Kidney-tubule issues &Nephritic/Nephrotic Dzs. Flashcards
Fanconi Syndroma MOA
increased excretion of glucose and other substances in PCT
“Fanconi is First”
Bartter Syndrome MOA
Like Loops
Gitelman Syndrome MOA
Like Thiazide
G after B (alphabetic)
Liddle Syndrome MOA
Like Hyper-Aldo. but without any Aldosterone in systm
Liddle Syndrome Tx.
Amiloride
K+-sparing diuretic use?
Hyper-Aldo. =Conn Syndrome
Syndrome of Apparent Mineralocorticoid Excess MOA
Enzyme that converts cortisol to cortisone is defective–>cortisol can act like Aldo.!
SAME Tx.
Give steroids so body stops making cortisol
Eating what causes SAME dz.
Licorice–also inhibits enzyme that converts cortisol to cortisone
Renin/Aldo. level in Liddle syndrom?
Low both
RTA Type 4 due to:
Hypo-Aldo. –>hyper-K+
RTA Type 1 due to:
intercalated cells can’t secrete H+ (even though in DCT)
RTA Type 2 due to:
Can’t reabsorb Bicarb. in PCT
RTA associated with AI Dzs.
RTA Type 1
2 Conditions associated with RTA Type 4
- SLE
2. SCD
RTA associated with high urine pH?
RTA Type 1 (odd one)
RTA associated with hyper-K+?
Type 4
RTA associated with stones?
RTA Type 1=odd one
RTA associated with hyper-Ca2+?
RTA Type 1=odd one
4 Nephritic Syndromes (Mnemonic)
“RAAS”
Rapidly Progressive
IgA nephro-pathy (Berger)
Strep
5 Nephrotic Syndromes
- Focal Segmental GlomeruloSclerosis
- MCD
- Membranous
- Amyloidosis
- Diabetic glomerulonephropathy
- Nephritic & Nephrotic mixed syndromes
- Diffuse Proliferative GlomeruloNephritis
2. MembranoProliferative GlomeruloNephritis
Membranous glomerular disease indicates
thicken glomerular BM
Proliferative glomerular disease indicates
more cells of glomeruli
What is a primary glomerular dz.?
MCD
Nephritic syndrome MOA?
GBM damage
=Inflammatory process
Nephrotic syndrome MOA?
podocyte (charge barrier) disruption–direct or from systemic dz.
4 Blood changes in Nephrotic syndrome?
- Hyper-lipidemia
- Hypo-Albumin
- lose AT III=thromboembolism, clots
- lose IgGs in urine=infxns.
How long after strep does acute post streptococcal glomerulonephritis occur?
2-4 weeks
Lumpy bumpy gbm due to antibodies and C3
PSGN
Cola colored urine
PSGN
Decreased C3 nephritis
PSGN
Abs against alpha 3 chain of type 4 collagen in gbm
Rapidly progressive (crescentic) glomerulonephritis
Goodpasture is a type of which nephritis?
Rapidly progressive (crescentic)
Antibodies to gbm and alveolar bm
Goodpasture
3 types of rapidly progressive (crescentic) glomerulonephritis
- Goodpasture syndrome
- Wegener
- Microscopic Polyangiitis
Other name for Wegener
Granulomatosis with polyangiitis
Necrotizing granulomas in lungs, sinuses and glomerulonephritis
Wegener
PR3-ANCA/c-ANCA. Pauci immune=no Ig or complement deposits
Wegener
MPO-ANCA/p-ANCA . Also pauci immune
Mnemonic
Microscopic Polyangitis
M P P
GN due to SLE
Diffuse proliferative—common cause of death
Wire looping of glomerular capillaries (Mnemonic)
Diffuse proliferative (wire lupus)
Effacement of foot processes
Minimal change disease
Most common nephrotic syndrome in kids
MCD
MCD triggered by
IS activation
MC cause nephrotic syndrome in African Americans and Hispanics
Focal segmental glomerulosclerosis
Effacement of foot processes similar to MCD
FSG
5 Causes of FSG
- HIV
- Infxn.
- SCD
- Heroin
- Obese
Spike and some due to immune complex deposits
Membranous nephropathy
Membranous nephropathy due to which 3 drugs?
- NSAIDs
- PCN
- Gold
Name of amyloidosis stain
Congo red
Congo red stain of amyloidosis shows what color under polarized light?
Apple green birefringence bc amyloid deposit in mesangium
Most common organ where amyloid desposits
Kidneys
Eosinophilic nodules glomerulosclerosis
Diabetic glomerulonephropathy
GBM changes in diabetic glomerulosclerosis
Sugar added causes thickening and increased permeability
IgA-based IC deposits in mesangium.
IgA nephropathy (Berger disease)
mesangium define
between the capillaries
Episodic gross hematuria that occurs concurrently with respiratory or GI tract infections
IgA nephropathy (Berger disease)
IgA is secreted by
mucosal linings
IgA nephropathy (Berger disease) occurs with what 2 kind of infxns.
respiratory or GI tract infections
Mutation in type IV collagen–>thinning and splitting of glomerular basement membrane.
Alport syndrome
Alport syndrome sxs. (mnemonic)
- Eye problems (eg, retinopathy, lens dislocation),
- glomerulonephritis,
- sensorineural deafness;
“can’t see, can’t pee, can’t hear a bee.”
“Basket-weave” appearance on EM.
Alport syndrome
subendothelial immune complex (IC) deposits with granular IF
Membrano- proliferative glomerulonephritis (MPGN)
“tram-track” appearance on PAS stain due to GBM splitting caused by mesangial ingrowth.
Membrano- proliferative glomerulonephritis (MPGN)
Nephritis assoc w. hepatitis B or C infection
Membrano- proliferative glomerulonephritis (MPGN)
nephritis assoc w. decr. serum C3 levels specifically
MPGN
henoch schonlein purpura 4 sxs.
- Abdominal pain/bloody diarrhea
- arthralgias
- Purpuric skin lesions on butt/legs
- IgA nephropathy =Berger dz