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Renal > SM 205 > Flashcards

SM 205 Flashcards

1
Q

How are renal syndromes classified?

A

Renal tubules are broadly classified as Glomerular and Tubular diseases

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2
Q

What are the two types of Glomerular renal syndromes?

A

Glomerular renal syndromes are classified as Nephrotic and Nephritic diseases

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3
Q

What are the 3 Nephrotic Glomerular diseases?

A

Minimal Change Disease FSGS Membranous Nephropathy

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4
Q

What are the 3 Nephritic Glomerular diseases?

A

Anti-GBM Disease Immune-complex mediated Glomerulonephritis Pauci-Immune Glomerulonephritis

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5
Q

What should be done if Hematuria is found?

A

Always repeat the urine! If it persists, urological workup If it doesn’t show up on the second urinalysis, treat it as transient and ignore it

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6
Q

Is most hematuria gross or microscopic?

A

Most hematuria is microscopic Gross hematuria suggests papillary necrosis

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7
Q

What should be done if Proteinuria is found?

A

If a small amount is found, repeat to see if it persists; if it doesn’t, treat it as transient due to exercise or infection If persistent or large amounts of protein, quantify with urine albumin/creatinine ratio

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8
Q

What are cellular casts?

A

Cells found in urine that suggest nephrotic syndrome

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9
Q

What is the purpose of a kidney biopsy?

A

Confirm diagnosis and dictate management

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10
Q

If the clinical picture and kidney biopsy do not agree, which one should you use to make a diagnosis?

A

Surprisingly, use the kidney biopsy

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11
Q

When is a kidney biopsy indicated?

A

When the cause of a kidney disease is not obvious

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12
Q

What is a characteristic trait of a nephrotic syndrome?

A

Heavy proteinuria

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13
Q

What is a characteristic trait of a nephritic syndrome?

A

Inflammation and hematuria

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14
Q

What are three ways to analyze kidney biopsies?

A

Light microscopy Immunofluorescence microscopy Electron microscopy

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15
Q

What is a characteristic trait of AKI?

A

Rising serum creatinine

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16
Q

What can light microscopy reveal?

A

Cell proliferation and lesions of the glomeruli

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17
Q

What can immunofluorescence microscopy reveal?

A

Specific Ig mediated diseases and complement mediated diseases

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18
Q

What can electron microscopy reveal?

A

Structural changes and immune complex deposits

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19
Q

What is the best microscopy to visualize the thickness of the glomerular membrane, deposits in the basement membrane, and podocyte foot processes?

A

Electron microscopy

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20
Q

What defines a nephrotic syndrome?

A

Proteinuria > 3g/day Hypoalbuminemia Hyperlipidemia Edema

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21
Q

What diseases can cause a nephrotic syndrome?

A

Minimal Change Disease FSGS Membranous Nephropathy

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22
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal Change Disease

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23
Q

What could cause Minimal Change disease in adults?

A

Medications like NSAIDS Malignancy

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24
Q

How does Minimal Change Disease present?

A

Sudden-onset edema described as “explosive”

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25
Q

What is Minimal Change disease?

A

Minimal Change disease is the most common cause of nephrotic syndrome in children, and commonly caused by NSAIDS in adults

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26
Q

How does Minimal Change disease appear on the 3 different types of microscopy?

A

Normal on Light Microscopy Negative on Immunofluorescent Diffuse podocyte foot process effacement on EM that appears “flattened”

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27
Q

What disease does this kidney biopsy suggest?

A

Minimal Change Disease due to the “flattened” foot processes

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28
Q

How is Minimal Change Disease treated?

A

Steroids

29
Q

How does FSGS present?

A

A nephrotoic syndrome secondary to HIV and Heroin that presnts with HTN, edema, and elevated serum creatinine

30
Q

What is needed to diagnose FSGS?

A

FSGS needs a kidney biopsy to be diagnosed

31
Q

Why is FSGS focal and segmental?

A

FSGS is focal because only some glomeruli involved
Segmental because only a portion of the Glomeruli is involved

32
Q

How does FSGS present on the three types of microscopy?

A

Need 1 or more leasions on light microscopy
Nonspecific staining on immunofluorescence
Podocyte foot process effacement on electron microscopy

33
Q

What disease is shown in this kidney biopsy?

A

FSGS due to only some glomeruli being involved and segmental because only parts of some glomeruli are effected

34
Q

How is FSGS treated?

A

DIfficult to treat, treat the secondary cause like HIV or obesity or try Calcineurin inhibitor for primary FSGS

35
Q

What is membranous nephropathy?

