Renal Glomerular Pathophysiology Flashcards
What are the types of proteinura?
- Glomerular (nephrotic)
- Tubular
- Overflow
What is nephrotic syndrome most commonly associated with?
Glomerular injury resulting in excess loss of proteins in the urine
What is primary nephrotic syndrome?
Minimal change disease - thinning of the podocyte foot processes
*Loss of negatively charged membrane, increased permeability, leads to proteinuria
Who gets primary nephrotic syndrome?
Kiddos
What is membranous nephropathy?
Primary nephrotic syndrome typically due to an autoimmune response to antigen
*Can be associated with lupus, Hepatitis B or C
What is Alport Syndrome?
Basement membrane collagen disorder resulting in problems with the glomerular epithelium
What medication can induce nephrotic syndrome?
NSAIDs
Contrast
What is the presentation of nephrotic syndrome?
- Proteinuria
- Hypoalbuminemia
- Hyperlipidemia
- Lipiduria
- Low vitamin D
- Hypothyroidism
What is nephritic syndrome pathophysiology?
Inflammation within the mesangium d/t antigen deposition leading to endothelium damage –> RBC loss
Less proteinuria than nephrotic
Maybe associated with infection, especially in kiddos
After what infection is it common to see nephritic syndrome, especially in kids?
Group A
Tubulointerstitial disease
Any process that causes damage to the interstitial tissues or tubules (basically all except glomerulus and capillaries)
What is the number one cause acute tubulointerstitial nephritis (ATIN)?
Medications!
RSVP: Rifampin, Sulfa Drugs, and the five (V) Ps
- PPI’s, Pain Killers (NSAIDs), Pee Pills (diuretics), Penicillin, Phenytoin
What is the presentation of ATIN?
Symptoms are vague, and going to look inflammatory (rheumatologic)
- Classic triad: fever, rash, athralgias
- Often with oliguria
What is the most definitive diagnostic test to diagnose ATIN?
Kidney biopsy (but not done very often)
What labs are going to be helpful in diagnosing ATIN?
WBC casts
Eosinophilia
Pyuria
Proteinuria
How are you going to diagnose ATIN?
Clinical Picture: are they on offending meds, oliguria, triad sx
Labs: WBC casts
What is the treatment of ATIN?
- Stop offending agent
- Supportive: BP control, treatment of anemias, fluids
- Maybe some steroids
How can you classify nephritic from nephrotic glomerular disease?
Proteinuria
Nephritic: < 3g/day
Nephrotic: > 3g/day
What are the tests to be ordered to determine proteinuria?
24 hour urine collection (< 3 g/day nephritic; > 3 g/day)
Spot urine protein:creatinine ration (< 3.5 nephritic; >3.5)
What is the best and most definitive diagnostic test for glomerular disease?
Kidney biopsy
Only if there are no contraindications
Who tends to get Post-Infectious glomerulus nephritis?
Kids (3-12) typically after a GABHS infection
If post-infectious GN goes onto be associated with palpable purpura on the LEs/buttocks what is the condition?
Henoch Schonlein Purpura
What is the treatment for minimal change nephrotic syndrome?
Steroids until proteinuria resolves
What is the treatment for focal and segmental nephrotic syndrome?
Steroids (but more likely to fail tx)
- then add immunosuppressant or ACE/ARB
What is the most important complication associated with nephrotic syndrome?
VTE, usually a DVT or renal artery thrombosis (may cause PE)
