GN Flashcards
Class of lupus nephritis with worst renal prognosis
Class IV
Remission in Class IV lupus nephritis
Return to near-normal renal function and proteinuria =<330 mg/dL/day
Class of lupus nephritis that is predisposed to renal vein thrombosis and other thrombotic complications
Class V
Target epitope for anti-GBM disease
a3 NC1 domain of collagen IV
In anti-GBM disease, this presentation is associated with bad outcome
Oliguria
Crescent formation in Bowman’a space
Anti-GBM disease
Characteristic of IgA nephropathy
Episodic hematuria associated with IgA deposition in the mesangium
In IgA nephropathy, greatest predictive power for adverse renal outcomes
Persistent proteinuria for 6 months or longer
Wegener’s is associated with A. Exposure to coal B. a1-antitrypsin deficiency C. Hepatitis B D. Hepatitis C
B. a1-antitrypsin deficiency
Others: silica dust exposure
Type 1 MPGN biopsy
Double contour “tram-tracking”
Type II MPGN biopsy
Ribbons of dense deposits and C3 “dense deposit disease”
Type III MPGN biopsy
Focal
Associated with nephrotic syndrome, except A. Hodgkin’s disease B. Allergies C. NSAID use D. All of the above
D
Electron microscopy of minimal change disease
Effacement of foot process
Average protein excretion in 24 hours in nephrotic syndrome
10 grams
Selective proteinuria
Minimal change disease
In minimal change disease, acute renal failure is often seen in these patients
Low serum albumin Intrarenal edema (nephrosarca)
Primary steroid responders
Complete remission after a single course of prednisone (<0.2mg/24hrs proteinuria)
Frequent relapsers
2 or more relapses in the 6 months following taper
Adults are not considered steroid-resistant until ___ months of therapy
4 months
First line therapy in minimal change
Prednisone
The following factors are associated with poor outcome in FSGS
Nephrotic-range proteinuria
African-American race
Renal insufficiency
Most common cause of nephrotic syndrome in the elderly
Membranous glomerulonephritis
Sensitive indicator for the presence of diabetes but correlated poorly with +/- clinically significant nephropathy
Thickening of the GBM
Nodular glomerulosclerosis or Kimmelstiel-Wilson nodules is seen in
Diabetic nephropathy
Earliest manifestation in DM nephropathy
Albuminuria
Microalbuminuria
30-300 mg/24hrs
When to test for microalbuminuria in type 1 and type 2 DM?
Type 1: 5 years after diagnosis
Type 2: at the time of diagnosis and yearly thereafter
Potent risk factor for CV events and deaths in DM Type 2 patients
Microalbuminuria
In DM nephropathy, kidney size is A. Normal
B. Enlarged
C. Decreased
D. A&B
D. Normal to enlarged
After onset of proteinuria, DM nephropathy patients will reach renal failure over
Another 5-10 years
Predicts which patients develop DM nephropathy
Hypertension
Cast nephropathy vs light chain deposition disease
Cast nephropathy: renal failure but NOT heavy proteinuria or amyloidosis
Light chain deposition disease: produces nephrotic syndrome with renal failure
True of primary amyloidosis
A. Lambda class
B. Associated with rheumatoid arthritis
C. Due to deposition of B-pleated sheets of serum amyloid A protein
D. Associated with ankylosing spondylitis or psoriatic arthritis
A.
associated with overt myeloma
B, C, D are characteristics of Secondary Amyloidosis
Diagnostics for Renal Amyloidosis
Congo red
Liver or kidney biopsy
Abdominal fat pad aspirates
Deficient lysosomal a-galactosidase A activity, resulting in excessive intracellular storage of globotriasylceramide
Fabry’s disease
Seen on renal biopsy of Fabry’s disease
Zebra bodies
FSGS
Urinalysis in Fabry’s
Maltese cross
Associated with sensorineural deafness, hematuria, thinning and splitting of the GBMs
Alport’s syndrome
X-linked inheritance of mutations in the a5(IV) collagen chain on chromosome Xq22-24
Alport’s syndrome
Skin biopsy in cholesterol emboli
Biconvex clefts
Best way to avoid progressive renal failure
Treating hypertension
Renal biopsy of glomerular capillary endotheliosis
TTP/HUS
Preeclampsia/HELLP
Maligant hypertension
APAS
Vascular nephropathy associated with ADAMTS13 deficiency
TTP/HUS
Bacterial causes of TTP/HUS
E. coli 0157:H7
Shigella dysenteriae
Treatment of adult TTP/HUS
Plasmapheresis
HUS from infectious diarrhea should be given antibiotics
TRUE or FALSE
FALSE
it is thought to accelerate toxin release
Lesion in HIVAN
FSGS
HIV patients presenting with nephrotic-range proteinuria and hypoalbuminemia
FSGS
Renal manifestations of hepatitis B
MPGN in adults
Renal artery aneurysms
Renal infarction
Ischemic scars
Schistosomes most commonly associated with clinical renal disease
S. mansoni
