Nephro Flashcards
Most common cause of death in SLE
Lupus nephritis
SLE peak incidence
15-45
Male vs female: SLE
Female
Male vs female: Lupus nephritis
Equal
Children vs adults: Lupus nephritis is worse
Children
Male vs female : Lupus nephritis is worse
Male
Hallmark of lupus nephritis
Deposition of circulating immune complexes and in situ formation of others
Subendothelial vs subepthelial: Circulating immune complexes
Subendothelial (and mesangial)
Subendothelial vs subepthelial: Complexes formed in situ
Subepithelial
Subendothelial deposits in SLE nephritis form
Wireloops
Mgt of SLE: Induction/emergency
Methylprednisolone
Mgt of SLE: Maintenance
Prednisone
Most common drugs used in the mgt of SLE (4)
1) Steroids
2) Cyclophosphamide
3) Mycophenolate mofetil
4) Azathioprine
Drug for SLE that causes hemorrhagic cystitis
Cyclophosphamide
Pathognomonic lesion of DM nephropathy
Kimmelsteil-Wilson Lesion
% of Type 2 DM that already have nephropathy when diagnosed
20%
30-40% of Type 2 DM develop diabetic nephropathy within __years of diagnosis
10
When microalbuminuria is observed in 40% Type 1 DM patients
Next 5-10 years of disease
Normal urine protein
150 mg/day
Microalbuminuria
150-300 mg/day
Macroalbuminuria
> 300 mg/day
BP ctrl recommended for DM
Less than 130/80 mmHg
First line of therapy for all patients with diabetes and htn
ACEI
Alternative to ACEI in treatment of Htn in pxs with DM and Htn who also have asthma exacerbations
ARB
Most important and commone type of tubulointerstitial inflammation
Acute pyelonephritis
Most common organism obtained in urine culture of patients with pyelonephritis
E. coli
2 routes in the devt of pyelonephritis
1) Ascending
2) Hematogenous
Most common route in the devt of pyelonephritis
Ascending
Important morphologic hallmark of acute pyelonephritis (3)
1) Patchy interstitial suppurative inflamm
2) Intralobular aggregates of neutrophils
3) Tubular necrosis
Pyelonephritis: Caseous necrosis
Tuberculous
Pyelonephritis: Proteus mirabilis
Xanthogranulomatous pyelonephritis
Drug that can cause tubulointerstitial nephritis via interstitial immunologic reaction
Methicillin
Form of adult polycystic kidney disease associated with polycystic liver disese
Juvenile
Syndrome: 1) Hemangioblastoma or hemangioma of cerebellum, brain stem or retina
Von Hippel-Lindau
Internist’s tumor
Renal cell CA
90-95% of renal neoplasms arise from
Kidney
Response of renal cell CA to radio and chemotherapy
Resistant
4 hereditary syndromes associated with renal cell CA
1) VHL
2) HPRC
3) FRO
4) HRC
All (>50%) glomeruli involved
Diffuse
Proportion (less than 50%) of glomeruli affected
Focal
Entire glomerulus involved
Global
Portion of glomerulus involved
Segmental
Reduction of GFR to __% heralds progression to end stage renal failure
30-50%
2 major histologic conditions in progressive glomerular disease
1) FSGS
2) Tubulointerstitial damage
APGN: Prototypical exogenous pattern
PSGN
APGN: Prototypical endogenous pattern
SLE
Organism that causes rheumatic fever and PSGN
GABHS
PSGN is most frequent in this age group
6-10 y/o
Etiopathogenesis of PSGN
Deposition of ICs
PSGN develops ____ days/weeks after strepthroat infection
5-21 days or ~10 days
PSGN develops ____ days/weeks after impetigo
4-6 weeks
Protein responsible for tropism to heart
M protein
Histologic morphology of PSGN
Humps (electron dense deposits)
__% of children with PSGN recover spontaneously
95
RPGN types
I, II, III
Type I RPGN causes
Goodpasture syndrome
Type II RPGN causes
1) SLE
2) HSP
3) IgA nephropathy
Type III RPGN causes
1) Wegener’s granulomatosis
2) Microscopic polyarteritis
Earliest symptom of nephrotic syndrome in adults
Bipedal edema
Earliest symptom of nephrotic syndrome in children
Periorbital edema
Massive/ nephrotic range proteinuria
> 3.5 g/day
Plasma albumin levels in nephrotic syndrome
Less than 3g/dL
Normal albumin excretion
Less than 30 mg/day
Primary vs secondary: Most cases of nephrotic syndrome in adults and children
Primary
Most common primary glomerular disease causing nephrotic syndrome in adults
Membranous glomerulonephritis
Most common primary glomerular disease causing nephrotic syndrome in children
MCD
Most common primary glomerular disease causing nephrotic syndrome in all ages
FSGS
Most common systemic diseases causing nephrotic syndrome (3)
1) DM
2) SLE
3) Amyloidosis
Drugs that may cause membranous GN (2)
1) Penicillamine
2) Captopril
Salts that may cause membranous GN (2)
1) Gold
2) Mercury
Proteinuria in membranous GB is probably caused by
MAC (C5b-C9)
Peak incidence of MCD
2-6 y/o
Incidence of MCD is increased in patients with
Hodgkin’s disease
Response of MCD to steroids
Dramatic
Most common CA in children
Leukemia
Most common leukemia in children
ALL
Drugs that cause ischemic nephrotoxic nephropathy (3)
1) Aminoglycosides
2) Amphotericin B
3) Contrast agents
Most common vasculitis in children
HSP
2nd most common vasculitis in children
Kawasaki
Common involvements in HSP
1) Purpuric skin lesions on extensor surfaces
2) Abdominal
3) Renal
4) Arthritis
Hallmark of HSP
Palpable purpura on legs and buttocks
Hallmark of FSGS
Epithelial damage
__% of patients with FSGS progress to chronic GN
50-80%
FSGS: Deposits seen on IF (2)
1) Ig
2) C3
Histologic morphology of MPGN
Double contour or tram-track appearance caused by duplication of GBM with mesangial and monocyte interposition
Most common type of GN worldwide
IgA nephropathy
Common symptom of IgA nephropathy
Hematuria after a respiratory infection
IgA nephropathy is also known as
Berger’s disease
Hereditary form of GB associated with nerve deafness
Alport’s syndrome
Defect in Alport’s syndrome
a5 chain of collagen type IV
Where Type I collagen is typically found
Bone
Where Type II collagen is typically found
Cartilage
Where Type III collagen is typically found
Reticular fibers of blood vessels
Where Type IV collagen is typically found
Basement membrane
Disease where Type V collagen is typically defective
Ehler’s Danlos
Drug associated with feral renal agenesis
ACEI
