13: Glomerular Disease- Belz Flashcards Preview

CS4: Exam 1 > 13: Glomerular Disease- Belz > Flashcards

Flashcards in 13: Glomerular Disease- Belz Deck (21)
Loading flashcards...
1
Q

nephrotic v. nephritic

A

Nephrotic syndrome involves the loss of a lot of protein, whereas Nephritic syndrome involves the loss of a lot of blood

2
Q

s/s glomerulonephritis

A
    • edema
  • –gross hematuria (RBC casts and dysmorphic RBC)
    • lipiduria
    • proteinuria (correlates with glomerular damage)
    • renal failure can be rapidly progressive
3
Q

pt with hematuria but no protein in urine likely has

A

asymptomatic hematuria

biopsy will show normal, thin BM nephropathy or IgA nephropathy

4
Q

describe IgA nephropathy **

A

Asymptomatic hematuria with proteinuria

Macroscopic hematuria associated with upper respiratory infection***

This can be associated with Henoch-Schönlein Purpura

5
Q

pt with asymptomatic heamturia post upper respiratory infection. prtn 1.5 g — what would you do diagnosis and how?

A

Would you pursue a renal biopsy? Yes – he has more than 1 g prtn/day
What is the most likely finding? IgA nephropathy
What correlates best with this patient’s prognosis long term? By how much prtn is the urine

6
Q

describe rapidly progressive glomerulonephritis

A
Renal failure
Oliguria
Edema
Hypertension
Proteinuria
Hematuria – active sediment

MEDICAL EMERGENCY

7
Q

Pathologically, this class of glomerular disease is characterized by the presence of cellular crescents

A

these crescents are a result of proliferation of parietal epithelial cells

Rapidly Progressive Glomerulonephritis

8
Q

causes rapidly progressive glomurelonephritis

A

Direct immunoglobulin attack (goodpasture syndrome) —-Linear deposits of IgG in the glomerular basement membrane

Immune complex deposition (post infectious GN among other cuases — Granular pattern of immune complex deposition )

Pauci-immune (ANCA + associated - lack of immune complexes — Granulomatosis with Polyangiitis (GPA) (Wegener Granulomatosis)
Eosinophilic Granulomatosis with Polyangiitis (EGPA) (Churg-Strauss Syndrome)
Microscopic Polyangiitis (MPA)

9
Q

pt with 3 mo hx edema, normal edema, urinalysis revealed red blood cell casts and lots of prtn

what diagnosis? how?

A

nephritic syndrome (glomerular nephritis)

How would you treat this patient initially? Steroid – immune suppression

Would you pursue a renal biopsy? yes

What pathologic finding is likely in the glomeruli? proliferation of parietal epithelial cells – see crescents

What blood testing would you do to evaluate this patient further? – check ANCA, antibody tests

10
Q

most common cause of acute glomerulonephritis worldwide

A

Post infectious glomerulonephritis

In situ immune complex formation due to glomerular deposition of streptococcal nephritogenic antigens

11
Q
Clinical Characteristics = ???
Usually an antecedent history of group A strep infection.
Latent period is weeks
Edema
Gross hematuria
Hypertension
A

Post Infectious Glomerulonephritis

the latent period distinguishes from IgA nephropathy

Laboratory findings:
Hematuria with and without red blood casts***
Proteinuria
Depressed C3 and CH50 complement activity(Return to normal within 4-8 weeks)
Elevated antibody titers to extracellular streptococcal antigens

12
Q

An 8 year old male with no significant past medical history presents with gross hematuria, proteinuria (3 g/24 hours) and acute kidney injury. He had an upper respiratory infection 2 weeks ago. Testing for group A strep was positive

Would you biopsy this patient?
What would you likely find?
Would you expect resolution of the hematuria and proteinuria over time?
Would you expect improvement in his renal function?

A

Yes - renal failure

Find- crescents (proliferation)

yes - self limiting disease

Yes

13
Q

s/s =

Massive proteinuria (>3.5 g/24 hours)***
Hypoproteinemia/hypoalbuminemia (albumin less than 3 g/dl)
Edema
Hyperlipidemia
Thrombotic disease
Lipiduria
A

Nephrotic Syndrome

complications:
- Thrombosis secondary to loss of hemostasis control proteins
- Infections secondary to loss of immunoglobulins
- Accelerated atherosclerosis from hyperlipidemia
- Protein malnutrition
- Iron-resistant microcytic hypochromic anemia due to transferrin loss
- Hypocalcemia and secondary hyperparathyroidism (Vitamin D deficiency due to urinary excretion of cholecalciferol-binding proteins)
- Depressed thyroxine levels due to loss of thyroxine-binding globulins

14
Q

maltese crosses

A

nephrotic syndrome

15
Q

primary v. seconday nephrotic syndrome

A

primary - only kidney
Minimal change disease
Focal Segmental Glomerulosclerosis
Membranous glomerulopathy

secondary - systemic
Diabetic glomerulopathy
Amyloidosis

16
Q

epithelium with effaced foot processes with everything else normal

A

minimal change disease

17
Q

microalbuminuria

A

diabetic glomerulonephropathy **

also see kimmelstiel-wilson nodules

18
Q

A 76 year old male with 20 year history of type II diabetes mellitus complicated by diabetic retinopathy presents for evaluation of slowly progressive chronic kidney disease. His blood pressure is elevated at 160/80. 24 hour urine collection reveals 6 g per day of proteinuria.

Would you biopsy this patient?

What other testing might you do to evaluate this patient further?

What is the most likely cause of his chronic kidney disease and proteinuria?

How would you treat this patient?

A

No - doesn’t change tx

diabetic nephropathy - rule out some other causes too

treat the blood pressure

19
Q

mechanism of diabetic nephropathy **

A
    • Glomerular hypertension or systemic hypertension
  • -Hyperglycemia
  • -Advanced glycosylation end-products
  • -Growth factors (growth hormone, IGF 1, angiotensin II)
  • -Cytokines (TGFβ)
20
Q

describe glomerular hypertension

A

Intraglomerular pressure is a stimulus for mesangial matrix production and glomerulosclerosis

Blockade of the renin-angiotensin-aldosterone system (angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, renin inhibitors, and/or aldosterone antagonists) is important in alleviating this type of injury

21
Q

Indications for Percutaneous Renal Biopsy

A
    • The cause cannot be predicted with reasonable accuracy by less invasive procedure.
    • The signs and symptoms suggest a disease that can be diagnosed by pathologic evaluation.
    • The differential diagnosis included diseases that have different treatments or prognoses