Renal Syndromes Wall 4/24 HIGH YIELD Flashcards
Diagnosis of kidney disease is best accomplished by looking at what four pieces of information?
1) changes in serum creatinine
2) Abnormalities in urinalysis
3) Altered Renal Homeostasis
4) Abnormal kidney imaging studies
More specific diagnoisis is started by asking what 4 questions?
1) acute or chronic
2) pre, intrinsic, or post renal
3) Glomerular, tubular, vascular
4) Inflmammatory, non-inflammatory
5) Assoc w/underlying systemic disease
Three categories of intrinsic disease?
Glomerular, tubular, vascular
5 categories of glomerular disease?
Nephrotic, Nephritic, Mixed, Mesangial Nephritic,Chronic glomerular
What are the features of Nephrotic syndrome according to Nichols?
Edema, selective heavy proteinuria, hypoalbuminemia, hyperlipidemia
What will GFR look like in Nephrotic?
Probably normal
BP in nephrotic?
Normal
What is the typical level of proteinuria in nephrotic syndrome?
3g/day
Is the urinary sediment in Nephrotic active or inactive and what does this mean?
Urinary sediment is inactive (no red cells or red cell casts)
Name the nephrotic syndromes we covered
FSGS, Minimal Change, Membranous nephropathy, post-infectious glomerulonephritis
Common symptoms of Nephritic syndrome?
hematuria, renal insufficiency, hypertension
Name the nephritic syndromes we covered?
MPGN, Dense Deposit Disease, IgA nephropathy, Anti-GBM, Rapidly progressing GN, Alport Syndrome
Signs of mixed glomerular disease?
heavy proteinuria, low albumin and edema, inflammation, hematuria (all of these can be presesnt but dont have to be)
Ex: Lupus Nephritis stage 4 diffuse proliferative type
What are the signs of Mesangial Nephritic Syndrome
capillary are fine so you should have steady GFR, steady BP, can have Hematuria because it is inflammatory
3 types of Tubular syndromes?
Inflammatory interstitial (infectious and non-infectious, Non-inflammatory interstitial, chronic interstitial
Vascular syndromes?
Prerenal azotemic, renal artery stenosis, hypertensive nephrosclerosis, vasculitis
Renal artery stenosis related to what>
hypertension
What is pre-renal azotemia?
Nothing wrong with the Kidney, just not enough flow or pressure due to another problem
What is a typical dipstick analysis reading in nephrotic syndrome?
3+ or 4+
What is the most common type of nephrotic syndrome in children?
Minimal Change Disease
What is the most common glomerulopathy in caucasians?
Membranous Glomerulopathy
What is the most common nephrotic syndrome in African Americans
Focal Segmental Sclerosis
What is the most common form of nephrotic disease overall?
Diabetic Nephropathy
Nephritic syndrome is most characterized by what?
Inflammation in the glomerulus. Can be driven by immune complex, anti-GBM antibodies, ANCA. etc…
Inflammation in the glomerulus causes what in the urine?
Blood (microscopic or gross) or red cell casts
A red cell cast is made by a red cell trapped in what protein?
Tamm-Horsfall
Why are you more likely to see declining GFR with nephritic syndrome than with Nephrotic?
Endothelial cells are swollen shut so you lose surface area for filtration.
Why do you have hypertension in Nephritic syndrome
Low GFR so you are retaining salt and water to keep fluid volume.
Why does the retention of salt and water in Nephritic syndrome lead to HTN whereas salt and water retention in Nephrotic syndrome leads to edema?
In nephritic syndrome, the plasma oncotic pressure is fairly stable because you’re not losing albumin and other proteins so the salt and water retention distributes evenly to the extracellular space and you get plasma volume expansion as well as some ISF volume expansion
Pulmonary edema is caused by what?
increased plasma volume
Classic example of nephritic syndrome?
Poststreptococal glomeruloephritis
Classic example of glomerulonephritis restricted to the mesangial space?
IgA nephropathy
Most common example of Mixed Nephrotic/Nephritic
Diffuse proliferative Glomerulonephritis related to SLE
Membranoproliferative Glomerulonephritis is in which category of glomerular disease and frequently follows what disease?
