Week 1

Question 1

what are the nephritic syndromes?

Answer 1

1. IgA nephropathy
2. Pauci-immune glomerulonephritis
3. Henoch-Schonlein purpura
4. Goodpasture syndrome
5. post-infectious glomerulonephritis

Question 2

what are the nephrotic syndromes?

Answer 2

1. minimal change disease

2. focal segmental glomerulosclerosis

Question 3

essentials of diagnosis for nephritic syndromes

in severe/inflammatory cases of nephritic syndromes?

in rapidly progressive GMN in most severe cases?

Answer 3

1. glomerular hematuria (dysmorphic RBCs) and modest proteinuria
2. RBC casts (may be present)

in more severe/inflammatory cases:

1. glomerular hematuria and proteinuria
2. HTN
3. edema
4. rising Cr over days-months

rapidly progressive GMN in most severe cases:

1. glomerular hematuria and proteinuria
2. HTN and edema UNCOMMON
3. rising Cr over days-months

Question 4

what are the three steps in the initial evaluation of kidney disease?

Answer 4

1. estimation of disease duration
2. careful urinalysis
3. assessment of GFR

Question 5

what are the most common clinical S/Sx of kidney disease that might prompt a workup?

Answer 5

HTN, edema, nausea, hematuria

Question 6

azotemia

Answer 6

retention of creatinine and nitrogenous wastes (such are urea nitrogen) in the blood

Question 7

hyaline casts

Answer 7

concentrated urine, febrile disease, after strenuous exercise, in the course of diuretic therapy

Question 8

red cell casts

Answer 8

glomerulonephritis

Question 9

white cell casts

Answer 9

pyelonephritis, interstitial nephritis (indicative of infection or inflammation)

Question 10

renal tubular cell casts

Answer 10

acute tubular necrosis, interstitial nephritis

Question 11

coarse, granular casts

Answer 11

nonspecific; can represent acute tubular necrosis

Question 12

broad, waxy casts

Answer 12

CKD (indicative of stasis in enlarged collecting tubules)

Question 13

nephrotic syndrome

general findings and 6 key features

Answer 13

can present w/ spectrum of findings. asymptomatic proteinuria to edema (most common)

1. proteinuria >3gm/day
2. albumin

Question 14

most common cause of nephrotic syndrome in the US

Answer 14

diabetes mellitus

others: SLE, leukemia, focal glomerulonephritis in African Americans

Question 15

nephritic syndrome 7 key features

Answer 15

acute, subacute, or chronic.

1. hematuria*
2. RBC casts*
3. oliguria*
4. variable proteinuria

Question 16

describe the general urinalysis workup

Answer 16

1. dipstick eval (pH, protein, hemoglobin, glucose, ketones, bilirubin, nitrates, leukocyte esterase, sometimes spec. gravity)
2. microscopic assessment if dipstick is positive (formed elements)

Question 17

glomerulonephritis

Answer 17

term given to disease presenting in nephritic spectrum. usually signifies an inflammatory process causing renal dysfunction. can be acute, chronic, or indolent w/ progressive scarring.

Question 18

two major causes of AKI

Answer 18

1. ischemia

2. nephrotoxin exposure

Question 19

essentials of diagnosis for interstitial nephrisis

Answer 19

1. fever
2. transient maculopapular rash
3. acute or chronic kidney injury
4. pyuria (including eosinophiliuria), WBC casts, hematuria

classic triad: fever, rash, arthralgia (only present in 10-15% of cases)

Question 20

etiology of interstitial nephritis

Answer 20

interstitial inflammatory response mediated by T lymphocytes w/ edema and tubular cell damage. drugs (penicillin, cephalosporins, sulfa drugs, NSAIDS, rifampin, phenytoin, allopurinol, PPIs) account for 70% of cases. some other causes: infectious, immunologic.

Question 21

Tx of interstitial nephritis

Answer 21

supportive measures, remove inciting agent, may give short course of corticosteroids.

Question 22

what are the 4 major cardiovascular complications of CKD?

Answer 22

1. HTN (most common)
2. CAD
3. Heart failure
4. Pericarditis

Question 23

what are the 2 major hematologic complications of CKD?

Answer 23

1. anemia

2. coagulopathy