Renal Flashcards
Features of Infection-associated glomerulonephritis
This is a nephritic syndrome.
It is a type 3 hypersensitivity reaction. Associated with hypocomplementemia (due to consumption).
Children-> due to group A strep (poststreptococcal glomerulonephritis), seen 2-4 weeks AFTER pharyngeal OR skin infections
Adults-> can be due to strep, but more commonly Staph, seen DURING the infection
This can progress to rapidly progressive (crescenteric) glomerulonephritis! BAD!
LM- glomeruli enlarged and hypercellular
IF- granular “starry sky” appearance and “lumpy bumpy” due to IgG, IgM, and C3 deposition in GBM and mesangium
EM- subepithelial IC humps
Features of Rapidly progressive (crescentric) glomerulonephritis:
what diseases contribute to this:
Nephritic
LM: Crescent moon shaped. has fibrin, plasma proteins, w/ macrophages
Linear IF: ab against GMB (type IV collagen): GOODPASTURE tx: plasmapharesis
Negative IF/Pauci-immune(no Ig/C3):
Proteinase3-ANCA/c-ANCA: GPA
MPO-ANCA/p-ANCA: microscopic polyangitis or Eosinophilic granulomatosis with polyangitis
Granular IF: PSGN or DPGN
Features of Diffuse proliferative glomerulonephritis:
Think SLE! DPGN and MPGN often present as nephrotic syndrome and nephritic at same time
LM: Wire looping of capillaries
IF: Granular
EM - subendothelial
can lead to rapidly cresecenteric glomerulonephritis
Features of IgA nephropathy (Berger disease)
episodic hematuria that occurs CONCURRENTLY with respiratory or GI tract infections
associated with IgA vasculitis (Henoch-Schhn purpura)
LM- mesangial proliferation
IF- IgA-based IC deposits in mesangium
EM- mesangial IC deposition
Features of Alport syndrome
mutation in type IV collagen causes irregular thinning and thickening and splitting of GBM
X-linked Dominant!
presents with eye problems, sensorineural deafness, and glomerulonephritis
EM- “basket-weave” appearance
features of Membrano-proliferative glomerulonephritis
Nephritic/nephrotic at same time :o
type I - who cares but might be secondary to hep infections
type 2 - C3 nephritic factor (IgG stabilizes C3 convertase – persistent complement activation – dec. C3 levels)
intramembranous deposits - dense deposit disease
Mesangial growth - GBM splitting – tram track appearance.
What is inflammation of the renal interstitium and how does this present?
Acute interstitial nephritis (tubulointerstitial nephritis). One of the causes of intrinsic renal failure!
Pyuria (eosinophils), and azotemia after administration of drug (NSAID, Penicillins, PPis, Rifampin).
Rash, fever, hematuria, CVA
What is inflammation of the renal interstitium and how does this present?
Acute interstitial nephritis (tubulointerstitial nephritis). One of the causes of intrinsic renal failure!
Pyuria (eosinophils), and azotemia after administration of drug (NSAID, Penicillins, PPis, Rifampin).
Rash, fever, hematuria, CVA
What are some causes for Prerenal Azotemia and how will this present? Urine osmolality? Urine Na? FeNa? Serum BUN/Cr
Hypovolemia, dec. CO, dec circulating volume (HF, liver failure)
Pt. will have oliguria (due to dec. RBF which leads to dec. GFR.)
Urine osmolality >500
Urine Na <20 (putting it back in blood)
FeNa <1%
Serum BUN/Cr >20 (more time to reabsorb due to low GFR)
How do thiazides work
block NaCl symporter in DCT
This reduces Na concentration inside the cells, which increases activity of basolateral Na-Ca exchanger. This puts Na inside the cell and Ca into serum
hypercalcemia
What is filtration fraction and how is this calculated
% of plasma that gets filtered through glomerulus.
FF = GFR/RPF
what is renal clearance and how is it measured
Compare the hypothetical outcome to GFR
the volume of plasma that is needed to completely clear a substance in the urine.
Cx = (UxV)/Px
If C > GFR : net tubular secretion of X
if C < GFR : net tubular reabsorption and/or not freely filtered
How to find RPF:
RPF= RBF(1-Hct)
Nuances about left kidney:
right kidney:
Left: receives 2 extra veins: left suprarenal and left gonadal. And longer renal vein (so the left is taken for transplant)
Right: slightly smaller
In anaphylaxis, what compartment is the plasma moving to and why
histamine release causes inc. permeability - fluid leaks from plasma and goes to interstitial space - edema
