Proteinuria/hematuria, Glomerular/tubulointerstitial Dz

Question 1

etiologies of hematuria

Answer 1

glomerular disease and post-renal causes (trauma, stones, cancer)

Question 2

etiology of nephritiv vs nephrotic syndomes

Answer 2

nephtritic = glomerular inflammation

nephrotic = loss of GBM negative charge

Question 3

S/s nephritic vs nephrotic

Answer 3

nephritic:

• hematuria
• oliguria
• HTN
• azotemia
• proteinuria (3.5 g)
• edema
• hypoalbuminemia
• hyperlipidemia
• hypercoagulability

Question 4

glomerular cellularity nephritic vs nephrotic

Answer 4

nephritic = hypercellular glomeruli

nephrotic = normo-hypocellularity

Question 5

casts assc w/ nephritic vs nephrotic

Answer 5

nephritic = RBC casts

nephrotic - fatty casts

Question 6

analgesic nephropathy presents as

Answer 6

Nephritic syndrome × chronic pain

Question 7

good pastures, nephritic or nephrotic?

Answer 7

nephritic

Question 8

wegners nephritic or nephrotic?

Answer 8

nephritic

Question 9

alport, nephritic or nephrotic?

Answer 9

nephrotic

Question 10

minimal change dz, nephritic or nephrotic?

Answer 10

nephrotic

Question 11

HBV, HCV, HIV cause nephritic or nephrotic?

Answer 11

nephrotic

Question 12

NephrOtic syndrome × Hodgkin lymphoma =

Answer 12

minimal change disease

Question 13

NephrOtic syndrome × HIV:

Answer 13

FSGN

Question 14

NephrOtic syndrome × HCV

Answer 14

MPGN

Question 15

NephrOtic syndrome × HBV

Answer 15

MGN (membranous GN)

Question 16

nephrOtic syndrome in kids
following a viral infx

How to dx and treat?

Answer 16

• Dx EM (foot process effacement)

* Tx steroids

Question 17

Dx with light microscopy showing segmental sclerosis

Answer 17

FSGN

Think HIV pt. STERIOD RESISTENT

Question 18

Dx LM (diffuse GBM thickening), EM (“spike and dome” appearance)

assc with what Hx?

Answer 18

Membranous glomerulonephritis

drugs, infx, SLE, solid tumors

Question 19

nephritic syndrome following
URI or gastroenteritis;
associated w/ Henoch-Schonlein
(palpable) purpura in kids

How to Dx?

Answer 19

IgA nephropathy

LM shows mesangial deposits and IF with IgA stain

Question 20

XR ∆type 4 collagen → split
GBM (nephritic and nephrOtic
syndromes), deafness, ocular
and nerve disorders

Answer 20

ALports

Question 21

Dx microalbuminuria, LM (mesangial expansion, Kimmelsteil-Wilson nodules)

Treatment?

Answer 21

Diabetic nephropathy (nephrOtic)

ACEi

Question 22

Dx LM (“wire loops”), EM (subendothelial deposits), IF (“full house”)

Answer 22

Lupus nephropathy

Question 23

Dx EM (“tram tracks” or “dense deposits”)

Answer 23

Membranoproliferative GN (MPGN)

Question 24

coke-colored urine and
periorbital edema in a kid w/
strep throat or cellulitis

how to dx and treat?

Answer 24

PSGN

• Dx ↑ASO, LM (“lumpy-bumpy” appearance)
• Tx reassurance

Question 25

anti-GBM → attacks glomeruli and alveoli → hematuria + hemoptysis How to Dx

Answer 25

Goodpastures Dx LM (crescent shaped), IF (linear staining)

Question 26

drug allergy → acute renal railure, rash, fever, eosinophilia how to dx? MC etiologies

Answer 26

Acute interstitial nephritis (AIN) Dx with UA Etiologies = gentamycin, IV dye, Hb/Mb

Question 27

slowly progressive nephritis → asx, but can lead to progressive scarring, renal failure, and ESRD

Answer 27

Chronic interstitial nephritis

Question 28

damage to renal papillae → necrosis → slough off and cause _____ How to Dx? etiologies?

Answer 28

Renal Papillary necroris causes... ureteral obstruction Dx with excretory urogram Etiology: analgesic nephropathy (chronic NSAID/Tylenol use), diabetic nephropathy, sickle cell, obstruction, txp rejection

Question 29

Defects in RTA type 1 vs 2 vs 3 vs 4 and acidic or alkaline urine + TREATMENT

Answer 29

1: (distal) CD cannot excrete H+ (alkaline Urine) | IV HCO3- 2: (proximal) cannot reabs HCO3- (alkaline urine) Tx underlying cause 3: none 4: (hyperK): either hyperaldo or lack of response to aldo (acidic urine) | fludrocortisone

Question 30

RTA assc with hypophos and rickets

Answer 30

type 2: (proximal) cannot reabs HCO3- (alkaline urine)

Question 31

``` AR ∆neutral amino acid transporter → ↓neutral amino acids → ↓tryptophan for niacin synthesis → pellagra (3 Ds – diarrhea, dermatitis, dementia) ``` Tx?

Answer 31

Hartnup syndrome niacin replacement

Question 32

Defects in Fanconi syndrome? + TX?

Answer 32

proximal tubule dysfxn → defective transport of glucose, amino acids, HCO3-, phosphate → glucosuria, aminoaciduria, type 2 RTA, hypophosphatemic rickets, etc. Tx electrolyte replacemetn