Renal Glomerular Pathophysiology

Question 1

What are the types of proteinura?

Answer 1

• Glomerular (nephrotic)
• Tubular
• Overflow

Question 2

What is nephrotic syndrome most commonly associated with?

Answer 2

Glomerular injury resulting in excess loss of proteins in the urine

Question 3

What is primary nephrotic syndrome?

Answer 3

Minimal change disease - thinning of the podocyte foot processes

*Loss of negatively charged membrane, increased permeability, leads to proteinuria

Question 4

Who gets primary nephrotic syndrome?

Answer 4

Kiddos

Question 5

What is membranous nephropathy?

Answer 5

Primary nephrotic syndrome typically due to an autoimmune response to antigen

*Can be associated with lupus, Hepatitis B or C

Question 6

What is Alport Syndrome?

Answer 6

Basement membrane collagen disorder resulting in problems with the glomerular epithelium

Question 7

What medication can induce nephrotic syndrome?

Answer 7

NSAIDs
Contrast

Question 8

What is the presentation of nephrotic syndrome?

Answer 8

• Proteinuria
• Hypoalbuminemia
• Hyperlipidemia
• Lipiduria
• Low vitamin D
• Hypothyroidism

Question 9

What is nephritic syndrome pathophysiology?

Answer 9

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

Question 10

After what infection is it common to see nephritic syndrome, especially in kids?

Answer 10

Group A

Question 11

Tubulointerstitial disease

Answer 11

Any process that causes damage to the interstitial tissues or tubules (basically all except glomerulus and capillaries)

Question 12

What is the number one cause acute tubulointerstitial nephritis (ATIN)?

Answer 12

Medications!

RSVP: Rifampin, Sulfa Drugs, and the five (V) Ps
- PPI’s, Pain Killers (NSAIDs), Pee Pills (diuretics), Penicillin, Phenytoin

Question 13

What is the presentation of ATIN?

Answer 13

Symptoms are vague, and going to look inflammatory (rheumatologic)

• Classic triad: fever, rash, athralgias
• Often with oliguria

Question 14

What is the most definitive diagnostic test to diagnose ATIN?

Answer 14

Kidney biopsy (but not done very often)

Question 15

What labs are going to be helpful in diagnosing ATIN?

Answer 15

WBC casts
Eosinophilia
Pyuria
Proteinuria

Question 16

How are you going to diagnose ATIN?

Answer 16

Clinical Picture: are they on offending meds, oliguria, triad sx

Labs: WBC casts

Question 17

What is the treatment of ATIN?

Answer 17

• Stop offending agent
• Supportive: BP control, treatment of anemias, fluids
• Maybe some steroids

Question 18

How can you classify nephritic from nephrotic glomerular disease?

Answer 18

Proteinuria
Nephritic: < 3g/day
Nephrotic: > 3g/day

Question 19

What are the tests to be ordered to determine proteinuria?

Answer 19

24 hour urine collection (< 3 g/day nephritic; > 3 g/day)

Spot urine protein:creatinine ration (< 3.5 nephritic; >3.5)

Question 20

What is the best and most definitive diagnostic test for glomerular disease?

Answer 20

Kidney biopsy

Only if there are no contraindications

Question 21

Who tends to get Post-Infectious glomerulus nephritis?

Answer 21

Kids (3-12) typically after a GABHS infection

Question 22

If post-infectious GN goes onto be associated with palpable purpura on the LEs/buttocks what is the condition?

Answer 22

Henoch Schonlein Purpura

Question 23

What is the treatment for minimal change nephrotic syndrome?

Answer 23

Steroids until proteinuria resolves

Question 24

What is the treatment for focal and segmental nephrotic syndrome?

Answer 24

Steroids (but more likely to fail tx)
- then add immunosuppressant or ACE/ARB

Question 25

What is the most important complication associated with nephrotic syndrome?

Answer 25

VTE, usually a DVT or renal artery thrombosis (may cause PE)