GN, nephrotic syndrome, PKD Flashcards
what is glomerulonephritis?
damage of the renal glomeruli by deposition of inflammatory proteins in the glomerular membranes as the result of an immunologic response.
60% of glomerulonephritis occurs in who? prognosis?
kids 2-12. prognosis only good in kids, worse in adults
Sx: edema in face/eyes in morning and edema of feet/ankles in the evening
glomerulonephritits symptoms
what is a common cause of GN
post streptococcal infection
what is the major lab to get in GN
antistreptolysin O titer
UA reveals oval fat body
think nephrotic syndrome (it is a renal tubular cell that has reabsorbed some of the excess lipids in urine)
Over 3.5 gm proteinuria/24 hrs
Nephrotic syndrome
Hypoalbumnemia, azotemina, hyperlipemia, C3 levels nml or low
Nephrotic syndrome
Maltese crosses and oval fat bodies
Nephrotic syndrome
Common cause of nephritic syndrome
Post strep throat inf
main difference in nephritic vs neprotic syndrome
nephritic is proliferation; nephrotic is membraneuous
eosinophils in urine
malignant HBP
SLE
Nephritic and nephrotic syndrome
what is the most common form of polycystic kidney disease(PKD)
autosomal dominant PKD, it is always bilateral. occurs in the 30s
common sx of autosomal dominant PKD
back and flank pain and headaches
tx for autosomal dominant PKD
supportive. antibx
UA shows proteinuria, hematuria, pyuria, and bacteriuria
PKD
glomerulonephritits symptoms
Sx: edema in face/eyes in morning and edema of feet/ankles in the evening
describe UA findings in GN
- hematuria (>3RBC/high power field, they will be misshapened due to passage through glomerulus(acanthocytes).
they are normal shaped when bleeding from bladder or urethra
-RBC casts, proteinuria(1-2 g/24h)
hematuria, RBC casts, proteinuria
GN
serum complement (C3) in GN
decreased
how to dx GN
antistreptolysin O titer
UA
C3
renal bx- determine exact dx or severity( electron microscopy and immunofluorescence)
tx for GN
- steroids and immunosuppressive drugs for inflammation. (none in PSGN)
- diet: decrease salt and fluid intake
- dialysis if azotemia
- ACE inh in chronic
treat hyperkalemia, pulm edema, peripheral edema, acidosis, HTN
benign hematuria
henoch schonlein purpura
mild post infectious GN
IgA nepropathy
hereditary nephritis
causes of focal GN in kids
tea or coca cola colored urine
hematuria, think GN or nephritic syndrome
bergers disease(Iga nephropathy)
endocarditis
lupus
infectious
strep
all causes of GN
main difference between nephrotic syndrome and nephritic syndrome
nephrotic has no inflammation
nephritic has inflammation of kidney
explain hyperlipidemia in nephritic syndrome
secondary to liver producing increased lipoproteins due to hypovolemia from loss of intravascular volume(edema)
post infectious GN
membranoproliferative GN
causes of diffuse GN in kids
IgA nepropathy
hereditary nephritis
SLE
causes of focal GN in adults
SLE
membranoproliferative GN
rapidly progressive GN
post infectious GN
vasculitis
causes of diffuse GN in adults
hypoalbuminemia
lipiduria
hypercholesterolemia
edema
nephrotic syndrome
nephrotic syndrome can predispose a pt to what
thrombus secondary to loss of proteins C and S and antithrombin III
abdominal distention, facial edema/puffy eyelids, scrotal swelling, SOB, wt GAIN, anorexia, malaise, oliguria
symptoms of nephrotic syndrome
ascites, retinal sheen, skin striae, edema, HTN, orthostatic hypoTN
signs of nephrotic syndrome
basic tx of nephrotic syndrome
meds, diet, anticoagulants if needed, avoid nephrotoxic drugs, steroids in kids
symptoms of nephrotic syndrome
abdominal distention, facial edema/puffy eyelids, scrotal swelling, SOB, wt GAIN, anorexia, malaise, oliguria
signs of nephrotic syndrome
ascites, retinal sheen, skin striae, edema, HTN, orthostatic hypoTN
UA in nephrotic syndrome
foamy urine, proteinuria, lipiduria, glycosuria, hematuria
microscopic urinalysis of nephrotic syndrome
RBC casts, granular casts, hyaline casts, fatty casts
