parenchymal kidney disease

Question 1

33 yr old woman presents with double vision, worsening headache, proteinuria for 3 years treated with ACEi
LVH
3+ protein, 3+ RBCs

Answer 1

.

Question 2

how do you eliminate a pre-renal cause to kidney injury

Answer 2

• ECF volume depletion?
• drugs?
• cardiac or liver dysfunction?

Question 3

how do you eliminate a post-renal cause?

Answer 3

no obstruction on ultrasound

Question 4

RBC casts should point you in the direction of

Answer 4

Proliferative glomerular disease

Question 5

nephrotic syndrome can ONLY be caused by

Answer 5

a glomerular disease that is nonproliferative

Question 6

4 features of nephrotic syndrome

Answer 6

proteinuria >3.5g/day

• edema
• hypoalbuminemia
• dyslipidemia

Question 7

which glomerular disease has RBC casts?

Answer 7

proliferative

Question 8

hypertension
hematuria 
proteinuria 
AKI 
typical constellation for

Answer 8

Nephritic syndrome, or glomerulonephritis

Question 9

mesangial cell proliferation is due to

Answer 9

IgA nephropathy

Question 10

how do you manage IgA nephropathy

Answer 10

Block RAAS

• steroids
• immunotherapy

Question 11

DDx for endocapillary proliferation

Answer 11

proliferative lupus nephritis

- post-infectious GN

Question 12

DDx for epithelial cell proliferation

Answer 12

crescentic GN, most aggressive

Question 13

Order of aggressiveness of GN

Answer 13

WORST - crescentic
- then endocapillary
then mesangial (best)

Question 14

Linear GBM stain –>

Answer 14

Anti- GBM

GOOD PASTURES

Question 15

Course/granular stain of glomerulus

Answer 15

SLE nephritis

post-infectious GN

Question 16

Little or no staining of Glomerulus

Answer 16

ANCA vasculitis

Question 17

which proliferative GN do you consider Plasma exchange for?

Answer 17

Crescentic GN

Question 18

what can cause decreased oncotic pressure?

Answer 18

Nephrotic syndrome, or redcued albumin synthesis

Question 19

what can increase capillary permeability?

Answer 19

diabetes

malnutrition

Question 20

syndrome that causes protein to leak into the urine

Answer 20

nephrotic syndrome

Question 21

how do you measure protein excretion?

Answer 21

24 hr urine collection

Albumin to CR ratio

Question 22

proteinuria is considered

Answer 22

> 3.5g/24 hours

Question 23

normal value for 24 hour urine collection

Question 24

why are lipids elevated in nephrotic syndrome?

Answer 24

hepatic lipoprotein synthesis is elevated by decreased oncotic pressure

Question 25

Fatty casts and OFB are indicative of

Answer 25

nephrotic syndrome

Question 26

important clinical feature of nephrotic syndrome is

Answer 26

Hypercoaguable state!! - 30% of patients have renal vein thrombosis

Question 27

3 pathologic causes of nephrotic syndrome

Answer 27

minimal change FSGS Membranous

Question 28

2 secondary causes of nephrotic syndrome

Answer 28

Diabetes | amyloid/MM

Question 29

most common cause of nephrotic syndrome ini children is

Answer 29

minimal change disease

Question 30

2 secondary causes of minimal change disease

Answer 30

NSAIDs | hodgkin lymphoma

Question 31

nephrotic syndrome cause that accounts for 50% of cases in blacks

Answer 31

FSGS

Question 32

presence in some glomeruli of focal/segmental areas of mesangial collapse and sclerosis is

Answer 32

FSGS

Question 33

most common cause of nephrotic syndrome in adults is

Answer 33

membranous

Question 34

Secondary causes of membranous GN

Answer 34

MAID

Question 35

thickening of BM with little or no cell proliferation is characteristic of

Answer 35

Membranous nephropathy

Question 36

Kimmelsteil wilson nodules are

Answer 36

characteritstic of diabetic glomeruloscelrosis

Question 37

what can be used to treat the proteinuria

Answer 37

ACEi/ARBs

Question 38

classic features of tubulointerstitial diseases

Answer 38

WBCs or WBC casts in urine

Question 39

2 clues that you have a tubulointersititial kidney disease

Answer 39

hyperkalemia | renal tubular acidosis

Question 40

Acute TBI disease can include

Answer 40

AIN | ATN

Question 41

chronic TBI can be caused by

Answer 41

drugs chronic obstruction autoimmune disease cystic diseases PKD