Mixed, Hepatitis C
What is the appearace of the BM in MPGN?
Tram track appearance
What is a cryoblobulin disease?
Hepatitis C….IgM
What is the hallmark of tubule injury?
Decreased GFR.
WHy does low GFR occur with tubule injury
No reabsorption is occuring which kills the pressure differental between the capillaries and the urinary space so filtration can’t occur.
Do you lose the ability to dilute or to concentrate first?
Concentrate, Bilution is collecting duct/distal tubule process.
Isothenuric urine means what and when is it seen>
Isothenuric urine means that the urine osmolarity is the same as the plasma osmolarity in the glomerulus . This occurs during episodes of tubule injury when reabsorption can’t occur.
What is the specific gravity of isosthenuric urine?
1.010
Fractional excretion of urine during tubule injury>
over 1%
What types of casts are seen in a tbular disease urinalysis?
Granular casts
What is the proteinuria in tubular injury?
Very low, glomerulus works fine
Hallmark of inflammatory tubular injury>
Sterile pyuria…wbcs in urine not in respone to infection. Also look for eosinophils
Example of infectious inflammatory kidney injury?
Pyelonephritis
specific gravity of 1.010 means what?
You cant concerntrate urine pretty much
Nocturia is a sign of what?
Inability to concentrate urine
What types of casts are seen in interstitial kidney diseases?
Waxy casts
Most interstitial kidney diseases lead to what in regards to kidney morphology?
small kidneys
What does chronic calcineurin inhibitor (cyclosporin, tacrolimus) use lead to?
Nephrotoxicity
Vascular syndromes include?
Renal Artery stenosis, hypertensive nephrosclerosis, renal artery stenosis, prerenal azotemia
High BUN: Creatinine ratio is the best marker of what?
Pre-renal disturbance. Why does this make sense, because anytime you have a pre-renal disturbance that cuts down on kidney perfusion, you autoregulate to keep GFR normal, When you auto-regulate, you enhance proximal reabsorption b/c this is where bulk reabsorption o things like sodium and water takes place ANNND, urea follows water so BUN goes up. Sucka
Will urine be concentrated or dilute in vascular syndrome?
Concentrated…high spec gravity
What defines pre-renal azotemia
problem is above the kidneys, leads to poor perfusion.
Lab findinrgs in pre-renal azotemia?
high BUN: creatinine ratio, low FENA (frac excretion of sodium), concentrated urine,
Causes of pre-renal azotemia
anything that decreases blood flow or volume
What effect do NSAIDs have on the kidneys that can make pre-renal azotemia worse
NSAIDS block prostaglandin production which means the afferent arterioles cannot dilate
What effect do ACEi (angiotensin converting enzyme) and ARB (angiotensin receptor blocker) have on the kidneys that makes pre-renal azotemia worse?
they inhibit angiotensin II function…this prevents AII from doing its vasoconstriction work on the efferent arteriole
Hypertensive nephrosclerosis leads to what?
medial hypertrophy of renal arterioles, ischemic glomerular atrophy, decreased number of functioning nephrons
Noninflammatory means the urinalysis is bland
true
Hypertensive nephrosclerosis does what to kidney size?>
decreases it
Vasculitis involving the kidney is generally nephritic or nephrotic?
Nephritic
WHat are examples of vasculitis involving the kidney>
Anything that presesnts as hemolytic uremic syndrome (red cells being injured), polyarteritis nodosa, ANCA associated vasculitis, Malignant hypertension
Rapidly progressing glomerulonephritis includes?
Immune complex, anti-GBM, pauci-immune
How quickly does rapidly progressing glomerulonephritis move?
Gets worse within weeks
Name two immune complex RPGNs?
Lupus diffuse proliferative, post-strep
Anti-GBM?
antibody against the noncolagenous portion of type IV collages
Ploasmapharesis to remove antibody in what disease?
Anti-GBM
Pauci Immune?
No immune deposits when looked at underimmunoflourescence
Rapidly progressing glomerulonephritis also distinguised by what microscopic feature?
crescents
BU: creatinine ratio high?
Prerenal azotemia
BUN and Creatinine high
kidney failure
