Lecture 7 Glomerular Flashcards
what is the main reason to evaluate hematuria?
to rule out cancer
how many RBC’s per high power field is indicative of the need for further evaluation?
3 or more
1st choice for ruling out renal mass/evaluate uroepithelium (ie anatomic study)
multiphasic CT
a ____ should be preformed in all patients with hematuria that are greater than 35 years of age
cystoscopy
Extraglomerular vs glomerular hematuria on UA:
which can have clots?
which has dysmorphic RBCs?
which has RBC casts?
extraglomerular,
glomerular,
glomerular
_____ persists as episodic hematuria with RBC casts, especially following a respiratory or GI infection
IgA nephropathy (berger disease)
What does immunofluorescence show in a patient with IgA nephropathy?
IgA deposits in the mesangium
what structural disorder can cause idiopathic hematuria, besides IgA nephropathy
thin basement membrane disease
Alport syndrome is due to a mutation in _____, causing thinning and splitting of the bm. Clinical triad?
type 4 collagen;
sensorineural deafness, glomerulonephritis, eye problems (ie retinopathy)
3 types of proteinuria by origin:
_____ = increased filtration of macromolecules
____ = increased excretion of LMW proteins
_____ = increased excretion of LMW proteins, typically immunoglobulin light chains in multiple myeloma
glomerular, tubular, overflow
nephrotic syndrome is characterized by more than _____ grams of ____ per day being excreted
3.5, protein
normal levels of urinary albumin is less than ____ mg of urine albumin per gm creatinine
30
____ is often the earliest clinical manifestation of diabetic nephropathy
increased albuminuria
first thing to be done when proteinuria is detected?
repeat UA. if negative, then “transient proteinuria”
if repeat UA is positive in an adolescent, consider ____ proteinuria.
orthostatic ie when standing
first line treatment to slow progression of kidney disease
ACE inhibitors
Nephrotic syndrome:
hypoalbuminemia causes _____. _____ also occurs due to the liver increasing production.
edema, hyperlipidemia
Other features of nephrotic syndrome:
_____ which can cause renal vein thrombosis. infection due to loss of ____ and ____ in urine. anemia due to loss of ____
hypercoagulation;
Ig, complement;
EPO
nephrotic syndrome is due to damage of the ____, affecting the filtration charge barrier
podocytes
the _____ receptor is the target antigen in 80% of patients with idiopathic membranous GN
phospholipase A2
Membranous nephropathy:
EM:
IF:
LM: diffuse capillary, GBM thickening
spike and dome appearance, subepithelial deposits;
granular pattern
membranous nephropathy has a high incidence of ______
renal vein thrombosis
minimal change disease (MCD) is also called _____
lipoid nephrosis
MCD is due to ____ of foot processes. it is the most common cause of nephrotic syndrome in ____. treatment is what
effacement;
children;
corticosteroids
_____ is the most common cause of nephrotic syndrome in blacks and hispanics. thought to be due to a ____ variation at the APOL-1 on chromosome 22
focal segmental Glomerular sclerosis(FSGS);
allelic
FSGS can occur secondary to ____ infection, ____ disease, or heroin abuse
HIV, sickle cell
FSGS:
LM: segmental ____ and _____
scelrosis, hyalinosis
light chain cast nephropathy is a tubular disease that is the most common renal involvement in _____
myeloma
Amyloidosis:
____ stain shows _____ _____ under polarized light
congo red, apple-green birefringence
____ amyloid is the most common. 50 percent of the time is is associated with meyloma. it is composed of fragments of monoclonal ____ ____
AL, light chain
____ amyloid is due to fragments of an acute phase reactant. it is seen in systemic _____ disease such as rheumatoid arthritis
AA;
inflammatory
diabetic glomerulonephropathy:
LM: _____ expansion, GBM thickening, eiosinophilic nodular glomerular sclerosis (aka ______ lesions)_
mesangial; kimmelstiel-wilson
