Nephritic and Nephrotic Syndrome Flashcards
How does Nephrotic syndrome present clinically?
Periorboital and Peripheral Edema Frothy Urine Massive Proteinuria (>3.5g/day Hypoalbuminemia Hyperlipidemia
Why are patients with nephrotic sydrome susceptible to infection and a hypercoaguable state?
Defective glomerulus causes the leakage of anti-clotting proteins (C and S) as well as immunoglobulins.
What is the difference between IgA Nephropathy and IgA Vasculitis?
IgA Nephropathy only affects the kidneys. IgA Vasculitis is a more systemic disease.
The glomerulus is supplied blood by the..
afferent and efferent arterioles
Which layer in the glomerulus is fenestrated and highly permeable to water and small solutes?
The endothelium
Which layer in the glomerulus is the charge barrier?
The glomerular basement membrane Negatively charged (due to proteoglycans)
Which layer in the glomerulus has a slit diaphragm, acting as a size barrier?
The visceral epithelial cells (Podocytes)
Define Azotemia
An increase in the level of nitrogenous waste in the blood (urea and creatinine) due to renal insufficiency
Signs of Nephritic Syndrome Include: (6)
Hematuria Hypertension Oliguria Azotemia Variable proteinuria (potential hypoalbuminemia) Edema
What diseases can cause mixed nephrotic and nephritic syndrome?
Lupus Nephritis
Membrano-proliferative glomerulonephritis (MPGN)
______ is the best diagnostic tool for a glomerular disease.
A Renal Biopsy
Triple approach: Light Microscopy, Immunoflorescence, Electron Microscopy
Define Olguria and Anuria
Oliguria - Low urine output (500mL/24hrs)
Anuria - Basically no urine output (<100mL/24 hrs)
500 mL is the minimum amount of fluid needed to be excreted to clear waste from blood.
Define Uremia
A variety of symptoms due to organ dysfunction caused by renal failure.
(Symptomatic renal failure)
In acute Kidney Injury, a fall in GFR can lead to (2)
Rise in serum creatinine (waste products)
Decreased urine output (sometimes)
Which type of AKI is the most common?
Pre-renal AKI (Decreased Renal Perfusion)
What is the classic triad of findings for acute interstital nephritis?
Fever
Rash
Eosinophilia
What is the equation used to calculate the Fractional Excretion of sodium in Acute Kidney Injury (AKI)?
FE(NA) = [(Urine Na / Plasma Na) / (Urine Creatinine / Plasma Creatinine)] x 100%
What is the equation used to calculate the Fractional Excretion of urea in Acute Kidney Injury (AKI)?
FE(urea) = [(Urine urea / BUN) / (Urine Creatinine / Plasma Creatinine)] x 100%
Acute Kidney Injury is defined as a…
…rapid (< 2 week) decline in the Kidney GFR.
Body retains waste products and urine output is decreased (not always.
Why does serum creatining have to be measured at multiple different times in order to diagnose an acute kidney injury (AKI)?
In order to set a baseline creatinine level so that we can determine if there is a rise in creatinine levels over time, which would indicate AKI.
____ allows for constriction of efferent arterioles and is blocked by____.
____ allows for dilation of afferent arterioles and is blocked by ___.
angiotensin II, ACE/ARBs
prostaglandins, NSAIDs
A low cardiac output could lead to what type of acute kidney injury? (pre, intra, or post)
Pre-renal AKI
What are the two types of Uretal Obstructions?
What are the two types of Bladder Obstructions?
What is the a type of Urethral Obstruction?
Extra (cervical cancer) and Intra (stones) Ureteral
Structural (bladder cancer) and Functional (anticholinergics, diabetes)
Prostate cancer, BPH
Which part of the nephron tubule system is most susceptible to toxins? Which is most susceptible to ischemia?
Toxins = The proximal convoluted tubule Ischemia = the loop of henle (medulla is an already hypoxic environment)
Radiocontrast, aminoglyosides, pigments (ie myo or hemoglobin), cisplatinum, & amphotericin B are likely to cause…?
