Glomerulopephropathies

Question 1

Nephritic Characteristics

Answer 1

red cells +/- white blood cells
red cell or mixed cellular casts
variable degrees of proteinuria

Question 2

Nephrotic Characteristics

Answer 2

proteinuria > 3.5g/day
lipiduria
fatty casts

Question 3

Focal nephritic

Answer 3

Inflammatory lesions in < ½ of glomeruli
UA shows RBCs, occasional RBC casts, mild proteinuria
Example: IgA nephropathy

Question 4

Diffuse nephritic

Answer 4

Affects > ½ of the glomeruli
UA similar to focal, but w/ more proteinuria, also edema, HTN, and/or renal insufficiency
Example: post-streptococcal glomerulonephritis

Question 5

Poststreptococcal glomerular nephritis (PSGN)

Answer 5

Most common cause of acute nephritis worldwide
The risk of PSGN is greatest in children between 5-12 years…seen after strep throat
Antibiotic treatment does not prevent glomerular disease

Question 6

IgA Nephropathy/Berger’s Disease

Answer 6

Most common lesion to cause primary GN
Higher frequency in Asians and Caucasians—rare in blacks
Males

Question 7

IgA Nephropathy Presentation

Answer 7

*Gross hematuria:
May be recurrent
Usually after URI “synpharyngitic hematuria.”
Flank Pain
Fever
Clinical predictors of progression include:
elevated serum creatinine
hypertension
and persistent protein excretion above 1000mg/day.

Question 8

Henoch-Scholein Purpura (HSP)/ IgA Vasculitis‏

Answer 8

Systemic vasculitis characterized by the tissue deposition of IgA-containing immune complexes
Most common cause of vasculitis in children (90%)
HSP usually occurs between ages of 3-15

Question 9

HSP Tetrad of clinical manifestations:

Answer 9

Palpable purpura without thrombocytopenia or coagulopathy
Arthritis/arthralgias
Abdominal pain
Renal disease (GN)

Question 10

Rapidly Progressive Glomerulonephritis (RPGN) Characterized morphologically

Answer 10

crescent formation and clinically by progression to end-stage renal disease

Question 11

RPGN Types

Answer 11

Anti-glomerular basement membrane (GBM/goodpastures syndrome) antibody disease of lungs and glomerulus caused by anti-GBM antibodies.

Immune complex RPGN deposition of immune complexes in the glomeruli

Pauci-immune RPGN a necrotizing glomerulonephritis and vasculitis

Question 12

Interstitial Nephritis

Answer 12

Acute interstitial nephritis (AIN) is a renal lesion that causes a decline in creatinine clearance and is characterized by an inflammatory infiltrate in the kidney interstitium.
intrinsic renal failure.
Drugs account for 70% of cases