Kidney 3 Flashcards
what is the semi-quantitative number for a trace dipstick protein
<30 mg/dL
A 2+ dipstick protein indicates what range of protein in the urine?
100>300 mg/dL
how many dL in a L?
10
what are the three types of proteinuria?
prerenal/overflow
glomerular
tubular
what is prerenal/overflow proteinuria?
globulins
light chains
what is glomerular protein that leads to proteinuria?
albumin
what can cause functional proteinuria?
fever
exercise
CHF stress
what is orthostatic proteinuria?
t occur when laying down
what are the three types of glomerular proteinuira?
functional
orthostatic
fixed/persistent (most concerning)
what causes tubular proteinuira?
microglobulins
albumin
what is the nephrotic range of proteinuria?
> 3.5 gm/day
with nephritic syndrome how will the urine sediment look?
active or angry
what will urine sediment look like w/ nephrotic syndrome?
bland or busy
is nephritis syndrome usually acute or chronic
acute
symptoms of nephrotic syndrome
proteinuria >3.5 gms hypoalbuminemia edema hyperlipidemia hyperlipiduria urine usually bland
what is seen with nephritis syndrome
proteinuria usually <3.5
hematuria- casts, dysmorphic rbcs
altered renal function (increased SrCr, decreased crCl)
HTN often severe
how much albumin can you make in one day?
12-15 grams
causes of a bland urine
minimal change dz
membranous glomerulonephropathy
focal segmental glomerulosclerosis
causes of a secondary bland urine
diabetic neuropathy
amyloidosis
primary cause of an angry urine
membranoproliferative glomerulonephritis
what can cause acute post infectious GN?
sub bacterial endocarditis
shunt nephritis
abscess
what types of nephritis syndromes will present w/ low complement levels?
Acute post infectious GN
membranoprolifeartive GN
SLE
lcryoglobulinemia
nephritis syndrome w/ normal complement levels can be caused by what?
IgA nephropathy idiopathic RPGN AG basement membrane PAN (polyarteritis nodosa) wegener's HSP Goodpasture's
what does a proliferative glomerulus dz involve?
> 3/lobule, increase in number of cells
what goes wrong in minimal change nephrotic syndrome
integrity of endothelial compromised
the podocytes are efaced
what goes wrong w/ the glomerulus in SLE
large subendothelial deposits are on top of the basement membrane
efaced podocytes
smaller deposits in subepithelial
what happens in post strep GN?
large subepithelial humps (antigen-antibody complexes)
what happens with membranous GN?
smaller depositions in the subepithelial humps
what are the three categories of renal biopsies?
light microscopy (LM) immunofluoresence (IF) electron microscopy (EM)
what will complement level be in minimal change dz?
normal
what is a hallmark of minimal change dz on EM?
foot process effacement
what causes MCD?
largely idiopathic
will minimal change dz respond to steroids?
yes, but if it doesn’t more likely to progress to renal failure
what are some associated w/ minimal change dz?
NSAIDs atopic allergic states hodgkins dz T-cell leukemias (these would make it more a secondary MCD)
what causes 85% of nephrotic syndrome in shildren and 20% of nephrotic syndrome in adults?
minimal change dz
are there any abnormalities on light microscopy w/ MCD?
no
what can’t see you on light microscopy?
foot process effacement
what is the most common primary glomerular disorder leading to ESRD and accounts for about 50% of ESRD from glomerular dz.
Focal and Segmental Glomerulosclerosis (FSGS)
are complement levels abnormal w/ FSGS?
no, complement levels are normal
what conditions are associated w/ FSGS
ADIS
heroin users
what symptoms are common at presentation for FSGS?
HTN
azotemia
hematuria
what peaks in the 4th and 5th decades, has normal complements and poor tx options. Often present w/ hematuria w/out casts
membranous nephropmathy (MN)
what is azotemia
elevated BUN
what is the rule of 1/3s with membranous nephropathy?
1/3 w/ spontaneous remissions
1/3 w/ persistent proteinuria but stable function
1/3 progress to ESRD within 10 years
what is frequently associated w/ Hep C, has low complement, commonly progressive.
