Nephritic Syndromes- GK Flashcards
Define Segmental
A portion of a glomerulus is involved
Define Global
All of a glomerulus is involved
Define Focal
Some of the glomeruli are involved
Define Diffuse
All or almost all of the glomeruli are involved
-itis
inflammation
-tic
pertaining to
What are podocytes?
Cells of the renal system
What is the four things does the kidney control?
- H20
- RBC production
- acidity
- BP
The kidney filters ______ and passes the _______ to the bladder for _______ as urine.
blood, waste, excretion
What is the average urine physiologic excretion in adults?
80mg/day
Pathologic proteinuria is equal to _____mg or greater over 24 hrs.
150
______ is the smallest plasma protein.
Albumin
- comprises 20-40% of physiologic proteinuria (16-32mg/day)
- Filtered more than other plasma proteins
What is this?
Albumin
T/F: microalbuminuria occurs before clinical proteinuria becomes evident and can therefore be used as an early diagnostic tool for early intervention in diabetic patients.
True
Microalbuminuria is defined as excretion of _____ to ______mg/day of albumin
30-300mg/day
Daily excretion of more than 3.5g of protein is called what?
nephrotic range proteinuria
What is the most common cause of proteinuria?
glomerular disease
What is the pathophys of Glomerular disease?
alteration of glomerular permeability –> injury to podocytes (renal cells), basement membrane, capillary endothelium or the mesangium.
Initially there is excess albumin w/eventual progression to larger proteins
What are 3 causes of proteinuria?
- Glomerular Disease MC
- Overflow proteinuria
- Tubular Proteinuria
What is this?
overproduction of smaller proteins overwhelming the reabsorptive ability of proximal tubule.
Overflow proteinuria
What is this?
Tubulointerstitial dz leads to diminshed reabsorptive capacity of the proximal tubule.
Tubular proteinuria
Glomerular Disease is classified into 2 classes. What are these two classes?
NephrITIC vs. NephrOTIC
Primary vs Secondary
Regardless of the classification, both types of Glomerular Dz cause what 3 things?
- glomerular damage
- hypoalbuminemia (low albumin in the blood since you have proteinuria)
- Biopsy = gold standard = definitive diagnosis
What dz?
inflammatory process w/associated immunologic response that leads to renal glomeruli damage.
*allows blood cell passage*
NephrITIC** syndrome**
Overall Clinical Px of NephrITIC syndrome
“PHAROH”
P—Proteinuria (<3.5g/day)
H—Hematuria (coca-cola urine)
A—Azotemia (inc. creatinine & uria)
R—RBC casts
O—Oliguria
H–HTN (secondary to urine retention= edema is distal extremities LE>UE)
Facial Clinical Px of NephrITIC syndrome
Periorbital edema
Puffy, pale face
Swollen lips
What do RBC casts in the urine signify?
severe inflammation
Describe the nephritic spectrum.
Asymptomatic Glomerular Hematuria –> Nephritic Syndrome –> Rapidly progressive glomerular nephritis –> chronic glomerular disease
What dz is this?
- glomerular capillary wall, glomerular basement membrane (GBM), and Bowman’s capsule are severely injured
- most severe & clinically urgent end of the nephritic syndrome
- progression to renal failure in weeks-months, resulting in kidney transplants or dialysis
Rapidly Progressive Glomerulonephritis (RPGN)
What are the 5 types of PRIMARY Nephritic Syndromes?
- Post-Inf Glomerulonephritis
- IgA nephropathy
- Henoch-Schonlein Purpura
- Pauci-immune glomerulonephritis (ANCA associated)
- Anti-Glomerular Basement Membrane Glomerulonephritis (Goodpasture Syndrome)
PIPHA
Pathophys of what dz?
Group-A Beta Hemolytic strept
Immune mediated injury: circulating immune complexes with strept antigen deposit.
Post Infectious Glomerulonephritis
Clinical Px of Post Infectious Glomerulonephritis
- occurs 1-3 wks after GABHS infection like pharyngitis or impetigo
- Oliguria
- Edema
- +/- HTN
Dx of Post-infectious GN
Coca cola urine
UA: RBCs, red cell casts, proteinuria
ASO (antistreptolysin) titers high _** unless immune response blunted by ABX tx**_
Tx of post-inf GN
supportive:
- anti-hypertensives (ACE-I, ARBs)
- restrict salt
- diuretics (loop/furosemide/thiazide)
Do steroids help with post-inf GN?
