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Gen Med Unit 4 > Glomerulonephritis > Flashcards

Glomerulonephritis Flashcards

1
Q

How is glomerulonephritis classified?

A

Nephritic syndrome

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2
Q

Sxs of glomerulonephritis

A

Hematuria, proteinuria, HTN, decreased GFR, +/- edema

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3
Q

What age/sex group is glm. most prevalent in?

A

males 3-7 years old

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4
Q

What percentage of pats recover without sequelea

A

95% children and 70% adults

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5
Q

Acute asymptomatic glomerular hematuria

subsets

A

Post-infectious glomerulonephritis & IgA nephropathies

Occur after acute infection

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6
Q

Post-infectious glmn. most prevalent in?

A

Children

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7
Q

What infectious agent causes Post-infectious Glomerulonephritis?

A

Group A strep
S. aureus
Secondary to strept throat, impetigo, bacteremia

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8
Q

What are the sxs of Post-infectious Glomerulonephritis?

A

+/- Proteinuria, gross hematuria, HTN, oliguria, low serum complement levels

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9
Q

What test is needed to diagnose post-infectious glmn?

A

Elevated ASO titer: Anti-streptolysin need to make diagnosis

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10
Q

IgA Neuropathy definition

A

Systemic IgA vasculitis

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11
Q

What is the most common glmn. worldwide?

A

IgA Neuropathy

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12
Q

What are the subsets of IgA neuropathy?

A

Berger disease

Henoch Schonlein Purpura

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13
Q

What are the sxs and etiology of berger disease? How is it diagnosed?

A
  1. Berger Disease: in males-late teens to 30’s (Acute or Chronic)
  2. Follows viral (usually) URI symptoms (1-2 days)
  3. Gross hematuria, edema (hands & feet)
  4. ESRD develops in 20-30% of cases
  5. Clinical diagnosis
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14
Q

Where does Henoch Schonlein purpura usually occur?

A

Small vessel vasculitis usually on trunk and legs, not arms or face

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15
Q

What infectious agents usually cause Henoch Schonlein purpura?

A

Follows Group A strep or viral inf.

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16
Q

What are the sxs for Henoch Schonlein purpura?

A

Vasculitis rash (palpable purpura), arthralgias, +/- melena, +/- abd pain

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17
Q

What are the ds for Henoch Schonlein purpura?

A

↓ GFR Check blood work, basic metabolic panel

18
Q

What is granulomatosis w/ polyangiitis classified as?

A

Rapidly Progressive Glomerulonephritis (RPGN)

19
Q

what is another name for granulomatosis w/ polyangiitis?

A

“Pauci-immune” necrotizing glomerulonephritis

Wegener’s disease

20
Q

What is the pathophysiology of granulomatosis w/ polyangiitis?

A

Circulating ANCA antibodies

Bind to cytoplasmic Ag on neutrophil surfaces

21
Q

Sxs of granulomatosis w/ polyangiitis?

A

Glomerulonephritis → ESRD , pulmonary nodules that may bleed (can have nosebleeds), arthritis, neuropathy, purpura, hematuria, proteinuria, upper or lower resp bleed (hemoptysis)

22
Q

What is goodpasture syndrome classified as?

A

Rapidly Progressive Glomerulonephritis (RPGN)

23
Q

Goodpasture syndrome pathophys

A

Autoimmune disease - immune system attacks kidney and lung tissue
Characterized by glomerulonephritis &/or bleeding of lungs

24
Q

Risk factors for goodpasture disease

A

M > F in early years
2nd-3rd decades OR 6th-7th decades
Lungs affected by smoking, hydrocarbon solvent exposure

25
Q

What is Systemic Complex glomerulonephritis classified as?

A

Immune Complex Glomerulonephritis

26
Q

What renal diseases are seen with SLE?

A

Glomerulonephritis
Tubulointerstitial nephritis
Vasculitis

27
Q

What is the diagnostic test for SLE?

A

Kidney bx

28
Q

What disorders are included in Nephrotic Spectrum Glomerular Diseases?

A 
Membranoproliferative glomerulonephritis
Membranous nephropathy
Focal granulosclerosis
Rapidly progressive glomerulonephritis
Post streptococcal glomerulonephritis
Hemolytic uremic syndrome (HUS)
29
Q

Sxs of Nephrotic Spectrum Glomerular Diseases?

A
  1. Bland urine sediment ( few/no cells or casts)
  2. Urine protein excretion > 3 g/24 hr
  3. Albumin < 3 g/dL
  4. Peripheral edema
  5. Hyperlipidemia
  6. Oval fat bodies in urine
30
Q

Pathophysiology of Glomerulonephritis

A
  1. Activation of coagulation system leads to fibrin deposits in Bowman’s capsule
  2. End result is crescent shaped blood cells and decreased blood flow and GFR
    Crescents signify SEVERE AND IRREVERSIBLE kidney damage
  3. Glomerular bleeding acidifies urine
    Transforms hemoglobin to methemoglobin
    Brown urine
31
Q

What is the most common cause of Nephrotic Glomerular Dz in the US?

A

DM

32
Q

What are 4 causes of Nephrotic Glomerular Dz?

A

DM (most common in US)
Amyloidosis
Focal segmental glomerulosclerosis
Membranoproliferative Glomerulonephritis

33
Q

What are 3 complications of glomerulonephritis?

A
  1. End Stage Renal Failure
  2. Cardiac hypertrophy: bc heart is trying to work harder due to hypervolemia
  3. Heart failure
34
Q

Glomerulonephritis sxs

A 
Periorbital & peripheral edema
Mild to severe HTN
Dyspnea, orthopnea, bibasilar rales
Decreased urination
Brown colored urine: methemoglobin
35
Q

DS results for glomerulonephritis

A
  1. Increased BUN & Creatinine
  2. Decreased serum protein: due to filtration problems and reabsorption problems
  3. Decreased hemoglobin
  4. Elevated anti-streptolysin O titers in 80% patients (post-infectious)
  5. Low serum complement levels
    Proteins in plasma that combine with antibodies causing destruction of antigens
36
Q

Urinalysis results for glomerulonephritis

A

RBC’s, WBC’s, mixed cell casts, protein

37
Q

When is a throat culture performed?

A

on pts with history of infection and sore throat

38
Q

For pts with DM, how often is a urine microalbumin test performed?

A

Annually or more frequently

39
Q

When is a renal biopsy indicated in glomerulonephritis?

A

If >50% of glomeruli contain crescents  rapidly progressive glomerulonephritis

40
Q

Tx for acute or progressive glomerulonephritis

A

Antibiotics for post-infectious type
Fluid restriction and dietary Na+ restriction
Bed rest: decrease demand on heart
Loop diuretics for ECF overload
ACE inhibitor or ARB for HTN
Corticosteroids suppress inflammatory response in immune complex GN
Immunosuppressive therapy (CellCept, Tacrolimus)
Plasmapheresis
Interferon-alpha for Hep C GN
Statins for hyperlipidemia: monitor for rhabdo

41
Q

Tx of chronic glomerulonephritis

A

Treat primary disease for chronic glomerulonephritis

Dialysis or kidney transplant

Gen Med Unit 4 (7 decks)

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