GN supportive care Flashcards
what are the best therapies for edema caused by GN?
salt restriction
bed rest
support stockings
diuretics
what is the goal blood pressure for a patient with proteinuria and a GFR less than 60?
130/80
what are the first line therapies for hypertension in GN?
why are they good?
ACEI’s and ARB’s
help stop protein loss in proteinurea
(delay loss of renal function)
what are good second line drugs for hypertension in GN?
what else are they good at treating specifically?
diltiazem and verapamil (nondihydropyridine Ca blockers)
help with proteinurea loss
what nonpham therapy helps with GN?
protein diet restriction
less than 0.8 g/kg/day
what is the primary cause and secondary causes of minimal change neuropathy?
primary = unknown secondary: 1. NSAIDs 2. Lupus 3. T cell autoimmune disorders
who is most commonly affected by minimal change mephropathy?
children
what is the clinical presentation of minimal change nephropathy
edema following infections
minimal change nephropathy
what is a very rare effect of vaccinations
minimal change nephropathy
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?
corticosteroids
50% have protein free urine after a week
90% after 4 weeks
what is the first line drug and dosing for minimal change nephropathy
prednisone
60mg/m2 daily for 4-6 weeks
followed by prednisone 40 mg/m2 daily or every other day for 4-6 weeks
if protein loss stops within 1-4 weeks of corticosteroid treatment, what is diagnosis? what must be done if it does not work?
minimal change nephropathy
biopsy
what condition is most likely to lead to end state renal disease?
focal segmental glomerulosclerosis
who is at greatest risk for FSGS?
African americans (4x’s greater risk due to more robust immune sytem)
what are 3 characteristics of FSGS
- focal = found in some glomeruli, not all
- segmental = involves a portion of the glomeruli
- sclerosis = leads to scarring
what is often seen in nonsclerotic glomeruli of FSGS?
fusion of the foot process
what has a greater prevalence of nephrotic range proteinuria: minimal change disease or FSGS?
minimal change
what is the primary cause of FSGS?
circulating factor that deposits in kidney causing immune reaction
what has been linked to secondary FSGS?
- Heroin
- Obesity
- Genetic mutation
- HIV
- Anabolic Steroids
- Rituxan
- Pamidronate
what is treatment for FSGS?
Always an ACEI or ARB
- prednisone 1-2 mg/kg/day for 4 months
- long term cyclosporine
- mycophenolate, cyclophosphamide
- plasmapheresis
why does plasmapheresis work in FSGS
pulls out a percentage of circulating factor
what is the recurrence for FSGS in kidney translpants
30%
if get it after 2 100% chance in 3rd
what GN occurs frequently in elderly patients
membranous nephropathy
if diagnosed with FSGS what occurance gives a poor prognosis for kidney transplant
ESRD in less than one year
what is the MOA of membranous nephropathy
membranes INSIDE the kidney begin to overgrow and damage kidney
what antigen is identified with membranous nephropathy?
PLA2R antigen on podocytes
what treatment is very effective in membranous nephropathy
Anti-PLA2R specific antibodies antibodies
what do antigens cause?
an immune response
membranous nephropathy can be treated with what non-pharm treatment
plasmapheresis
what are presentation symptoms of membranous nephropathy?
heavy proteinuria > 3.5 gm/day IgG in urine lipiduria and oval fat bodies in urine ascities hypercoaguable state
what are the 2 optimal treatments for membranous nephropathy
- steroids
2. chlorambucil
what is an alternative if chlorambucil is not tolerated?
cyclophosphamide