** oval fat body
foamy urine, proteinuria, lipiduria, glycosuria, hematuria
UA in nephrotic syndrome
RBC casts, granular casts, hyaline casts, fatty casts
** oval fat body
microscopic urinalysis of nephrotic syndrome
meds for nephrotic syndrome
ACE inh early in course
lots of diuretics
diet management for nephrotic syndrome
sodium and fluid intake restricted
not excessive protein and potassium in diet
what to give frequent relapsers or steroid non responders in nephrotic syndrome
cycophosphamide, cyclosporine, tacrolimus, mycopenolate mofetil
primary renal disease, SLE, post infectious diseases, DM, NSAIDs, lithium, toxins, pregnancy, multiple myeloma
causes of nephrotic syndrome
cyclophosphamide, cyclosporine, tacrolimus, mycopenolate mofetil
what to give frequent relapsers or steroid non responders in nephrotic syndrome
mnemonic for nephritic syndrome
PHAROH
proteinura, hematuria, azotemia, RBC casts, oliguria, HTN
key things on how to differeniate post infectious GN and IgA nephropathy
PI GN presents 2-6 wks after an infection and has a low C3
IgA nephropathy presents a few days after an infection and has a normal C3
foamy urine
nephrotic syndrome
preferable urine test for nephrotic syndrome
spot protein to creatinine ratio rather than 24 hr urine
vaccination for nephrotic pts
23 polyvalent pneumococcus vaccine
autosomal dominant PKD vs
autosomal recessive PKD
1) common one(uni or bilateral?)
2) age
3) more severe?
1) AD PKD (usually bilateral)
2) ADPKD in pts over 30 y.o
ARPKD in infants and young kids with renal failure, liver fibrosis, and portal HTN
3) ARPKD, can lead to death in the first few years of life
AD PKD and ESRD
-associated with increased risk of what
1/2 of pts with AD PKD will have ESRD requiring dialysis by age 60
increased with increased risk of cerebral aneurysm, especially with pts with a +FH
what is an early sign of abnormal kidney function
nocturia
reflects early impairment of urinary concentration
what occurs with pts with long term renal diseases or ESRD?
what race is common
acquired form of cystic kidney d/s
blacks
common symptoms of AD PKD
back pain, flank pain and HA
pain and hematuria most common initial presenting symptoms of what
PKD
HTN, hepatic cysts, cerebral artery anerysms, diverticulosis, and MVP additional findings in what
PKD
CBC findings in PKD
anemia
diagnostic choice for PKD
ultrasonography
is there early detection for PKD
yes genetic testing for PKD1 and PKD2
tx for PKD
supportive
ACE for HTN
low protein
high intake of fluids
antibx for infections
antibiotics that can penetrate the cyst wall (PKD)
bactrim, FQ, chloramphenicol, vancomycin
normal GFR
100-130
red cell casts
GN(nephritic syndrome)
tx for GN
high dose corticosteroids!
protein >3.5 day
protein < 3.5 day
>3.5 is nephrotic syndrome
< 3.5 is nephritic syndrome
percentage of people will have ESRD by 60 years old in PKD
50%
granular or muddy brown casts
ATN
broad waxy casts
ATN
WBC casts
infections, pyelonephritis
epithelial casts
ATN
tea colored urine
GN
hydronephrosis occurs when
in kids
adults
can also be caused by what else
secondary to an obstruction of the urinary tract.
in kids, occurs at the UPJ
in adults, due to BPH, neurogenic bladder, tumor, aortic anerysm, renal calculi
high output urinary flow and vesicouretal reflux
hydronephrosis symptoms
may be asymptomatic or have back/flank pain, decreased urine output, abd pain, or UTIs
how to diagnose for hydronephrosis
ultrasonography or CT scan to detect dilation of renal calcyces and/or ureter
increase BUN and Cr provide evidence of secondary renal failure.
tx for hydronephrosis
surgically correct obstruction; use lithotripsy if calculi
stent placement
percutaneous neprostomy tube placement to relieve pressure if urinary outflow tract is not sufficiently cleared or obstruction
foley or suprapubic catheters may be required for lower urinary tract obstructions (ex BPH)
complications of leaving hydronephrosis from urinary obstruction untreated
HTN
acute or chronic renal failure
sepsis
