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Rezi > Nefro > Flashcards

Nefro Flashcards

1
Q

Elementele care au rol in desfasurarea/impiedicarea filtrarii

A

Endoteliu
MBG
Podocite

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2
Q

Din ce este alcatuita bariera de filtrare glomerulara (diafragma cu sita)?

A

Endoteliul fenestrat
MBG
Celule epiteliale viscerale diferentiate (podocite)

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3
Q

Proteinele ce realizeaza diafragma cu fante

A

Nefrina
Podocina
P-cadherina
Alfa si beta-catenina
Proteina asociata CD2 (CD2AP)
TRPC6
ZO1

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4
Q

Citoscheletul de actina poate fi modificat prin:

A

Anomalii ale proteinelor citoscheletale (alfa actinina 4 -> GSFS ereditara)
Leziuni/anomalii ale proteinelor diafragmei cu fanta
Modificari ale MBG
Injurie podocitara directa

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5
Q

Ce poate determina injurie podocitara directa?

A

Infectii virale
Medicamente
Toxine
Activare locala de SRAA

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6
Q

Leziuni imune ce pot aparea la nivel glomerular si antreneaza leziuni secundare

A

Depunerea de fibrina
Agregarea plachetara
Infiltrarea neutrofilelor
Injuriile provocate de radicalii liberi

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7
Q

Glomerulopatiile sunt a …(a) cauza de BRT si reprezinta … (b) din cazuri

A

a = treia
b = 10-15%

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8
Q

Frecventa NTI ca reactie de HS la medicamente

A

70% cazuri
Cel mai des
* penicilina
* AINS
* IPP

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9
Q

Unele sindroame nefrotice mostenite implica mutatii ale unor gene ce codifica proteine podocitare precum

A

Nefrina (tipul finlandez)
Podocina
Alfa-actinina 4
Gena supresoare a tumorii Wilms

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10
Q

Proteinuria posturala poate fi semn precoce de leziuni glomerulare grave precum

A

GNM
GSFS
Nefropatia IgA
Nefropatia diabetica
Amiloidoza

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11
Q

Frecventa proteinuriei posturale si valoarea ei

A

> 50% din pacientii cu functie renala normala
Masoara de obicei < 1g/zi

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12
Q

Proteinuria usoara/tranzitorie poate acompania:

A

Starile febrile
Bolile infectioase
ICC

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13
Q

MO in HIVAN

A

Colaps glomerular
Podocitele sunt
- marite de volum (hipertrofice)
- hiperplazice
- vacuolate grosier (contin picaturi de absorbtie ale proteinelor)
Capilarele adiacente - diferite grade de colaps + plicaturare a peretilor

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14
Q

Markeri specifici podocitelor

A

Sinaptopodina
Factor tumoral Wilms

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15
Q

Clinica HIVAN

A

Proteinurie nefrotica
Edeme
BCR - posibil rapid progresiva

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16
Q

Mutatia APOL1 creste susceptibilitatea la GSFS ca raspuns la insulte precum

A

HTA
HIV
LES

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17
Q

Mutatia APOL1 protejeaza impotriva

A

Bolii somnului (tripanosomiazei africane)

18
Q

Ce gene MHC pot creste susceptibilitatea la glomerulonefrita primara?

A

HLA-A1
HLA-B8
HLA-DR2
HLA-DR3

19
Q

Cu ce se asociaza HLA-DQA1?

A

GNM idiopatica cu ac anti-PLA2R

20
Q

Hematuria cu/fara proteinurie subnefrotica poate duce la descoperirea timpurie a unei glomerulopatii potential grave precum

A

LES
PHS
GNPI
Hipercalciurie idiopatica la copii

21
Q

Ce boli glomerulare secundare pot sa suprapuna si GNRP?

A

Nefropatia IgA
GNM
GNPI

22
Q

GNRP cu model liniar

A

GNRP anti-MBG (idiopatica mediat de Ac)
Goodpasture

23
Q

GNRP cu model granular

A

GNRP idiopatica mediata de CI
Asociat cu GN primare
* GNMC (tip 2 > tip 1)
* Nefropatie IgA
* GNM
Asociat cu GN secundare
* GNPI
* LES
* PHS
* Crioglobulinemie

24
Q

Microorganisme ce pot determina GNPI non-streptococica

A

Staphylococcus
S. pneumoniae
Legionella
T. pallidum (sifilis)
Varicela
Oreion
VHB, VHC
EBV
Echovirus
Toxoplasma
Plasmodium (malarie)
Schistosoma
Trichinella

25
Q

Obiective tratament GNMC la copii

A

Urmarire regulata
Control TA
Agenti antiproteinurici
Corectia tulburarilor lipidice

26
Q

Caracteristici extraglomerulare ale NL

A

NTI (75%)
Tromboza de vena renala
Stenoza de artera renala

27
Q

Manifestari trombotice asociate NL

A

Infarct glomerular segmentar
Microangiopatie trombotica
Vasculita

28
Q

In ce nefropatii se poate administra rituximab?

A

GNLM
GNM
Amiloidoza AL
Vasculite
Gamapatia monoclonala cu semnificatie renala (MGRS)
Nefrita lupica
Nefropatia CG

29
Q

Ce nefropatii au depozite subepiteliale?

A

GNM

30
Q

GNRP se poate suprapune glomerulopatiilor secundare precum

A

Nefropatie IgA
GNM
GNPI

31
Q

In ce boli mai apare IgA crescut

A

PHS
Hepatopatii cronice
Cancere (mai ales bronsice)
SpA seronegativa
Psoriazis
BC
Mycosis fungoides

32
Q

Cauze reversibile de BCR

A

Obstructie de tract urinar
HTA
Stenoza de artera renala
Glomerulonefrite/vasculite sistemice

33
Q

Prevalenta BCR in functie de varsta

A

<65 ani = 1.5%
65-74 ani = 15.9%
75-84 ani = 30.9%
>85 ani = 33.4%

34
Q
A
35
Q

Medicatie GNLM

A

GC doze mari
Ciclosporina/tacrolimus
Rituximab
CFS + GC
Levamisol

36
Q

Medicatie GSFS I

A

Prednisolon
Ciclosporina/tacrolimus
CFS/clorambucil/AZT
Abatacept
ACTH - gel topic

37
Q

Medicatie GNM

A

Toti pacientii - IEC (doza maxima tolerata), diuretic, statina, anticoagulant
Rituximab
Ciclosporina/tacrolimus
CFS + prednisolon oral alternativ
Clorambucil + prednisolon oral alternativ
GC orali dar NU singuri

38
Q

Medicatie nefropatie IgA

A

IEC/sartan - toti pacientii
GC
Amigdalectomie

39
Q

Medicatie vasculite ANCA+

A

GC orali doze mari + CFS iv pulsuri - inductie
Rituximab - varianta de inductie
AZT/CFS/MMF/Rituximab - mentinere

40
Q

Cel mai eficient in mentinerea remisiei in vasculite ANCA+

A

Rituximab la 3 luni in D fixa

41
Q

Medicatie NL

A

HTA, edemele - tratate mereu
Rituximab - cazuri refractare severe
MMF/AZT - mentinere
GC + D mari de CFS/MMF - inductie
CFS - la albi
MMF - la negri si hispanici

42
Q

Cel mai bun in mentinerea remisiei in NL

A

Micofenolat

Rezi (15 decks)

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