatie intestinala
114
Q

manif renale - purpura HS - 5

A
  1. hematurie micr/macro
  2. proteinurie
  3. HTA
  4. IRA
  5. BCR
115
Q

HP - purpura HS

A

de la MODIF MIN la GLOMERULONEFRITA MEMBRANOPROLIFERATIVA CU SEMILUNE

116
Q

tratament - purpura hs - 3

A
  1. renoprotectie
  2. corticoterapie
  3. ciclofosfamida - iv sau po
116
Q

glomerulonefrita membr prolif cu semilune - ?

A

purpura henoch schonlein

117
Q

ce folosim pt renoprotectie in purpura hs? 2

A
  1. ieca
  2. omega 3
118
Q

ce folosim in corticoterapia din hs? 2

A
  1. metilprednisolon - iv
  2. prednison po cu reducere progresiva doze
119
Q

cand debuteaza LES de obicei?

A

in copilarie

120
Q

pe cine afecteaza cel mai frecv LES?

A

pe copii

121
Q

cei 4 factori de risc in afectarea renala din LES?

A
  1. sex M
  2. debut in copilarie
    3.Ac anti-C1q pozitivi
  3. fractiuni complement C3 si C4 scazute
122
Q

cum se manif clinicobio nefrita lupica? 6

A
  1. edeme periferice/palpebrale/generalizate
    2.HTA
    3.hematurie micro/macro
    4.cilindrii hematici/leuco
  2. proteinurie
  3. IRA
123
Q

suspiciune de dg in nefrita lupica 4

A

un pacient cu LES care prezinta si:
1. scadere RFG
2. proteinurie
3. HTA
4. sediment urinar activ: hematurie, (acantocite), leucociturie fara inf urinara si cilindrii hematici sau leuco

124
Q

sediment urinar activ in susp de nefrita lupica: 3

A
  1. hematurie - acantocite
  2. leucociturie fara inf urinara
  3. cilindrii hematici sau leuco
125
Q

unde apar acantocitele?

A

hematuria din nefrita lupica

126
Q

ce face PBR in nefrita lupica? 5

A
  1. cf dg
  2. clasif dg
    3.prognostic
    4.ghideaza tratam
  3. urmareste evol - se repeta pbr
127
Q

indicatii pbr la pac cu les :

A

MINIMA UNA:
1. proteinurie: >500mg/24h sau prot/creat >500mg/g urina spont
2. sed ur activ: hematurie persistenta >=5hematii/vamp maj dismorfe si/sau cilindrii cel
3. crestere creat serica care nu are alt mec

128
Q

NL clasa 1

A

cu lez mezangiale minime

129
Q

NL clasa 2

A

cu lez mezangiale proliferative

130
Q

NL clasa 3

A

prolif focala
a=lez active
c=lez cronice

131
Q

NL clasa 4

A

prolif difuza, segmentala sau globala
A= lez active
C=lez cronice

132
Q

NL clasa 5

A

membranoasa

133
Q

NL clasa 6

A

cu scleroza avansata >90% glomeruli

134
Q

tratam nefrita lupica -4

A
  1. igieno-dietetic
  2. antiproteinuric
  3. hidroxiclorochina
  4. imunosupresor
135
Q

in ce trat se fol HIDROXICLOROCHINA?

A

NL

136
Q

regim igieno-dietetic in NL? 4

A
  1. hiposodat
    2.scadere proteina la 0.8-1 g/kgc/zi in caz de IR
    3.aport hidric -diureza
    4.fara eforturi fizice intense
137
Q

trat antiproteinuric/antiHTA in Nl? 2

A
  1. ieca
  2. bloc rec angiotens 2
138
Q

la ce pac cu NL se da hidroxiclorochina?

A

la toti pac cu NL

139
Q

in ce stadii ale nl confera protectie hidroxiclorochina? 4

A
  1. debut
  2. recaderi
  3. bcr stadiu terminal
  4. tromboze vasc
140
Q

in functie de ce criteriu se adm tratam imunosupresor in NL?

A

clasa de NL/forma histologica

141
Q

trat imunosupresor in NL?

A
  1. corticoterapie
  2. imunosupresoare
142
Q

ce corticoterapie se da in trat imunosupresor din nl?

A
  1. metilprednisolon iv
  2. prednison po cu red progresiva doze sau trecere la regim alternativ
143
Q

ce imunosupresoare se dau in NL?

A
  1. ciclofosfamida
  2. azathioprina/imuran
  3. mycophenolat mofetil/cellcept
  4. ciclosporina - glomerulonefrita membrnoasa
144
Q

in ce clasa NL se da ciclosporina?

A

clasa 5 - glomerulonefrita mebranoasa

145
Q

ce alternative terapeutice avem in NL?

A

RITUXIMAB

146
Q

CAND SE DA RITUXIMAB?

A

CA alternativa terapeutica in NL

147
Q

ce este RITUXIMAB?

A

anticorp monoclonal anti CD20

148
Q

cand este eficient RITUXIMAB?

A

tratament LEZ cu sau fara NL cand nu rasp la trat standard

149
Q

ce studii randomizate controlate s au facut pt RITUXIMAB?

A
  1. LUNAR
  2. EXPLORER
150
Q

cum evolueaza NL?

A

BCR - epurare extrarenala (HD/DP) - TR

151
Q

GN rapid progresiva - clinic

A

evol rapid spre IRA

152
Q

histo GN rapis progr

A
  1. semilune/crescens
  2. prolif severa in spatiul Bowman : cel epiteliale, fibroblasti, fagocite
153
Q

clasif etiologica GN rapid progr - 2

A
  1. primare/idiopatice
  2. secundare
154
Q

GN rapid progresive primare / idiopatice - 2

A
  1. Ac anti mb bazala glomerurala
  2. nefropatia cu IgA
155
Q

GN rapid progresive secundare - 4

A
  1. nefrita de sunt
  2. endocardita infectioasa
  3. LES
  4. purpura HS
156
Q

tratam GN rapid progresive 3

A
  1. cortico
  2. imunosupres
  3. trat ira
157
Q

ce se poate adm ca corticoterapie in GN rapid progresiva? 2

A

1.metilprednisolon puls iv de 3 ori pe luna
2. prednison po

158
Q

ce imunosupresoare se pot adm in GN rapid progr? 2

A
  1. ciclofosfamida iv 6 luni sau po
  2. mycophenolt mofetil = cellcept
159
Q

unde avem semilune?

A
  1. purpura HS
  2. GN rapid progresiva

PEDIATRIE (7 decks)

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