Renal: Glomerulonephritis Flashcards
Nephritic or Nephrotic?
AKI w/ proteinuria 1-3 g/d
Hematuria (coca cola)
RBC Casts
Edema
HTN
decreased GFR
Oliguria
nephritic
Nephritic or Nephrotic?
Proteinuria > 3 g/d
Hypoalbuminemia
edema
hyperlipidemia
oval fat bodies
Nephrotic
Glomerulonephritis presents in nephritic or nephrotic spectrum?
nephritic
Focal or diffuse?
< 50% of glomeruli involved…
focal
What condition is described below?
nephritic disease
inflammatory process w/ renal dysfunction
often caused by immune complex deposition
glomerulonephritis
Which type of glomerulonephritis?
- most severe/clinically urgen
- progressive loss of renal fxn over short period of time
- crescent formation
rapidly progressive glomerulonephritis
Glomerular or extraglomerular hematuria?
red/pink
+ clots
(-) proteinuria
normal RBCs
no RBC casts
extraglomerular
Glomerular or extraglomerular hematuria?
cola colored
(-) clots
+ proteinuria
dysmorphic RBCs
+ RBC casts
glomerular
Serologic tests in addition to UA and microscopy in glomerulonephritis…
Cr ANA anti-DS DNA ab ANCAs anti-GBM Abs ASO
Tx of glomerulonephritis (4)
tx underly cause and complications (HTN, volume status)
ACE/ARB
Nephrology referral
Which GN?
MC primary GN
peak 2nd and 3rd decade of life
IgA deposition –> inflammatory/glomerular injury
IgA Nephropathy
Pt. presents w/ the following, concerning for…
gross, recurrent hematuria
URI w/in 1-2 days
Nephritic presentation
IgA Nephropathy
What confirms IgA nephropathy?
kidney biopsy
Tx of IgA nephropathy w/ persistent proteinuria > 1 g/d, elevated Cr, reduced GFR or HTN
ACE/ARB
slow progression to ESRD occurs in wht percentage of IgA nephropathy patients?
50%
This condition occurs after GAS infection like pharyngitis or impetigo.
more common in males
Post Strep GN
A patient presents with sxs in the nephritic spectrum 1-3 weeks after ST onset.
PSGN
Low complement
documented GAS infx
and elevated _____ or positive _____ can indicate PSG
elevated ASO
(+) throat/skin culture
Resolution of PSGN generally occurs within…
2 weeks
how common are recurrent episodes of PSGN?
rare
prognosis of PSGN depends on…
age and severity of sxs
This was previously called HSP…
IgA vasculitis
this disease:
- deposition of IgA immune complexes
- renal issue occurs 1 month post-URI/systemic sxs
Tetrad:
palpable purpura
arthralgia
abd. pain
renal dz
IgA Vasculitis
IgA nephropathy or vasculitis?
- Nephritic MC, but can be nephrotic
- favorable prognosis
- supportive care
IgA Vasculitis
This is a rare autoimmune disorder where Abs are directed against the glomerular basement membrane…
Anti-GBM disease
Anti-GBM with GN + Pulmonary hemorrhage =
goodpasture syndrome
describe the 2 peaks of anti-GBM disease in the lifecycle
3rd decade and 6/7 decade
Which peak of anti-GBM is more likely to present with the full constellation of goodpasture syndrome?
3rd decade
GN + pulmonary hemorrhage + anti-GBM Abs =
goodpasture disease
Onset of RPGN, cough, dyspnea is concerning for…
anti-gbm disease (goodpasture)
What two methods confirm anti-gbm disease?
anti-GBM Abs in serum or biopsy
can be double positive with (+) ANCA
How is anti-GBM treated?
plasmapheresis + prednisone/cyclophosphamide
This is a complex-mediated glomerular disease directed by Anti-ds DNA Abs.
Suspicion via abn. UA and/or elevated Cr and nephritic presentation.
confirmed with renal bx
lupus nephritis
Who do you refer to with lupus nephritis?
nephro, rheum
Pauci-immune GN is associated with what lab which produce tissue and vascular damage?
ANCA
Which three diseases are pauci-immune GN?
GPA
MPA
EGPA
pauci-immune GN is characterized by what in renal histology?
absence of immune deposits in kidney
Which pauci-immune GN?
- ANCA associated, small-medium vessels
- Necrotizing granulomatous inflammation
- Crescentic necrotizing GN and RPGN
- Nasal/Oral inflammation
- Saddle nose deformity
Granulomatosis w/ Polyangiitis (GPA)
What differentiates microscopic polyangiitis from GPA?
no granuloma
spares upper respiratory tract
Which pauci-immune GN?
-Associated w/ asthma and eosinophilia
eosinophilic granulomatosis with polyangiitis
What are the three phases of EGPA?
Prodrome: atopy, allergic rhinitis, asthma
eosinophilic infiltrative
Vasculitic: systemic, small medium vessels
Absence of treatment in Pauci-Immune GN renders a poor prognosis. What two drugs can be used and what type of approach to managing the disease?
multi-disciplinary approach (nephro, neuro, rheum, pulm, cards, GI)
CS and cytotoxic agents
Which Pauci-immune GN?
(+) C-ANCA
Upper respiratory sx
Lower respiratory sx
GN
GPA
Which Pauci-immune GN?
(+) P-ANCA
No granuloma
spares upper respiratory tract
MPA
Which Pauci-immune GN?
(+) P-ANCA
Asthma
Eosinophilia
EGPA
Most renal masses (65-70%) are…
simple renal cysts
On US, you see a round, sharply demarcated mass with smooth walls.
The mass is anechoic, there is no enhancement with contrast
Simple renal cyst
Polycystic Kidney Disease causes an irreversible decline in kidney function. what is the etiology?
inherited, autosomal
Which type of PKD?
(+) FHx
- PKD1 or PKD2 gene
- most common genetic cause of CKD
autosomal dominant PKD
Which type of PKD?
- massive bilateral kidney enlargement
- Progressive decline in GFR
- deterioration in 4th decade
- 50% will have ESRD by 60 yo
ADPKD
As cysts accumulate fluid, enlarge and compress what structures, which leads to decreased renal fxn?
parenchyma
Describe the kidney function timeline from age 15 to age 60 in ADPKD…
15: normal
30: hyperfiltration
40: impairment
60: failure
In addition to hepatic cysts, what are three manifestations of ADPKD?
HTN
Abd./Flank Pain
Hematuria
Hx UTI/nephrolithiasis
What is the initial modality for ADPKD and what can be used when that isn’t conclusive?
US initial
CT/MRI if inconclusive
What confers definitive dx of ADPKD?
genetic testing
What is the definitive treatment of ADPKD?
transplant
What are 4 components to managing ADPKD prior to transplant?
BP/salt control
Supportive tx/tx of complications
Tolvaptan
Dialysis
Autosomal recessive PKD is primarily a disease of what population?
infants and children
What two organ systems are affected by ARPKD
kidneys
hepatobiliary tract
In addition to bilaterally enlarged kidneys, what else can be found with ARPKD?
congenital hepatic fibrosis
+/- ESRD or respiratory distress
US can detect ARCKD after what week?
24 weeks
