Renal Disorders (exam2) Flashcards
What is largely in charge or retaining proteins in the blood
negative charge of the podocytes
What is Nephrotic Disease or syndrome
The increased permeability to Plasma Proteins
what test is needed to determine proteinuria
a 24 hr urine collection
What is the definition of Proteinuria
> 3.5 g of protein in 24 hours
what is the most common protein leaked out when gaps in podocytes allow proteins to leak out
Albumin
Hypoalbuminemia results in decreased intravascular oncotic pressure leading to what
edema
Treatment of Glomerular Dz
Low Salt diet
Diuretics
Treatment of HTN
Statins
What is Minimal change Disease
Abnormality in the capillary walls in the glomerulus
common in children 80-90 % of the cases
Focal Segmental Glomerulosclerosis (FSGS)
Sclerosing in glomerulus
Causes 35% of nephrotic syndrome in adults
Second most common cause in children
Membranous Nephropathy
Immune complexes deposited in glomerulus
Rare in childre
Secondary causes of Nephrotic Diseases (30%)
- Systemic Lupus Erythematousus
- Diabetic Nephropathy
- Amyloidosis
- Hepatitis B and C
- HIV
Regardless the cause of the NS primary or secondary . consultation with a nephrologist is needed
What keeps the proteins from leaking out
the foot processes of the podocytes
Minimal Change Disease is the most common or least common Neprhrotic Disease ?
Most common #1 most common epecially in children 2-6 y.o.
Average age in adults who get MCD is 40
what percentage of Minimal Change Disease is idopathic
90%
Clinical Presentation of Minimal change disease
Facial edema - number 1
malaise/ fatigue, muscle wasting
wt gain-
Most serious complication of Minimal Change Disease
Hypovolemia
what will be found in the urine that is specific to Minimal change disease
Oval Fat Bodies
Diagnosis MCD
24 hour urine collection needed.
A albumin/creatinine ratio >5
specific gravity
low albumin
True or False- Minimal change Disease is treated first in Adults but hold treatment for Pediatrics until a Renal Biopsy
False- Treat children right away without biopsy first.
this is because the children will respond really well to the steroids
Tx of Minimal Change Disease
Corticosteroids
90% of children respond within 2 weeks
Adults can take up to 16 weeks
Continue steroids for 6 wks after remission of proteinuria
If they are steroid resistant or if the pt can not have steroids we utilize what to treat Minimal Change Disease
Cyclophosphamide-Antineoplastics
Chlorambucil-Immunosuppressants
Mycophenolate- Immunomodulators
Exam findings of pts with FSGS
Pleural effusion Ascites Abdominal pain Ulcerations and infections d/t edema severe hypertension
UA of focal segmental glomerulosclerosis will find what
Large amounts of protein
Hyaline and broad waxy casts, red blood cell casts are generally absent
broad casts may be observed
serum creatinine
concentration or creatinine clearance usually within reference ranges in early stages
Tx of FSGS
Ace or Arb
Treat secondary processes
if persistant proteinuria/MS -corticosteroids: 60-80 mg/d for 2-6 months
