Nephritic syndrome

Question 1

What are the clinical features of nephritic syndrome?

Answer 1

hematuria, oliguria, azotemia, limited proteinuria, HTN

Question 2

what does biopsy of a kidney with nephritic syndrome reveal? What is seen in urinalysis?

Answer 2

hypercellular inflamed glomeruli

RBC casts and dysmorphic RBCs

Question 3

What causes alport syndrome? What are the presenting symptoms?

Answer 3

inherited x linked defect of type IV collagen

presents with hematuria, sensory hearing loss, occular dysfunction

Question 4

What is the signature sign of rapidly progressive renal failure?

Answer 4

crescents

Question 5

What are crescents composed of?

Answer 5

fibrin and macros

Question 6

In poststrep glomerulonephritis what are the antibodies against? where are they found?

Answer 6

anti strep O

-mostly subepithelial

Question 7

What virulence factor does the strain of strep have that allows it to cause poststrep glomerulonephritis?

Answer 7

M protein

Question 8

What are some clinical features seen in poststrep glomerulonephritis?

Answer 8

hematuria - cola colored
hypocomplementemia
htn
oliguria

Question 9

In IgA nephropathy, where do the antibodies deposit?

Answer 9

the mesangium

Question 10

What is igA nephropathy associated with?

Answer 10

respiratory and GI infections

Question 11

What is pathologically present in the urine in IgA nephropathy?

Answer 11

RBC casts

Question 12

describe class I SLE

Answer 12

minimal mesangial lupus nephritis

-no microscopic changes

Question 13

describe class II SLE

Answer 13

mesangial proliferative lupus nephritis

-mesangial hypercellularity and expansion

Question 14

describe class III SLE

Answer 14

focal proliferative lupus nephritis

• subendo and mesangial deposits
• inflammation is present - PMNs, monocytes

Question 15

describe class IV SLE

Answer 15

diffuse proliferative nephritis
same as class III but involves >50% of glomeruli

Question 16

describe class V SLE

Answer 16

membranous lupus nephritis

-subepithelial immune deposits

Question 17

describe class VI SLE

Answer 17

advanced sclerosing lupus nephritis

Question 18

What are tubuloreticular inclusions?

Answer 18

organized subcellular structures that may be found in endothelial cells . They are clusters of anastomosing tubule-like structures within cisternae of endoplasmic reticulum

Question 19

When are tubuloreticular inclusions seen?

Answer 19

SLE and viral infections - particularly HIV

-thought to be related to interferon production

Question 20

What causes pulmonary hemorrhage more frequently: goodpasture syndrome or wegners?

Answer 20

wegners

Question 21

What type of nephropathology is present in ANCA glomerulonephritis?

Answer 21

focal glomerular necrosis and crescents

Question 22

What causes wegners? what is the triad of symptoms?

Answer 22

cANCA

hemoptysis, hematuria, sinusitis

Question 23

What causes microscopic polyangitis?

Answer 23

pANCA

Question 24

What causes churgg strauss syndrome? what are the symptoms and pathological findings?

Answer 24

pANCA
eosinophils and granulomas
asthma , vasculitis

Question 25

In which vasculites that affect the kidney, are granulomas present?

Answer 25

churgg strauss, wegners

Question 26

Which tends to affect the kidney, PAN or microscopic polyangitis?

Answer 26

microscopic polyangitis

Question 27

What are the symptoms of henoch schonlein?

Answer 27

palpable purpura, hematuria, GI bleeding

Question 28

What are three general causes of cryoglobulinemic vasculitis? (proteins that become insoluble at cold temps)

Answer 28

1. multiple myeloma and waldenstroms macroglobulinemia 2. hepatitis C - monoclonal rheum factor 3. polyclonal Ig with antiglobulin activity - autoimmune/inflam disorders

Question 29

What is henoch shonlein purpura associated with?

Answer 29

viral infections

Question 30

What occurs pathologically in benign hypertension?

Answer 30

hyaline arteriosclerosis fibrotic intimal thickening of the arcuate arteries medial hyperplasia of the interlobar arteries

Question 31

Who is especially susceptible to the effects of benign hypertension?

Answer 31

blacks

Question 32

What is present pathologically in malignant htn?

Answer 32

red fibrinoid necrosis and edematous intimal expansion

Question 33

What autoimmune disease mimics malignant hypertension?

Answer 33

scleroderma

Question 34

what do the light chains bind to in the urine of a multiple myeloma patient?

Answer 34

tamm horsfall glycoproteins secreted by the DT

Question 35

In severe ischemia, what part of the kidney is preferentially affected?

Answer 35

the cortex

Question 36

What is the classic situation for cortical necrosis?

Answer 36

besides hypovolemia and endotoxic shock: | -->premature placental separation