parenchymal disease 2

Question 1

3 alterations of sterling forces causing edema

Answer 1

1. increase hydrostatic pressure (Na retention)
   - heart failure
   - drugs
2. decrease oncotic pressure (hypoalbumin)
   - neprotic syndrome
   - reduce syn in liver
3. increase cap. perm
   - diabetes
   - malnutrition

Question 2

what happens in nephrotic syndrome

Answer 2

non-prolif. damage to basement membrane that causes protein to leak out

Question 3

3 ways to measure protein urine excretion

Answer 3

screening
1. dipstick
quantatitive
2. Alb to Cr ratio
3. 24 hour urine

Question 4

what is urine ACR

Answer 4

-spot check
- best in AM
-

Question 5

what is 24hour amount

Answer 5

• normal is

Question 6

2 ways proteinuria can cause edema

Answer 6

1. hypoalbuminemia>Na and water retention

2. primary defect in collectin tubule

Question 7

what is cause of hypoalbumin

Answer 7

1. loss

2. poor liver creation

Question 8

what is connection to hyperlipidemia/lipiduria

Answer 8

• hepatic lipoprotein syn. stimed by increased oncotic pressure
• further exacerbated by poor clearance
• CV risk

Question 9

other feature of nephrotic syndrome

Answer 9

hypercoag

- DVT and PE

Question 10

2 general classifications of cause of nephrosyndrome and their 5 subtypes**

Answer 10

PRIMARY
1. minimal change
2. focal segmental sclerosis
3. membranous
SECONDARY
1. diabetes
2. amyoid/myeloma

Question 11

what is minimal change disease

Answer 11

• most common cause in young childers

- main secondary causes are NSAIDs and hodkins lymph

Question 12

what is focal segmental glomerulosclerosis

Answer 12

- 1/3 of cases in adult - more in blacks
main secondary causes are 
- HIV
- heroin
- sickle cell
- obesity
generally has worse response to tx and outcomes

Question 13

what is membranous

Answer 13

• most common cause in adults
• peak 30-50yo
  main secondary causes
  MAID
  malig
  autoimmune
  infection
  drugs

Question 14

what is relationship with diabetes

Answer 14

most common cause of secondary
risks
- uncontrolled sugars
- HT
- proteinuria
- smoking
- dyslipidemia

Question 15

3 things to assess on Phx

Answer 15

1. volume status
2. look for underlying systemic disease
3. thromboembolism?

Question 16

what is step 1 to Tx nephrotic Syndrome

Answer 16

treat Sx

• salt restrict
• ACEi/ARB
• statins

Question 17

step 2?

Answer 17

treat pathological cause

• if secondary treat the proimary
• otherwise immunosuppress
• steoids

Question 18

what are 2 main classification of tubointerstitial disease

Answer 18

1. acute/chronic

2. 1ry, 2ry

Question 19

3 hints that tubointerstitial

Answer 19

• *1. WBC casts

2. proteinuria

Question 20

**2 main causes of acute tubointersitial

Answer 20

1. acute interestitial nephritis - drugs

2. acute tubular necrosis

Question 21

4 causes of chronic tubointerstitial

Answer 21

1. drugs
2. chronic obst/reflux/stones
3. autoimmune
4. cystic - esp polycystic

Question 22

what is polycyctic ovary syndrome

Answer 22

• commonest genetic abnormality
• progressive cyst growth and enlargment
• can bleed rupture and become infected

Question 23

5 extra renal manif of polycystic kidney

Answer 23

1. aneurysms
2. other organ cysts
3. valvular heart disease
4. diverticulosis
5. hernia formation

Question 24

4 regions of vascular disease and issues

Answer 24

1. ateries
   - renal aretery stenosis, sclerosis
2. arterioloes
   - atheroembolic disease
3. caps
   - TTP
   - HUS
4. veins
   - thrombosis