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CMLFInal Sem2 > Poststrep Glomerulonephritis > Flashcards

Poststrep Glomerulonephritis Flashcards

1
Q

What is the most common cause of acute nephritis in kids worldwide?

A

Poststreptococcal glomerulonephritis

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2
Q

PSGN develops in 3-6 weeks after ________

A

impetigo

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3
Q

A patient comes into clinic with honey colored crust on face nose and mouth. If PSGN were to occur, how many weeks would it occur in?

A

3-6 wks

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4
Q

PSGN develops 1-3 weeks after _______

A

pharyngitis

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5
Q

strep nephritogenic antigens deposit where in the glomerulus which causes problems?

A

basement membrane

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6
Q

What is the presentation of nephritic syndrome?

A
  1. Hematuria
  2. Proteinuria
  3. Edema
  4. Hypertension
  5. Elevated serum Cr
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7
Q

What are the three most common presenting symptoms of PSGN?

A
  1. Generalized edema
  2. Gross hematuria
  3. HTN
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8
Q

Possible systemic symptoms of PSGN?

A

HA, malaise, anorexia, flank pain

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9
Q

What is present on UA for PSGN?

A

RBCs, red cell casts, proteinuria

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10
Q

In PSGN, there will be an __________ BUN/Cr ratio and a _____ serum complement

A

increased, low

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11
Q

ASO, anti-DNAse is present due to evidence of what?

A

evidence of a recent strep infection

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12
Q

If a patient comes in with PSGN but might not have a current infection should we perform a throat culture?

A

NO- perform a streptozyme test which measures 5 different streptococcal antibodies and we do this because most of the infectiction has passed the time of current infection

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13
Q

T/F: a renal biopsy is performed in most PSGN pts

A

FALSE- renal biopsy not performed in most patients

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14
Q

How to make the PSGN dx?

A

Clinical findings of acute nephritis PLUS demonstration of a recent GAS infection (positive throat of skin culture or serologic tests)

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15
Q

Treatment goals for PSGN?

A
  • Eradicate the residual nephritogenic bacteria

- Provide supportive care

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16
Q

Is there a specific therapy for PSGN?

A

No specific therapy: treat the clinical manifestations, esp volume overload

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17
Q

What is preferred over diuretics in kids with PSGN?

A

Sodium and water restriction

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18
Q

How should we reduce BP and edema in a patient with PSGN?

A

Furosemide

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19
Q

What should we do if a patient has hypertensive encephalopathy and PSGN?

A

Treat emergently to lower BP

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20
Q

What are three reasons someone with PSGN would need dialysis?

A
  • Life threatening fluid overload (pulmonary edema, heart failure, HTN) refractory to medical tx
  • Hyperkalemia (>6.5 unresponsive to medical tx)
  • Uremia with BUN b/t 89-100 (normal ~10)
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21
Q

What are the admissions criteria for PSGN?

A

SOSCS!

  • Severe renal dysfunction
  • Oliguria (not urinating enough)
  • CHF
  • Significant volume overload
22
Q

What is the drug of choice for PSGN?

A

Penicillin

23
Q

What is an alternate 1st line tx for PSGN for kids that tastes better?

A

Amoxicillin

24
Q

If a patient has a MILD allergy to PCN what is the tx for PSGN?

A

Cephalexin (Keflex)

25
If pt can't take cephalosporins, what is the PSGN tx?
Azithromycin
26
When does Cr go back to baseline after PSGN?
3-4 wks
27
How long after PSGN do patients begin diuresing?
1 wk
28
How long does it take for hematuria to resolve after PSGN?
3-6 months
29
What is the last thing to resolve in PSGN? Which sometimes takes 10 yrs?
Proteinuria
30
This is a multisystem disease that results from an autoimmune reaction to infection with GAS?
Rheumatic fever
31
This is the most common cause of heart disease in kids in developing countries and mainly a disease of children age 5-14?
Rheumatic fever
32
Rheumatic fever starts ___ days to several weeks after GAS infecition
10
33
What are two common presentation patterns in a patient with rheumatic fever?
- Acute febrile illness with joint manifestations and/or carditis - Neurologic and behavioral manifestations with chorea
34
T/F: Fever is present in all cases of rheumatic fever?
False >90%
35
With RF and _______ a patient may have dyspnea, orthopnea, CP, palpitations
carditis
36
With RF and _______ a patient will have generally large joints, migratory, dramatic response to NSAIDs/salicylates
joint pain
37
What helps leg/joint pain in pts with RF?
NSAIDs
38
With RF and _______ a patient will have uncontrolled jerky movements limbs, face, tongue, usually worse on one side, stop while sleeping, often associated with emotional lability
chorea
39
With RF and _______ a patient will have painless, resolve 1-2 weeks
Nodular SQ lesions
40
With RF and _______ a patient will have nonpruritic, nonpainful, evanescent, usually on trunk. May have central pallor
rash (erythema marginatum)
41
What is the jones criteria?
-Need 2 major or 1 major and 2 minor PLUS evidence of a strep infection
42
What are the major jones criteria?
- Carditis & valvulitis - Arthritis - CNS involvement (usually chorea) - Subq nodules - Erythema marginatum
43
What are the minor jones criteria?
- Arthralgia - Fever - Elevated ESRs - Prolonged PR on EKG
44
Does this meet the jones criteria? Evidence of GAS, carditis and chorea?
Yes
45
What is the difference between arthritis and arthralgias?
Arthritis: large joint migratory arthritis from joint to joint Arthralgias: joint discomfort/pain involving several joints
46
What is a common EKG findings in RF?
PR prolongation
47
Which valve is mostly affected in a a patient with RF? And what finding is associated with it?
Mitral valve and mitral regurg
48
What is the tx for arthritis and how long should you take it for?
NSAID (Aspirin or Naproxen) and until the joint symptoms have resolved
49
Is there prophylaxis for RF? If so, what is it?
Yes patients who have one attack of RF are at high risk for getting it again and WORSE every time. Prophylaxis: PCN or Clinda
50
* Antibody directed against antigen on cells or extracellular materials (ie: basement membrane) * Ab-Ag complexes activate complement via classic pathway --> cell lysis or extracellular tissue damage
Type II Acute Rheumatic Fever
51
* Immune complexes (Ab & Ag) promote tissue damage through complement activation (alternate pathway) * Complexes deposited in tissues
Type III PSGN

CMLFInal Sem2 (10 decks)

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