Glomerulopathies

Question 1

Focal Nephritic

Answer 1

Inflammatory lesions in s, Casts, Proteinuria

IgA Nephropathy

Question 2

Diffuse Nephritic

Answer 2

Affects most of glomeruli
UA similar to focal, edema, HTN
Post-strep glomerulonephritis

Question 3

Glomerulonephritis (GN) Patho

Answer 3

Most forms are immunologic. autoimmune
Etiology generally unknown except for strep
Humor and cellular response results in inflammation

Question 4

GN S/S

Answer 4

HTN
Edema
Tea colored urine
Fatigue
Oliguria
Azotemia

Question 5

Post Strep Glomerulonephritis

Answer 5

60% of cases in kids 2-12
More male than female
Usually occurs 7-10 days post strep throat
Abx do not prevent glomerular dz

Question 6

Post strep GN presentation

Answer 6

Sudden onset gross hematuria (100%)
Edema
HTN
Back pain
Oliguria
Renal insufficiency
Azotemia

Question 7

Post strep GN course

Answer 7

Generally rapid resolution
Diuresis within 1 week
Hematuria resolves within 3-6 months

Question 8

Post strep GN Tx

Answer 8

Decrease sodium intake
Fluid restriction
Control HTN
Dialysis for severe dz

Question 9

Henoch-Schoenlein Purpura (HSP)

Answer 9

Most common cause of vasculitis in kids

usually occurs btw ages of 3-15

Question 10

HSP Tetrad

Answer 10

Palpable purpura w/o thrombocytopenia
Arthralgias/Arthritis
Abd pain
Renal dz

Question 11

HSP renal dz

Answer 11

More likely to occur in older children and adults
Identical to IgA nephropathy
Nephrotic presentation
Methylpred can be used.

Question 12

IgA Nephropathy (Berger’s Dz)

Answer 12

Most common lesion to cause primary GN
COmmon in asians and caucasians
More males
Most diagnosis made btw 15-35 yo

Question 13

IgA Nephropathy presentation

Answer 13

Gross hematuria
Proteinuria
Flank pain
Nephritic syndrome
Autoimmune

Question 14

IgA GN Biposy

Answer 14

Prominent IgA deposits in mesangium

C3 and IgG also deposited

Question 15

IgA GN Tx

Answer 15

HTN control (ACE, ARB)
Corticosteroids, immunosupressive for severe dz

Question 16

Rapidly Progressive Glomerulonephritis (RPGN)

Answer 16

Features of glomerular dz in urine
Progressive loss of renal fxn over short period
Crescent GN

Question 17

RPGN Tx

Answer 17

Pulse Methylpred
Then daily pred
Oral or IV cyclophosphamide

Question 18

Goodpastures Dz

Answer 18

Anti GBM
Pulmonary hemorrhage and RPGN with circulating antibodies against basement membrane antigens.
Hemoptsys, infiltrates, dyspnea, renal failure
One in a million (holy rare batman)

Question 19

Membranoproliferative Glomerulonephritis (MPGN)

Answer 19

10% of all nephrotic syndrome in adults

ages 8-30 primarily

Question 20

MPGN histologic changes

Answer 20

Thickening of glomerular basement membrane
Proliferation of mesangial cells
Influx of monocytes

Question 21

MPGN Tx

Answer 21

Treat underlying infxn if cause
Tx for idiopathic is BP control (ACE)
High dose corticosteroids
Plasmapheresis
Immunisuppressive agents

Question 22

Interstitial Nephritis

Answer 22

Accounts for 10-15% of cases of intrinsic renal failure.

Interstiital inflammatory response with edema and tubular cell damage

Question 23

Interstitial Nephritis Causes

Answer 23

Generally drugs
Abx
Infectious diseases (strep)
Immunologic entities (SLE, sarcoid)

Question 24

Interstitial Nephritis Causes

Answer 24

Fever
Rash
Arthralgias
Red cells in urine
White cell casts
oliguria, azotemia

Question 25

Interstitial nephritis tx

Answer 25

rarely progresses to ESRD
Supportive care
Usually recover over weeks to months
Can use corticosteroids

Question 26

Which antigen is associated with P-ANCA?

Answer 26

MP3

mostly kidney

Question 27

Which antigen is associated with C-ANCA

Answer 27

PR3

lungs and maybe kidney

Question 28

What type of cast is seen in interstitial nephritis?

Answer 28

White cell casts