NO
What is the main tx for post-inf GN?
treat the underlying infection!!
What is the prognosis of post-inf GN in children?
GOOD
What is the prognosis of Post-inf GN in adults?
less favorable: more prone to develop CKD or RPGN
Also known as Berger’s disease….
IgA nephropathy
“I, GArima like burgers”
Pathophys of which dz?
IgA deposition in the glomerular magnesium
same lesion is seen in Henoch-Schonlein Purpura
IgA Nephropathy
IgA nephropathy is most common in _____(gender) and _______(population)
Male
children & young adults
“I, gArima am not a male but I do love children & young adults”
sorry, i know it was super corny lol
Clinical Px of IgA Nephropathy
- follows a URI or GI infection
- coca-cola urine 1-3 days after infection (unlike 1-3 weeks like in post-inf GN)
Dx of IgA Neuropathy
Labs:
- Hematuria
- Proteinuria
Serum:
Inc. IgA levels, complement levels normal
What is the prognosis of IgA Nephropathy?
1/3 of pts = spontaneous clinical remission
20-40% = CKD
Most imp: *Remaining* = chronic microscopic hematuria, stable serum creatinine.
What is the most unfavorable prognostic indicator of IgA Nephropathy?
Proteinuria > 1g/d
When are corticosteroids helpful in IgA Nephropathy?
proteinuria 1-3.5 g/d
Tx of IgA Nephropathy
ACE-I or ARB if severe proteinuria
What is the target BP of IgA Nephropathy?
<130/80
Pathophys of what dz?
systemic small-vessel vasculitis w/IgA deposition in vessel walls
- associated with an inciting infection: group A strept
Henoch-Schonlein Purpura (HSP)
Clinical Px of Henoch-Schonlein Purpura
- palpable purpura in buttocks & LE
- arthralgias & abd sx (nausea, colic, melena)
melena = dark starry stool w or w/o blood.
- dec. GFR (if inc, damage = nephrOTIC px)
“PAAG”
Tx of Henoch-Schonlein Purpura
no definitive tx
case studies: plasmaphoresis (plasma exchange) & DMARD (dz modifying anti-rheumatic drugs)
Pathophys of which dz?
- seen with small vessel vasculitis
- granulomatosis w/polyangiitis (Wegener’s granulomatosis)
-
eosinophillic granulomatosis w/polyangiitis (Churg-Strauss syndrome)
- microscopic polyangiitis
Pauci-immune glomerulonephritis (ANCA associated)
Clinical Px of Pauci-immune GN (ANCA associated)
look like a systemic inflammatory dz
- fever, malaise, weight loss
- purpura
- if pt has granu w/poly, they will have resp tract sx with bleeding nodular lesions
Dx for Pauci Immune GN (ANCA associated)
- ANCA ++ (antineutrophil cytoplasmic antibodies)
- UA: heamturia &proteinuria
Tx for Pauci-Immune GN (ANCA associated)
- high dose corticosteroids
- DMARDS
What is the prognosis of Pauci-immune GN (ANCA Associated)
w/tx = 75% complete remission
w/o tx= poor prognosis
Pathophys of which dz?
Glomerulonephritis + pulm hemorrhage
basement membrane injured from anti-GBM antibodies
Goodpasture syndrome
AKA
anti-glomerular basement membrane glomerulonephritis
T/F: 1/3rd of pts with anti-GBM glomerulonephritis (Goodpasture syndrome) have no lung injury.
TRUE
When is the peak incidence of Goodpasture syndrome (Anti-Glomerular Basement Membrane Glomerulonephritis)
20-30
60-70
Clinical Px of Goodpasture syndrome (Anti-Glomerular Basement Membrane Glomerulonephritis)
- preceded by URI
- Hemoptysis, dyspnea
- RPGN
Dx of Goodpasture syndrome (Anti-Glomerular Basement Membrane Glomerulonephritis)
sputum: hemosiderin-laden macrophages
anti-GBM antibodies
CXR: pulm infiltrates
Tx of Goodpasture syndrome (Anti-Glomerular Basement Membrane Glomerulonephritis)?
Plasmapheresis
corticosteroids
DMARDs
