Nephrology: Nephritic Syndrome Flashcards
Glomerulonephritis
nephritic syndrome
*red cells urine protein in urine red cell casts < 3.5 grams protein in urine per day edema ( mostly salt and water retention) low oncotic pressure dysmorphic red cells low fractional excretion of Na
best test - Urinalysis
most accurate - renal biopsy
Nephrotic Syndrome
> 3.5 grams protein per day in urine
not the etiology, it’s the severity
Wegener’s Granulomatosus
upper and lower respiratory and renal systemic vasculitis (joint, skin, eye, renal, go)
dx:
C-ANCA + (antiproteinase 3 antibody) most important initial test
biopsy the lung, not sinuses - most accurate
tx: cyclophosphamide and steroids
Goodpasture’s
idiopatic pulmonary and renal (only lung and kidney!)
dx: anti-basement membrane antibodies
* linear deposits on biopsy
tx:
steroids and cyclophosphamide
plasmapheresis to get rid of circulating antibodies
Churg-Strauss
asthma and eosinophils, atopy
(allergic angiitis)
dx: biopsy
tx: cyclophosphamide and steroids
Post-strep glomerulonephritis
strep is most common, but all infections can cause this
antibody response, antibodies clog up the glomeruli
skin and pharyngeal can both cause kidney (only pharyngeal causes rheumatic fever)
periorbital edema
tea or coca colored urine (hematuria, protein urea)
week after pharygitis
dx:
anti-streptolysin or anti-dnase best initial test
most accurate is biopsy, but don’t do it because disease is self-limited
biopsy show “humps” of IgG and C3
tx:
usually resolves on it’s own
cyclophosphamide and steroids
Henoch-Schonlein
IgA
Gi, joint, skin, and renal
purpuric skin lesions
dx: biopsy is most accurate test, but don’t do it
no specific therapy, gets better on its on
NO cyclophosphamide NO steroids
Berger’s Dz
IgA nephropathy
most common cause of glomerulonephritis in adults in USA
only the kidney
happens within 1 - 2 days of pharyngitis (synpharyngitic)
common in Asians
must biopsy, no blood test
granular deposits on biopsy
no effective therapy (not steroids, they don’t reverse IgA things)
ACE inhibitors or ARBs or fish-oil for massive proteinuria
steroids for sudden increase in proteinuria (not really beneficial)
Polyarteritis Nodosa
no lung involvement, but everything else that wegener’s does (skin, joint, renal, eye, gi track)
associated with hepatitis B (and C a little bit)
abdominal pain
dx:
p-anca in 20-30% patients
get angiogram to see if you need to get biopsy
sural nerve biopsy is most specific test
tx: cyclophosphamide and steroids
Lupus nephritis
dx: ANA, anti double stranded DNA
no need for biopsy for diagnosis
do biopsy to see if you need to treat for proliferative dz.
if proliferative give steroids and mycophenylate
if just scarring, no therapy
Alport’s syndrome
congenital with eye and ear and renal problems (lens dislocation)
cryoglobulins
cause kidney disease
purpuric skin lesions
joint pain
associated with hepatitis b and c
tx: interferon and ribovarin, rarely plasmapharesis
cold-agglutinins
this isn’t renal slide!
cause hemolysis (not renal)
associated with epstein-bar and mycoplasma
TTP
Thrombotic Thrombocytopenic Purpura is HUS plus fever and neurologic problems
hemolysis, uremia, low platelets, and increased creatinine + fever and neurologic problems
don’t need all five at the same time
associated with e-coli 015787
associated with ticlopitine
microangiopathic hemolytic anemia
deficiency in metaloprotease that dissolves platelet plugs - plasmapharesis replaces this
increased LDH, schistocytes, helmet cells (like any intravascular hemolysis)
tx: clopidogrel
plasmapheresis if severe
don’t give antibiotics
don’t give platelets!! makes it worse
Hemolytic Uremic Syndrom
hemolysis, uremia, low platelets, and increased creatinine
associated with e-coli 015787
microangiopathic hemolytic anemia
deficiency in metaloprotease that dissolves platelet plugs - plasmapharesis replaces this
increased LDH, schistocytes, helmet cells (like any intravascular hemolysis)
tx:
plasmapheresis if severe
don’t give antibiotics (dieting bugs release toxins making it worse)
don’t give platelets!! makes it worse