A

A primary nephrotic syndrome that can be associated solid tumors like lung cancer and NSAIDS and slow onset edema

36
Q

How is the edema in Membranous Nephropathy and Minimal Change disease differentiated?

A

Although both are nephrotic diseases, Membranous Nephropathy involves slow onset edema while Minimal Change disease is “explosive” and rapid

37
Q

What does Membranous Nephropathy present with on the three types of microscopy?

A

Thickened GBM on light microscopy
Granular IgG on Immunofluorescence
Subepithelial immune deposits on Electron microscopy

38
Q

What glomerular disease presents as “spikes and holes” on silver stain?

A

Membranous Nephropathy

39
Q

What glomerular disease can stain with +PLA2R?

A

Membranous Nephropathy

40
Q

What glomerular disease is shown on these slides?

A

Membranous nephropathy

41
Q

What is the treatment for Membranous Nephropathy?

A

RAAS blockade, immune modulation, or a known secondary cause

42
Q

What are the characteristics of Nephritic Syndrome?

A

Proteinuria < 3gm/day
Sequelae of glomerular inflammation
Renal Insufficiency
HTN
Edema

43
Q

How does proteinuria vary between Nephrotic and Nephritic syndromes?

A

Nephrotic syndromes have > 3gm/day while Nephritic syndrome have < 3gm/day

44
Q

How does Rapid Progressive Glomerulonephritis present on biopsy?

A

Crescent glomeruli

45
Q

What are the types of Nephritic syndrome?

A

Immune-complex mediated
Pauci-immune
Anti-glomerular Basement Membrane Disease

46
Q

What does this glomeruli biopsy show?

A

Crescent lesion indicative of nephritic disease

47
Q

What is the pathophysiology of anti-GBM disease?

A

Auto-antibodies against Type IV collagen in the basement membrane, that can also involve lung involvement (Goodpasture’s), as well as Malaise, Weight Loss, Hemoptysis

48
Q

What lab finding is specific for anti-GBM disease?

A

Anti-GBM antibodies

49
Q

What does anti-GBM disease look ike on biopsy?

A

Diffuse crescentic glomerulonephritis on light microscopy

50
Q

What is the treatment for Anti-GBM disease?

A

Very aggressive: steroids + cyclophosphamide + plasmapheresis

51
Q

What infection does post-infectious glomerulonephritis tend to follow?

A

Strep pneumo

52
Q

Describe the onset of post-infectious glomerulonephritis?

A

10-14 days after strep pharyngitis, with gross hematuria, fever, malaise, and HTN

53
Q

How does PIGN show up on labs?

A

Low C3/C4, +ASO titer, elevated Creatinine

54
Q

What presents as “starry sky” on immunofluorescence biopsy?

A

PIGN

55
Q

What is the treatment for PIGN?

A

Supportive (antibiotics for infection) or steroids if severe

56
Q

What is Lupus Nephritis?

A

An immune complex glomerulonephritis common in younger women with Lupus that causes malaise and edema

57
Q

What does lupus nephritis look like on labs?

A

+ANA, +anti-dsDNA, low C3/C4

58
Q

How is Lupus Nephritis managed?

A

Supportive if low systemic inflammation
Steroids + cyclophosphamide if active inflammation

59
Q

What is IgA nephropathy?

A

A common glomerulonephritis secondary to IBD or cirrhosis that causes hematuria at the same time or shortly after a URI

60
Q

What does IgA nephropathy look like on biopsy?

A

Mesangial proliferation, +IgA

61
Q

How is IgA nephropathy treated?

A

ACEi/ARB if mild
Steroids and immunosuppressants if severe

62
Q

What type of kidney disease is associated with Hepatitis C?

A

Membranoproliferative Glomerulonephritis (MPGN)

63
Q

What causes a “tram-track” apperance on silver stain?

A

Membranoproliferative Glomerulonephritis

64
Q

What causes necrotizing crescentic glomerulonephritis on bipsy?

A

Granulmoatosis with Polyangiitis

65
Q

What causes palpapble purpura?

A

Granulomatosis with Polyangiitis

66
Q

What causes +c-ANCA and PR-3 on labs?

A

Granulomatosis with Polyangiitis

67
Q

What is MPA?

A

Microscopic polyangiitis is a pulmonary-renal syndrome that causes hemoptysis, lower resporitary tract infections, and palpable purpura

Has necrotizing crescentic glomerulonephritis like GPA and positive MPO on labs

68
Q

What diesease has strong overlap between Nephritic and Nephrotic disease?

A

Lupus Nephritis and MPGN

Renal (19 decks)

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