Nephrology

Question 1

Normal urinary protein excretion
urinary Protein/Creatinine

Answer 1

is < 4 mg/m’/ hour or
ratio < 0.2

Question 2

Heavy-range proteinuria:

Answer 2

Urinary Protein/Creatinine ratio > 2 or
urinary protein excretion > 40 mg/m*/hour

Question 3

Define proteinuria and enumerate its causes

Answer 3

Proteinuria is excretion of abnormal amounts of protein in urine.

orthostatic (postural) proteinuria: Commonest cause
Glomerular: Nephrotic syndrome, glomerulonephritis…
Tubular: Acute tubular necrosis

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Question 4

classification of proteinuria

Answer 4

a. According to the duration:
= Transient: Fever, exercise, seizures
= Persistent: as orthostatic (Postural) Proteinuria
b. According to the origin:
Glomerular: Nephrotic syndrome, glomerulonephritis…
Tubular: Acute tubular necrosis, tubular disorders as cystinosis

Question 5

Etiology of Hematuria

Answer 5

1. Glomerular
   = Glomerulonephritis: APSGN is the most common cause
   = Non-minimal change nephrotic syndrome (e.g., FSGS)
   = IgA nephropathy
   = Collage IV nephropathies:
   Alport syndrome (hereditary nephritis that may be associated with deafness)
   Thin basement membrane disease
   = SLE
   = Henoch-Schonlein purpura nephritis
2. Non-Glomerular
   = Urinary tract infection (pyelonephritis & cystitis): the commonest cause
   = Urolithiasis (Stones) and hypercalcuria
   =Sickle cell nephropathy
   = Exercise
   = Anatomic abnormalities e.g., cystic kidney disease
   = Trauma, Tumors (Wilms tumor), Bleeding disorders

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Question 6

what is alport syndrome

Answer 6

hereditary nephritis that may be associated with deafness)

Question 6

Etiology of NS

Answer 6

1. Idiopathic (iry) NS (90%): Renal pathology may be one of these pictures:
   a. Minimal change NS (MCNS)* [85%]
   b. Mesangial proliferation
   c. Focal segmental glomerulosclerosis (FSGS
2. Secondary NS (10%)
   a. Collagen-Vascular diseases: SLE & Henoch-Schonlein purpura
   b. Infection: Malaria, Schistosomiasis, HBV & HCV
   c. Malignancy: Lymphoma
   d. Drugs: Penicillamine, Gold

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Question 8

Hyperlipidemia due to:

Answer 8

decrease Lipoprotein lipase; the main enzyme that degrades circulating triglycerides (2ry to urinary loss)

increase Hepatic synthesis of lipoproteins lipase (2ry to hypoalbuminemia)

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Question 10

whcih more sex in MCNS

Answer 10

male to female 2:1

Question 10

CP and complication of NS

Answer 10

C/P
1. Generalized edema:
Site of onset: Periorbital (more apparent in morning and decreases by the end of the day)
March: Then becomes generalized (LL, ascites, pleural effusion, scrotal / vulval
edema)
e Character: Pitting
2. No persistent hypertension, No hematuria
3. Nephrotic syndrome has_a relapsing nature; often triggered by upper respiratory tract infection
Complications
1.Infection (The major complication)
Predisposing Factors:
= Edema, ascites “is good medium for infection”
= Urinary loss of Immunoglobulins
= Decreased production of opsonins that facilitate phagocytosis of capsulated
bacteria> e.g. pneumococci is the commonest
= Steroid and immunosuppressive therapy
Organisms: Pneumococci and Staphylococci are the most common
Site of infection:
“ Peritonitis > acute abdominal pain Capsiulated Srganism
= Sepsis, pneumonia, cellulitis, UTI
2.Thromboembolic events:
Predisposing Factors:
= Hemoconcentration
= Hyperlipidemia
* Urinary loss of natural anticoagulants (Antithrombin III, Protein C & S)
Site:
= Deep venous thrombosis (DVT)
= Pulmonary embolism
3. Hypovolemia: Precipitated by aggressive diuresis or diarrhea
4. Other complications: Respiratory distress,