Lecture 7 Glomerular

Question 1

what is the main reason to evaluate hematuria?

Answer 1

to rule out cancer

Question 2

how many RBC’s per high power field is indicative of the need for further evaluation?

Answer 2

3 or more

Question 3

1st choice for ruling out renal mass/evaluate uroepithelium (ie anatomic study)

Answer 3

multiphasic CT

Question 4

a ____ should be preformed in all patients with hematuria that are greater than 35 years of age

Answer 4

cystoscopy

Question 5

Extraglomerular vs glomerular hematuria on UA:
which can have clots?
which has dysmorphic RBCs?
which has RBC casts?

Answer 5

extraglomerular,
glomerular,
glomerular

Question 6

_____ persists as episodic hematuria with RBC casts, especially following a respiratory or GI infection

Answer 6

IgA nephropathy (berger disease)

Question 7

What does immunofluorescence show in a patient with IgA nephropathy?

Answer 7

IgA deposits in the mesangium

Question 8

what structural disorder can cause idiopathic hematuria, besides IgA nephropathy

Answer 8

thin basement membrane disease

Question 9

Alport syndrome is due to a mutation in _____, causing thinning and splitting of the bm. Clinical triad?

Answer 9

type 4 collagen;

sensorineural deafness, glomerulonephritis, eye problems (ie retinopathy)

Question 10

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

Answer 10

glomerular, tubular, overflow

Question 11

nephrotic syndrome is characterized by more than _____ grams of ____ per day being excreted

Answer 11

3.5, protein

Question 12

normal levels of urinary albumin is less than ____ mg of urine albumin per gm creatinine

Answer 12

30

Question 13

____ is often the earliest clinical manifestation of diabetic nephropathy

Answer 13

increased albuminuria

Question 14

first thing to be done when proteinuria is detected?

Answer 14

repeat UA. if negative, then “transient proteinuria”

Question 15

if repeat UA is positive in an adolescent, consider ____ proteinuria.

Answer 15

orthostatic ie when standing

Question 16

first line treatment to slow progression of kidney disease

Answer 16

ACE inhibitors

Question 17

Nephrotic syndrome:

hypoalbuminemia causes _____. _____ also occurs due to the liver increasing production.

Answer 17

edema, hyperlipidemia

Question 18

Other features of nephrotic syndrome:

_____ which can cause renal vein thrombosis. infection due to loss of ____ and ____ in urine. anemia due to loss of ____

Answer 18

hypercoagulation;
Ig, complement;
EPO

Question 19

nephrotic syndrome is due to damage of the ____, affecting the filtration charge barrier

Answer 19

podocytes

Question 20

the _____ receptor is the target antigen in 80% of patients with idiopathic membranous GN

Answer 20

phospholipase A2

Question 21

Membranous nephropathy:
EM:
IF:
LM: diffuse capillary, GBM thickening

Answer 21

spike and dome appearance, subepithelial deposits;

granular pattern

Question 22

membranous nephropathy has a high incidence of ______

Answer 22

renal vein thrombosis

Question 23

minimal change disease (MCD) is also called _____

Answer 23

lipoid nephrosis

Question 24

MCD is due to ____ of foot processes. it is the most common cause of nephrotic syndrome in ____. treatment is what

Answer 24

effacement;
children;
corticosteroids

Question 25

_____ 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

Answer 25

focal segmental Glomerular sclerosis(FSGS);

allelic

Question 26

FSGS can occur secondary to ____ infection, ____ disease, or heroin abuse

Answer 26

HIV, sickle cell

Question 27

FSGS:
LM: segmental ____ and _____

Answer 27

scelrosis, hyalinosis

Question 28

light chain cast nephropathy is a tubular disease that is the most common renal involvement in _____

Answer 28

myeloma

Question 29

Amyloidosis:

____ stain shows _____ _____ under polarized light

Answer 29

congo red, apple-green birefringence

Question 30

____ amyloid is the most common. 50 percent of the time is is associated with meyloma. it is composed of fragments of monoclonal ____ ____

Answer 30

AL, light chain

Question 31

____ amyloid is due to fragments of an acute phase reactant. it is seen in systemic _____ disease such as rheumatoid arthritis

Answer 31

AA;

inflammatory

Question 32

diabetic glomerulonephropathy:

LM: _____ expansion, GBM thickening, eiosinophilic nodular glomerular sclerosis (aka ______ lesions)_

Answer 32

mesangial; kimmelstiel-wilson