Tubular acute kidney inury (AKI)
Acute Tubular Necrosis causes a decrease in the GFR. How?
Tubuloglomerular feedback. An obstruction can occur in the luminal space which will lead to vasoconstriction of the afferent arteriole.
The most likely complication of Acute Tubular Necrosis that can lead to death is…?
Infection!
Arrhythmias and GI hemorrhages are other complications
Describe the pathophysiology of acute/allergic interstitial nephritis.
A hypersensitivity reaction to drugs (penicillin), infection, or systemic disease (lupus) leading to inflammation of the interstitial nephron space.
What would you expect to see in the urinalysis of fa patient with Acute Interstitial Nephritis (AIN)?
WBCs
WBC Casts
Eosinophils (could also be high in blood)
How can you treat Acute Interstitial Nephritis?
Remove offending agent (ie. drug)
Use corticosteroids
Two blood vessel related complications that could lead to AKI are…
Renal Artery Thrombosis
Thrombotic Microangiopathy
Diuretic use, burns, or hemorrhage are items that could lead to…
Pre-renal AKI?
Intrinsic AKI?
Post-renal AKI?
Pre-Renal AKI
Infection, surgery, or toxin exposure could lead to…
Pre-renal AKI?
Intrinsic AKI?
Post-renal AKI?
Intrinsic AKI
Anuria and history of pelvic malignancies could lead to… Pre-renal AKI?
Intrinsic AKI?
Post-renal AKI?
Post-Renal AKI
A distended bladder is a big indicator of…
Pre-renal AKI?
Intrinsic AKI?
Post-renal AKI?
Post-Renal AKI
What two useful tools in diagnosing a post-renal AKI?
Renal ultrasound
Bladder catheter or scan
How should you treat pre-renal AKI?
Fix Volume!
Give IV fluids, Increase CO
How should you treat post-renal AKI?
Remove the obstruction.
How should you treat intrinsic AKI?
Treat the underlying issue.
- avoid nephrotoxin, hypotension
- maintain metabolic balance
- good nutrition (1.5g protein, 35 kcals)
What are the indication for dialysis in the treatment of acute kidney injury (AKI), more specifically acute tubular necrosis?
A E I O U
Acidosis (hyperkalemia), Electrolyte Imbalance, Intoxiation (symptoms), vOlume overload, Uremia
Describe the pathophysiology of Goodpasteur’s Syndrome or Anti GBM Disease.
Rare autoimmune disease characterized by circulating antibodies against the alpha-3 chain of type IV collagen present in the glomerular basement membrane and pulmonary capillary basement membranes. Leading to crescentic nephritis.
Antigens can be present in the glomerulus in what 3 ways?
Antigens can be native to the glomeruli, “planted” in the glomeruli, or an immune complex can travel into the glomeruli.
Do immune complexes cause nephritis?
Do “planted antigens cause nephritis?
Yes, yes they do. (glomerulonephritis)
No, it leads to glomerulopathy (nephrotic)
Why do immune complexes lead to inflammation of the glomerulus?
They activate the complement system
What is the difference between the classical and alternative pathway complement activation
classical - complement is activated by an immune complex
alternative - complement is activated without immune complex (due to antibody against C3 activation regulator)
A disease caused by a mutation in the “nephrin” gene which maintains the podocyte “slit diaphragm” leading to overall podocyte effacement and proteinuria (nephrotic syndrome)
Congenital Congenital Nephrotic Syndrome of the Finnish Type
Typically presents as at infancy
This gene is responsible for maintaining the “slit diaphragm” of podocytes. It hold the slit diaphragm together through disulfide bonds which prevent macromolecule escape.
Nephrin
Nephrin is mutated in what congenital disease?
Congenital Nephrotic Syndrome of the Finish Type
What are the 3 types of Rapidly Progressive Glomerulonephritis (RPGN)?
- Anti-GBM - 10%
- Immune complex mediated (IgA Nephropathy, Post infectious GN) - 40%
- Pauci Immune Vasculits (Glomerulonephritis with associated vasculitis) - 50%
All RPGN’s can have have cellular crescents. True or False?
True All RPGN’s are capable to have cellular crescents.