Membranoproliferative glomerulonephritis (MPGN)
what makes the prognosis of MPGN worse?
early age on onset
cresentic changes
persistent NS
decreased GFR
Worldwide the most common primary glomerular disease. accounts for 40-50% of asymptomatic hematuria and associated w/ viral illness. normal complement levels
IgA neprhopathy mesangioproliferative GN (IgAN)
tx for IgA nephropathy mesangioproliferative GN
tx associated HTN (ARB, ACEI)
variation of IgA nephropathy, present like a GI virus
Honch-Schonlein purpua
worse prognosis for IgAN with what other factors?
NR proteinuria Uprot -HTN
-High grade biopsy changes -Age
what is the Leading cause of ESRD in US ~40%
diabetic nephropathy (DN)
what cancers can cause 2ndary glomerular dz?
lyphoma
myeloma
adenoCA
what connective tissue disorders can cause 2ndary glomerular dz?
SLE
RA
sjogrens
ACL syndrome
what needs to be controlled in diabetics to prevent nephropathy
BP control
weight control
reduction of proteinuria
what is the most common cause of post-infectious glomerulonephritis?
Group A beta hemolytic strep
do you treat PIGN associated w/ GAS?
no, self-limited
what will complement levels be like with PIGN?
low
who will have persistent GN from PIGN?
those w/ chronic infections
for a skin cause of PIGN what lab do you need?
anti-DNAase strep test
what will most patients with PIGN present with?
hematuria proteinuria rbc casts ARF HTN
are complement levels high or low with lupus nephritis
low
with lupus nephritis what will there be deposits of?
IgA
IgG
IgM
subendothelial deposits associated w/ poor tx outcomes
more common in males and hearing loss is seen in 50%, will have hematuria w/ variable proteinuria
alport syndrome
thin basement membrane diseaes
is there a specific treatment w/ alport syndrome?
no
is thin basement membrane disease usually progressive?
no
is pregnancy discouraged in basement membrane disease?
no, but in lots of other renal conditions
what does rapidly progressive glomerulonephritis mean?
creatinine is going up on a daily basis
what are ANCA associated rapidly progressive glomerulonephritis?
Wegner’s granulomatosis
Microscopic polyarteritis nodosa (PAN)
Idiopathic cresentic glomerulonephritis
what are anti-GBM mediated conditions that can cause RPGN?
Goodpasture’s syndrome
Idiopathic anti-GBM disease
rapid renal failure + upper resipratory syndromes
wegner’s granulmatosis
ANCA positive that may have a respiratory component
Microscopic polyarteritis nodosa (PAN)
what are immune-complex mediated conditions that can lead to RPGN?
Lupus nephritis
Infection associated
Cryoglobulinemia
Henoch-Schonlein purpura
associated w/ a dramatic respiratory componenet, but has anti-GBN antibody
goodpasture’s syndrome
protein deposition dz, associated w/ hep c when showing RPGN
Cryoglobulinemia
present w/ a vasculitis and RPGN
henoch-schonlein purpua
what does the C-ANCA correspond to?
Wegner’s
what does the p-ANCA correspond to?
polyangitis
what are the four types of kidney disorders
simple cyst (aging)
ADPKD
ACKD (acquired)
MSK
CKD commonly found in aging people. Will have a normal kidney size and no stones.
simple cyst
CKD associated w/ hematuria, pain, UTI is larger than normal and stones are common
ADPKD
CKD associated w/ people on dialysis. Hematuria is common, will ahve a small kidney, stones aren’t common
ACKD
CKD that is common and associated with UTIs. stones are common
medullary (MSK)
what are 3 main causes of acute interstitial nephritis
diuretics (most common)
abx
NSAIDs
features of acute interstitial nephritis
Fever Skin rash Arthralgias Peripheral eosinophilia Eosinophiliuria Sterile pyuria (leukocyte cast) Hematuria/proteinuria (<1 gm/day) Hyperkalemia RTA
what is seen in fanconi’s syndrome
Uglucose, Uaa, Uposphate, RTA.
what will chronic tubulointerstitial disease look like on urinalysis?
sterile pyruia
proteinuria (<1gm/day)
low specific gravity
