SM 205 Flashcards
How are renal syndromes classified?
Renal tubules are broadly classified as Glomerular and Tubular diseases
What are the two types of Glomerular renal syndromes?
Glomerular renal syndromes are classified as Nephrotic and Nephritic diseases
What are the 3 Nephrotic Glomerular diseases?
Minimal Change Disease FSGS Membranous Nephropathy
What are the 3 Nephritic Glomerular diseases?
Anti-GBM Disease Immune-complex mediated Glomerulonephritis Pauci-Immune Glomerulonephritis
What should be done if Hematuria is found?
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
Is most hematuria gross or microscopic?
Most hematuria is microscopic Gross hematuria suggests papillary necrosis
What should be done if Proteinuria is found?
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
What are cellular casts?
Cells found in urine that suggest nephrotic syndrome
What is the purpose of a kidney biopsy?
Confirm diagnosis and dictate management
If the clinical picture and kidney biopsy do not agree, which one should you use to make a diagnosis?
Surprisingly, use the kidney biopsy
When is a kidney biopsy indicated?
When the cause of a kidney disease is not obvious
What is a characteristic trait of a nephrotic syndrome?
Heavy proteinuria
What is a characteristic trait of a nephritic syndrome?
Inflammation and hematuria
What are three ways to analyze kidney biopsies?
Light microscopy Immunofluorescence microscopy Electron microscopy
What is a characteristic trait of AKI?
Rising serum creatinine
What can light microscopy reveal?
Cell proliferation and lesions of the glomeruli
What can immunofluorescence microscopy reveal?
Specific Ig mediated diseases and complement mediated diseases
What can electron microscopy reveal?
Structural changes and immune complex deposits
What is the best microscopy to visualize the thickness of the glomerular membrane, deposits in the basement membrane, and podocyte foot processes?
Electron microscopy
What defines a nephrotic syndrome?
Proteinuria > 3g/day Hypoalbuminemia Hyperlipidemia Edema
What diseases can cause a nephrotic syndrome?
Minimal Change Disease FSGS Membranous Nephropathy
What is the most common cause of nephrotic syndrome in children?
Minimal Change Disease
What could cause Minimal Change disease in adults?
Medications like NSAIDS Malignancy
How does Minimal Change Disease present?
Sudden-onset edema described as “explosive”
What is Minimal Change disease?
Minimal Change disease is the most common cause of nephrotic syndrome in children, and commonly caused by NSAIDS in adults
How does Minimal Change disease appear on the 3 different types of microscopy?
Normal on Light Microscopy Negative on Immunofluorescent Diffuse podocyte foot process effacement on EM that appears “flattened”
What disease does this kidney biopsy suggest?
Minimal Change Disease due to the “flattened” foot processes
How is Minimal Change Disease treated?
Steroids
How does FSGS present?
A nephrotoic syndrome secondary to HIV and Heroin that presnts with HTN, edema, and elevated serum creatinine
What is needed to diagnose FSGS?
FSGS needs a kidney biopsy to be diagnosed
Why is FSGS focal and segmental?
FSGS is focal because only some glomeruli involved
Segmental because only a portion of the Glomeruli is involved
How does FSGS present on the three types of microscopy?
Need 1 or more leasions on light microscopy
Nonspecific staining on immunofluorescence
Podocyte foot process effacement on electron microscopy
What disease is shown in this kidney biopsy?
FSGS due to only some glomeruli being involved and segmental because only parts of some glomeruli are effected
How is FSGS treated?
DIfficult to treat, treat the secondary cause like HIV or obesity or try Calcineurin inhibitor for primary FSGS
What is membranous nephropathy?
A primary nephrotic syndrome that can be associated solid tumors like lung cancer and NSAIDS and slow onset edema
How is the edema in Membranous Nephropathy and Minimal Change disease differentiated?
Although both are nephrotic diseases, Membranous Nephropathy involves slow onset edema while Minimal Change disease is “explosive” and rapid
What does Membranous Nephropathy present with on the three types of microscopy?
Thickened GBM on light microscopy
Granular IgG on Immunofluorescence
Subepithelial immune deposits on Electron microscopy
What glomerular disease presents as “spikes and holes” on silver stain?
Membranous Nephropathy
What glomerular disease can stain with +PLA2R?
Membranous Nephropathy
What glomerular disease is shown on these slides?
Membranous nephropathy
What is the treatment for Membranous Nephropathy?
RAAS blockade, immune modulation, or a known secondary cause
What are the characteristics of Nephritic Syndrome?
Proteinuria < 3gm/day
Sequelae of glomerular inflammation
Renal Insufficiency
HTN
Edema
How does proteinuria vary between Nephrotic and Nephritic syndromes?
Nephrotic syndromes have > 3gm/day while Nephritic syndrome have < 3gm/day
How does Rapid Progressive Glomerulonephritis present on biopsy?
Crescent glomeruli
What are the types of Nephritic syndrome?
Immune-complex mediated
Pauci-immune
Anti-glomerular Basement Membrane Disease
What does this glomeruli biopsy show?
Crescent lesion indicative of nephritic disease
What is the pathophysiology of anti-GBM disease?
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
What lab finding is specific for anti-GBM disease?
Anti-GBM antibodies
What does anti-GBM disease look ike on biopsy?
Diffuse crescentic glomerulonephritis on light microscopy
What is the treatment for Anti-GBM disease?
Very aggressive: steroids + cyclophosphamide + plasmapheresis
What infection does post-infectious glomerulonephritis tend to follow?
Strep pneumo
Describe the onset of post-infectious glomerulonephritis?
10-14 days after strep pharyngitis, with gross hematuria, fever, malaise, and HTN
How does PIGN show up on labs?
Low C3/C4, +ASO titer, elevated Creatinine
What presents as “starry sky” on immunofluorescence biopsy?
PIGN
What is the treatment for PIGN?
Supportive (antibiotics for infection) or steroids if severe
What is Lupus Nephritis?
An immune complex glomerulonephritis common in younger women with Lupus that causes malaise and edema
What does lupus nephritis look like on labs?
+ANA, +anti-dsDNA, low C3/C4
How is Lupus Nephritis managed?
Supportive if low systemic inflammation
Steroids + cyclophosphamide if active inflammation
What is IgA nephropathy?
A common glomerulonephritis secondary to IBD or cirrhosis that causes hematuria at the same time or shortly after a URI
What does IgA nephropathy look like on biopsy?
Mesangial proliferation, +IgA
How is IgA nephropathy treated?
ACEi/ARB if mild
Steroids and immunosuppressants if severe
What type of kidney disease is associated with Hepatitis C?
Membranoproliferative Glomerulonephritis (MPGN)
What causes a “tram-track” apperance on silver stain?
Membranoproliferative Glomerulonephritis
What causes necrotizing crescentic glomerulonephritis on bipsy?
Granulmoatosis with Polyangiitis
What causes palpapble purpura?
Granulomatosis with Polyangiitis
What causes +c-ANCA and PR-3 on labs?
Granulomatosis with Polyangiitis
What is MPA?
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
What diesease has strong overlap between Nephritic and Nephrotic disease?
Lupus Nephritis and MPGN
