Renal Diseases

Question 1

What is glomerulonephritis?

Answer 1

GN generally refers to damage of the renal glomeruli by deposition of inflammatory proteins in the glomerular membranes as a result of an immunologic response

Question 2

What is the most common cause of glomerulonephritis?

Answer 2

IgA GN

Question 3

Who do we most commonly see GN in?

Answer 3

Children 2-12 yo

Question 4

What does focal and diffuse GN mean?

Answer 4

Focal- characterized by involvement of less than 50% of the glomeruli

Diffuse- affects most glomeruli

Question 5

What are the clinical features of GN?

Answer 5

Hematuria is present; urine is often tea colored. Oliguria or anuria is present. Edema of the face/eyes in the AM and Feet/ankles in the PM.

Question 6

What are the laboratory findings for GN?

Answer 6

Antistreptolysin-O titier is increased in 60-80% of cases and should be considered if there is a possibility of a recent strep infection.

UA reveals hematuria (>3) also RBCs will often be mis-shapen (acanthocytes), RBC casts will be present as well as proteinuria. Serum compliment C3 will be decreased.

Question 7

How do we treat GN?

Answer 7

Steroids and immunosuppressive drugs may be used to control inflammatory response, which is responsible for the damage. They are generally not needed in PSGN.

Question 8

What is nephrotic syndrome?

Answer 8

nephrotic syndrome is defined as excretion of more than 3.5g of protein in 24 hrs. It manifests with hypoalbuminemia, lipiduria and hypercholesterolemia, and edema.

Question 9

What are the clinical findings of nephrotic syndrome?

Answer 9

facial edema, weight gain, maliase, oliguria

Question 10

What are the laboratory findings for nephrotic syndrome?

Answer 10

UA shows hypoalbuminemia, lipiduria and hypercholesterolemia. The urine also appears foamy.

Question 11

What is the key finding on microscopic UA for nephrotic syndrome?

Answer 11

oval fat bodies

Question 12

How do we treat nephrotic syndrome?

Answer 12

ACE inhibitors should be used early in the course of the disease. Judicious use of diuretics is recommended to reduce fluid accumulations.

Question 13

What are the common types of nephritic syndromes?

Answer 13

Pauci
IgA
Goodpastures
Lupus
Rapid progressing

Question 14

What are the key features of nephritic syndrome?

Answer 14

RBC and RBC casts

Question 15

What are the key elements of Lupus?

Answer 15

+ ANCA and ds DNA, as well as a malar rash and low C3

Question 16

How do we diagnoses Lupus?

Answer 16

renal biopsy

Question 17

What are the key elements of goodpastures?

Answer 17

Also affects lung cells, its seen mainly in male smokers

hemoptysis

Question 18

How do we treat goodpastures?

Answer 18

plasmaphoresis, immunosuppressants

Question 19

What are the key elements of Pauci-immune?

Answer 19

Wegners
Not immune complexed
Vasculidities are complex multi organ disorders
+ ANCA

Question 20

What are the key elements of IgA?

Answer 20

slow progressive disease
often asymptomatic
microscopic or gross hematuria
\+mild protein
deposits Iga on glomerular membrane

Question 21

What are the key elements of rapidly progressing GN?

Answer 21

biopsy will show cresents

Question 22

What are the key features of nephrotic syndrome?

Answer 22

> 3.5 proteinuria
hypoalbuminemia
edema
hyperlipidemia

Question 23

What is the most common cause of nephrotic syndrome?

Answer 23

DM

Question 24

What are categories of nephrotic syndrome?

Answer 24

Minimal change disease
Focal and segmental GN
Membranous nephropathy
Membranoproliferative nephropathy

Question 25

What are the key elements of minimal change disease?

Answer 25

renal function is normal, edema is present
UA = +4 protein, hyaline casts
Circulating factor -> Podocyte injury -> proteinuria

Question 26

What are the key elements of focal and segmental GN?

Answer 26

not mediated by immune complexes
proteinuria and hypotension
heroin, HIV, sickle cell can trigger it
Tx with steroids

Question 27

What are the key elements of membranous nephropathy?

Answer 27

idiopathic
due to antibody PLAZR
50% develop ESRD

Question 28

Which type of syndrome is associated with Hep C?

Answer 28

membranoproliferative

Question 29

What is polycystic kidney disease?

Answer 29

PKD is characterized by growth of numerous cysts in the kidneys. The cysts are made of epithelial cells from the renal tubules and collecting system. The cysts replace the mass of the kidney, reducing function and leading to kidney failure.

Question 30

What is the most common PKD?

Answer 30

ADPKD, it usually presents bilaterally

Question 31

What are the most common symptoms of PKD?

Answer 31

back and flank pain, secondary to enlarged kidneys and/or liver, and headaches. Nocturia is an early sign of abnormal renal function.

Question 32

What are the laboratory findings for PKD?

Answer 32

Anemia may be noted of CBC, UA shows proteinuria, nocturia, and commonly pyuria and bacteriuria

Question 33

What is the diagnostic study of choice for PKD?

Answer 33

US

Question 34

What is the treatment for PKD?

Answer 34

There is no cure for ADPKD; treatment is supportive to ease symptoms and prolong life.

Question 35

What is hydronephrosis?

Answer 35

Hydronephrosis is a condition that typically occurs when one kidney becomes swollen due to the failure of normal drainage of urine from the kidney to the bladder. It is a result of a blockage of or obstruction in the urinary tract.