SU2M - Glomerular Disease Flashcards
Pathogenesis of nephritic v nephrotic syndrome?
- nephrITIC= inflammation of glomeruli due to any cause of glomerularnephritis
- nephrOTIC= abnormal glomerular permeability due to a number of conditions
3 Causes of glomerular nephritis?
- Immune-mediated disease –> most common!
- Metabolic disturbance
- Hemodynamic disturbance
Causes of nephritic v nephrotic syndrome?
- nephrITIC = poststreptococcal glomerulonephritis is the most common cause (can be due to any cause of glomerularnephritis)
- nephrOTIC = membranous glomerulonephritis is the most common cause in adults (other causes = DM, SLE, etc) and minimal change disease is the most common cause in children
Lab findings in nephritic (3) v nephrotic (3) syndrome?
- nephrITIC:
1. Hematuria
2. AKI = azotemia, oliguria
3. Protienuria –> if present, will be mild and NOT in the nephrotic range - nephrOTIC:
1. Proteinuria >3.5 g/24hr
2. Hypoalbuminemia
3. Hyperlipidemia –> w/ fatty casts in the urine
Clinical findings of nephrITIC (2) v nephrOTIC (3) syndrome?
- nephrITIC:
1. HTN
2. Edema - nephrOTIC:
1. Edema
2. Hypercoagulable state
3. Increased risk of infection
Glomerular disease v. Tubular dz: acute or chronic?
- GD = chronic
- TD = acute
Glomerular v. Tubular disease: which is usually caused by toxins?
-TD!
Glomerular v. Tubular disease: which can cause nephrotic syndrome?
-GD!
Glomerular v. Tubular disease: require biopsy?
-ONLY GD!
Glomerular v. Tubular disease: steroids and/or immunosuppresive medications for tx?
-both steroids and immunosuppresive medications are used to tx GD
Who is minimal change disease typically seen in?
- children
- also associated with hodgkin’s and non-hodgkin’s lymphoma
Minimal change’s disease: histology?
- NONE seen with light microscope!
- see fusion of foot processes on EM
Minimal change disease: prognosis?
- very responsive to steroid tx (4-8 wks)
- but relapses can occur
What is most likely the cause of minimal change disease?
-T cell dysfunction
Focal segmental glomerulosclerosis: who is it most commonly seen in? What 2 ssx are often present?
- most commonly seen in adults, esp blacks
- often seen with hematuria and HTN
Focal segmental glomerulosclerosis: prognosis
- fair to poor prognosis
- generally resistant to steroid tx
- pts usually develop renal insufficiency w/in 5-10 yrs of diagnosis
- progressive dz
Focal segmental glomerulosclerosis: tx?
- controversial
- cytotoxic agents, steroids, immunosuppressive agents, and ACEi/ARBs are all options
Membranous glomerulonephritis: common presentation?
- presents with nephrotic syndrome
- glomerular capillary walls are thickened
Causes of primary and secondary membranous glomerulonephritis?
- primary: usually idiopathic
- secondary:
1. Infection - hep C, hep B, malaria, syphilis
2. Drugs - gold, captopril, penicillamine
3. Neoplasm
4. Lupus
Membranous glomerulonephritis: prognosis?
- fair to good
- course can be variable
- remission can happen in 40% of the cases
- renal failure occurs in 33% of cases
- steroid tx does not change survival rate
How does IgA nephropathy usually present?
- recurrent asymptomatic hematuria/mild proteinuria
- or gross hematuria after URI (or exercise)
- renal function is usually normal
- *this is th most common cause of glomerular hematuria
IgA nephropathy: histology?
-mesangial deposits of IgA and C3 seen on EM
IgA neohropathy: prognosis?
- good as long as renal fctn is preserved
- renal insufficiency can occur in 25% of cases
IgA nephropathy: tx?
- no tx has been proven to be effective
- steroids are sometimes used for unstable dz
Hereditary nephritis: genetics?
-x-linked or autosomal-dominant with variable penetrance
Hereditary nephritis: ssx?
- AKA Alport’s syndrome
1. Hematuria
2. Pyuria
3. Proteinuria
4. High-freq hearing loss, w/out deafness
5. Progressive renal failure
Hereditary nephritis: tx?
-No effective tx
Most common cause of end stage renal disease?
-diabetic nephropathy
Membranoproliferative glomerulonephritis: causes
- usually due to hep C
- other causes: hep B, syphilis, or lupus
Membranoproliferative glomerulonephritis: prognosis?
- prognosis is poor
- renal failure develops in 50% of pts
Most common cause of nephritic syndrome?
-post streptococcal GN
Poststeptococcal glomerulonephritis: who is it commonly seen in? When?
- primarily seen in children
- 10-14 days after an infection with group A beta-hemolytic step infection of upper resp tract or skin (impetigo)
Poststreptococcal GN: ssx (6)?
- Hematuria
- Edema
- HTN
- Low complement levels
- Proteinuria
- Elevated antistreptolysin-O
Poststreptoccoal GN: tx?
- usually supportive
- antiHTNs
- loop diuretics –> edema
- antibiotics –> controversial
- steroids –> can be helpful in severe cases
Goodpasture’s syndrome: classic triad?
- Proliferative glomerulonephritis –> usually crescentic
- Pulmonary hemorrhage
- IgG anti-glomerular basement membrane antibody
Goodpasture’s syndrome: clinical features (4)?
- Rapidly progressive renal failure
- Hemoptysis
- Cough
- Dyspnea
* *lung disease usually precedes kidney disease by days to weeks
Goodpasture’s syndrome: histology?
-renal biopsy shows linear immunofluorescence pattern
Goodpasture’s syndrome: tx?
- plasmaphresis –> remove circulating anti-IgG antibodies
- cyclophosphamide and steroids –> decrease the formation of new antibodies
HIV nephropathy: ssx?
- Proteinuria
- Edema
- Hematuria
HIV proteinuria: histopathology?
-looks like a collapsing form of focal segmental glomerulosclerosis
HIV nephropathy: tx (3)?
- Prednisone
- ACEi
- Antiretroviral tx
