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Therapeutics Test 2 > GN supportive care > Flashcards

GN supportive care Flashcards

1
Q

what are the best therapies for edema caused by GN?

A

salt restriction
bed rest
support stockings
diuretics

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2
Q

what is the goal blood pressure for a patient with proteinuria and a GFR less than 60?

A

130/80

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3
Q

what are the first line therapies for hypertension in GN?

why are they good?

A

ACEI’s and ARB’s
help stop protein loss in proteinurea
(delay loss of renal function)

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4
Q

what are good second line drugs for hypertension in GN?

what else are they good at treating specifically?

A

diltiazem and verapamil (nondihydropyridine Ca blockers)

help with proteinurea loss

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5
Q

what nonpham therapy helps with GN?

A

protein diet restriction

less than 0.8 g/kg/day

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6
Q

what is the primary cause and secondary causes of minimal change neuropathy?

A 
primary = unknown
secondary:
1. NSAIDs
2. Lupus
3. T cell autoimmune disorders
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7
Q

who is most commonly affected by minimal change mephropathy?

A

children

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8
Q

what is the clinical presentation of minimal change nephropathy

A

edema following infections

minimal change nephropathy

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9
Q

what is a very rare effect of vaccinations

A

minimal change nephropathy

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10
Q

minimal change nephropathy is very responsive to what type of treatment?
what percent of pt’s are urine free with this treatment after how long?

A

corticosteroids

50% have protein free urine after a week
90% after 4 weeks

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11
Q

what is the first line drug and dosing for minimal change nephropathy

A

prednisone
60mg/m2 daily for 4-6 weeks
followed by prednisone 40 mg/m2 daily or every other day for 4-6 weeks

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12
Q

if protein loss stops within 1-4 weeks of corticosteroid treatment, what is diagnosis? what must be done if it does not work?

A

minimal change nephropathy

biopsy

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13
Q

what condition is most likely to lead to end state renal disease?

A

focal segmental glomerulosclerosis

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14
Q

who is at greatest risk for FSGS?

A

African americans (4x’s greater risk due to more robust immune sytem)

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15
Q

what are 3 characteristics of FSGS

A
  1. focal = found in some glomeruli, not all
  2. segmental = involves a portion of the glomeruli
  3. sclerosis = leads to scarring
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16
Q

what is often seen in nonsclerotic glomeruli of FSGS?

A

fusion of the foot process

17
Q

what has a greater prevalence of nephrotic range proteinuria: minimal change disease or FSGS?

A

minimal change

18
Q

what is the primary cause of FSGS?

A

circulating factor that deposits in kidney causing immune reaction

19
Q

what has been linked to secondary FSGS?

A
  1. Heroin
  2. Obesity
  3. Genetic mutation
  4. HIV
  5. Anabolic Steroids
  6. Rituxan
  7. Pamidronate
20
Q

what is treatment for FSGS?

A

Always an ACEI or ARB

  1. prednisone 1-2 mg/kg/day for 4 months
  2. long term cyclosporine
  3. mycophenolate, cyclophosphamide
  4. plasmapheresis
21
Q

why does plasmapheresis work in FSGS

A

pulls out a percentage of circulating factor

22
Q

what is the recurrence for FSGS in kidney translpants

A

30%

if get it after 2 100% chance in 3rd

23
Q

what GN occurs frequently in elderly patients

A

membranous nephropathy

24
Q

if diagnosed with FSGS what occurance gives a poor prognosis for kidney transplant

A

ESRD in less than one year

25
Q

what is the MOA of membranous nephropathy

A

membranes INSIDE the kidney begin to overgrow and damage kidney

26
Q

what antigen is identified with membranous nephropathy?

A

PLA2R antigen on podocytes

27
Q

what treatment is very effective in membranous nephropathy

A

Anti-PLA2R specific antibodies antibodies

28
Q

what do antigens cause?

A

an immune response

29
Q

membranous nephropathy can be treated with what non-pharm treatment

A

plasmapheresis

30
Q

what are presentation symptoms of membranous nephropathy?

A 
heavy proteinuria > 3.5 gm/day
IgG in urine
lipiduria and oval fat bodies in urine
ascities
hypercoaguable state
31
Q

what are the 2 optimal treatments for membranous nephropathy

A
  1. steroids

2. chlorambucil

32
Q

what is an alternative if chlorambucil is not tolerated?

A

cyclophosphamide

Therapeutics Test 2 (31 decks)

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