Renal Flashcards
Syndrome: persistent microscopic hematuria, proteinuria, and family history of renal failure and deafness.
Inherited disorder involving __ (tissue). and __ (gene) found on __ (chromosome).
Alport syndrome: basement membrane collagen disorder, COL4A genes (X-linked q22)
Males tend to progress by age 20 (juvenile type) or 40 (adult type).
Microscopic hematuria in children - asymptomatic persistent work up?
PARENT urinalysis, urine ca/cr ratio, hearing screen, renal US, hemoglobin electrophoresis, nephrology consult
New-onset nephrotic syndrome in middle aged adult. Workup includes?
___ antigen testing, biopsy, and screening for ___
Treatment? When should it be considered?
Many cases of primary membranous nephropathy may be due to autoantibodies directed against the phospholipase A2 receptor found on podocytes. Secondary causes include hepatitis B antigenemia, autoimmune diseases, thyroiditis, carcinoma, and the use of certain drugs such as NSAIDs, penicillamine, gold, and captopril.
PLA2R, biopsy, and age/sex-appropriate screening with mammography, colonoscopy, etc.
Immunosuppression should not be offered in this case until a secondary form has definitively been ruled out and the patient has been carefully monitored for at least 3 to 6 months (sometimes the tumor is found a year AFTER the proteinuria), if this is a primary form of membranous glomerulopathy, for spontaneous remission, which occurs in approximately one third of primary cases. (Primary meaning no secondary cause as noted above)
Management of hypermagnesemia?
Intravenous calcium!
nephropathy + bone pain + exposure to plastic, metal, alloys, electrical equipment manufacturing + aminoaciduria or renal glycosuria = patient with __ exposure
cadmium exposure
Describe Type 1 RTA. __kalemic __ tubular acidosis due to ___ in the __ of the nephron.
Because of this, there is a compensatory hyper__, __ anion gap, and urine pH is always __.
hypokalemic distal tubular acidosis due to decreased activity of proton pump in collecting duct intercalated A cells (cannot excrete H ions)
Hyperchloremia, normal anion gap, and urine pH >6.
Pt with kidney disease from southeastern Europe _ consider this noninherited cause. They have a particularly high risk of urothelial cancer
Balkan endemic nephropathy (BEN), a slowly progressive tubulointerstitial disease that has been linked to aristolochic acid. Aristolochic acid is a nephrotoxic alkaloid from the plant Aristolochia clematitis. BEN has a high prevalence rate in southeastern Europe (Serbia, Bulgaria, Romania, Bosnia and Herzegovina, and Croatia) and is the cause of kidney disease in up to 70% of patients receiving dialysis in some of the most heavily affected regions.
What testing should be considered in a medium vessel vasculitis (ie polyarteritis nodosa), especially with signs of renal disease?
Renal arteriography should be performed in patients with medium-vessel vasculitis such as polyarteritis nodosa.
