Renal Patient Case Questions Flashcards
An 8 year old male is brought to your clinic by his mother. She has stated that he has had a fever for the past couple of days, and hasn’t been able to get up and around. He has had significant N/V. You find out that he has not been using the bathroom as much as he used too, and when he has, has noticed a red twinge to the urine. On PE, you notice a slight peri-orbital edema and a distressed child.
He has elevated BUN levels, and on IF you notice what kind of staining?
Filled with?
on EM you would see?
Granular Deposits
IgG, C3, IgM
SUBepithelial Humps
An 8 year old male is brought to your clinic by his mother. She has stated that he has had a fever for the past couple of days, and hasn’t been able to get up and around. He has had significant N/V. You find out that he has not been using the bathroom as much as he used too, and when he has, has noticed a red twinge to the urine. On PE, you notice a slight peri-orbital edema and a distressed child.
What Ag would be causing this?
And where do these Ag’s plant in the kidney?
SpeB (Streptococcal Pyogenic Exotoxin B)
Along the GBM, and Mesangium (forming those SUBepithelial humps)
An 8 year old male is brought to your clinic by his mother. She has stated that he has had a fever for the past couple of days, and hasn’t been able to get up and around. He has had significant N/V. You find out that he has not been using the bathroom as much as he used too, and when he has, has noticed a red twinge to the urine. On PE, you notice a slight peri-orbital edema and a distressed child.
What would be expected upon Histological Section?
How would this be spread throughout the kidney?
Hypercellular Glomeruli, with ENALRGED mesangial and endothelial cells, and Red Cell Casts
It would be at all Lobules of all Glomeruli (Global and Diffuse)
An 8 year old male is brought to your clinic by his mother. She has stated that he has had a fever for the past couple of days, and hasn’t been able to get up and around. He has had significant N/V. You find out that he has not been using the bathroom as much as he used too, and when he has, has noticed a red twinge to the urine. On PE, you notice a slight peri-orbital edema and a distressed child.
What clinical manifestation is he presenting with?
What disease caused the glomeruli disease?
What is his Glomeruli Disease?
Nephritic Syndrome
Strep
Acute Proliferative GN
An 8 year old male is brought to your clinic by his mother. She has stated that he has had a fever for the past couple of days, and hasn’t been able to get up and around. He has had significant N/V. You find out that he has not been using the bathroom as much as he used too, and when he has, has noticed a red twinge to the urine. On PE, you notice a slight peri-orbital edema and a distressed child.
How long will it take for him to recover?
If he doesnt recover what 2 things could he progress too?
If this patient had been a 25 year old what would his prognosis have been?
6-8 weeks
Can progress to RPGN (type II) or Chronic GN (both less than 1%)
Longer Recovery time, and more chances of progressing to RPGN and Chronic GN
An 8 year old male is brought to your clinic by his mother. She has stated that he has had a fever for the past couple of days, and hasn’t been able to get up and around. He has had significant N/V. You find out that he has not been using the bathroom as much as he used too, and when he has, has noticed a red twinge to the urine. On PE, you notice a slight peri-orbital edema and a distressed child.
Upon further testing you find that child had a staph infection that caused his illness – What sort of immunoglobulins would be found now?
IgA deposits (staph) – (IgG is for Strep)
An 8 year old male is brought to your clinic by his mother. She has stated that he has had a fever for the past couple of days, and hasn’t been able to get up and around. He has had significant N/V. You find out that he has not been using the bathroom as much as he used too, and when he has, has noticed a red twinge to the urine. On PE, you notice a slight peri-orbital edema and a distressed child.
What is the best sort of treatment/management option you can offer this little guy?
Tx: w/ Fluid and Electrolyte Management
You have a 23 year old male who presents to your office with hematuria. He notes that he has delt with this for some time now. His BP is 150/92 and is taking Lisinopril and HCTZ. He notes that he has also been short of breath for a while now. When you take a urine sample you note numerous red cell casts in his urine and mild proteinuria (<3gm).
How would his IF appear?
Linear with IgG and C3; and Fibrin CRESCENTS
You have a 23 year old male who presents to your office with hematuria. He notes that he has delt with this for some time now. His BP is 150/92 and is taking Lisinopril and HCTZ. He notes that he has also been short of breath for a while now. When you take a urine sample you note numerous red cell casts in his urine and mild proteinuria (<3gm).
What would we Diagnosis this man with?
What makes up the antigen?
What HLA do we associate this with?
Goodpasture Syndrome
The Goodpasture Ag –> is an ALPHA 3 chain within the noncollagenous regions of collagen Type IV
HLA-DRB1
You have a 23 year old male who presents to your office with hematuria. He notes that he has delt with this for some time now. His BP is 150/92 and is taking Lisinopril and HCTZ. He notes that he has also been short of breath for a while now. When you take a urine sample you note numerous red cell casts in his urine and mild proteinuria (<3gm).
How would we treat this patient most effectively?
Plasmapheresis
You have a 23 year old male who presents to your office with hematuria. He notes that he has delt with this for some time now. His BP is 150/92 and is taking Lisinopril and HCTZ. He notes that he has also been short of breath for a while now. When you take a urine sample you note numerous red cell casts in his urine and mild proteinuria (<3gm).
What type of disease process does this man have?
he has RPGN (type I – Anti GBM ab)
You have a 32 year old woman who shows up to your clinic with hematuria – you diagnose her with a Rapidly Progressive Glomerulonephritis. You see granular pattern to staining and cell proliferation and crescent formation. You note many immune complexes.
Which form of RPGN does she have?
How do we treat this form?
What disease(s) could be causing this RPGN?
She has Type 2 (immune complex deposition)
we treat her underlying disease
Could be a Post Strep GN, or Lupus Nephritis, IgA Nephropathy, of even HS Purpura
You have a 32 year old woman who shows up to your clinic with hematuria – you diagnose her with a Rapidly Progressive Glomerulonephritis. You see granular pattern to staining and cell proliferation and crescent formation. You note many immune complexes.
If she were noted to not have had immune complexes, and she was noted to have had some dyspnea and upper respiratory complaints – what would we look for?
What would the possible diagnosis be now? (list all)
ANCA’s
Wegner’s (most likely), Microscopic Poly, etc
You have a 32 year old woman who shows up to your clinic with hematuria – you diagnose her with a Rapidly Progressive Glomerulonephritis. You see granular pattern to staining and cell proliferation and crescent formation. You note many immune complexes.
How would you characterize her clinical symptoms?
Nephritic Syndrome
A 45 year old male presents to your clinic with edema and complains of fatigue. He says that he noticed a slight red color to his urine: and upon further work up you notice that he has massive protein in his urine (3.5 gm).
You suspect this to be idiopathic, what would the autoantigen be?
If you suspected a systemic disease what would need to look for?
Phopholipase A2 Receptor
Malignant Tumors, SLE, Bacterial Infections, H Thyroiditis, Drugs that cause it
A 45 year old male presents to your clinic with edema and complains of fatigue. He says that he noticed a slight red color to his urine: and upon further work up you notice that he has massive protein in his urine (3.5 gm).
What sort of clinical manifestation is showing?
Will this patient respond to corticosteroids?
Nephrotic Syndrome
NO, she will continue to have sclerosis of the glomerulus
A 45 year old male presents to your clinic with edema and complains of fatigue. He says that he noticed a slight red color to his urine: and upon further work up you notice that he has massive protein in his urine (3.5 gm).
What would you expect to see upon Light Microscopy?
Uniform, Diffuse thickening of the capillary wall -- Silver Staining Spikes of matrix that project from the BM toward the urinary spaces
A 45 year old male presents to your clinic with edema and complains of fatigue. He says that he noticed a slight red color to his urine: and upon further work up you notice that he has massive protein in his urine (3.5 gm).
What would you expect to see upon IF?
What would you see on EM?
A Granular “Lumpy Bumpy” IgG deposits
Epimembranous Deposits
A 45 year old male presents to your clinic with edema and complains of fatigue. He says that he noticed a slight red color to his urine: and upon further work up you notice that he has massive protein in his urine (3.5 gm).
What is the antigen causing complex formation?
What allele is associated with it?
PLA2R Ag
HLADQ1
A 45 year old male presents to your clinic with edema and complains of fatigue. He says that he noticed a slight red color to his urine: and upon further work up you notice that he has massive protein in his urine (3.5 gm).
What would the diagnosis be?
What physiologically is happening in this patient?
Membranous Nephropathy (Glomerulopathy)
He is having excessive complement activation (MAC) and IgG4
A 45 year old male presents to your clinic with edema and complains of fatigue. He says that he noticed a slight red color to his urine: and upon further work up you notice that he has massive protein in his urine (3.5 gm).
The patient later has ESRD, and undergoes a transplant – What is the outcome?
He has a high chance of of Reccurence of symptoms.
A 45 year old male presents to your clinic with edema and complains of fatigue. He says that he noticed a slight red color to his urine: and upon further work up you notice that he has massive protein in his urine (3.5 gm).
Because of his loss of protein what vital sign would you expect to be elevated?
You would expect him to have slightly elevated BP (maybe has mild HTN)
You have an adorable little 4 year old girl who arrives at your clinic. Her mother says she recently got some of her immunizations and now has some fluid build up. She is noted to have some eczema. Urine tests confirm your diagnoses.
What is the quickest way to help this patient, and get a diagnosis?
Give her some Corticosteroids to see if she improves. (Minimal Change Dz)
You have an adorable little 4 year old girl who arrives at your clinic. Her mother says she recently got some of her immunizations and now has some fluid build up. She is noted to have some eczema. Urine tests confirm your diagnoses.
What would be expected from the Urine Tests?
SELECTIVE Proteinuria (Albumin)