308 - Glomerular Diseases (nephritic) Flashcards by Guy Schachter

Glomerular disease are usually accompanied by ___ and ___

hematuria

proteinuria

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In most cases hematuria will not be macroscopic, beside in the case of ___ and ___

IgA nephropathy

sickle cell anemia

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When microscopic anemia is found, we should rule out: (5). Also remember- kidney cysts and vascular kidney injury

BPH
IS nephritis
papillary necrosis 
hypercalciuria
nephrolithiasis

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When dysmorphic RBC or RBC ____ are found, there is a high chance for ____

casts

glomerulonephritis

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Common symptoms of proteinuria include: ___ and ____

edema

foamy urine

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Transient proteinuria is usually < ___ g/24hr. It is more common in situations such as: (5)

1
Fever
physical activity
obesity
OSA
CHF

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Glomerular proteinuria in the adult is non selective, while in ___ in children the proteinuria is selective- mostly for ____

MCD

albumin

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Pyuria is more common in ___ disease, such as: ___ or ____

inflammatory glomerular
post acute strep
MPGN

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Acute nephritic syndrome is define by proteinuria of ___g/24hr, ____, ___, ___, ____, ____ (5).

1-2
hematuria (with RBC casts)
pyuria
HTN
edema
decreased GFR

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Extreme acute nephritic syndrome may lead to ___ (RPGN) within days. The histopathological expression is called ____

Rapidly progressive glomerulonephritis

Crescentic glomerulonephritis

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Pulmonary renal syndrome is the combination of ___ and ___

RPGN

pulmonary bleeding

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Pulmonary renal syndrome may be caused by: (4)

Goodpasture’s syndrome
ANCA associated small vessel vasculitis
SLE
cryoglobulinemia

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Nephrotic syndrome is defined by massive proteinuria > ___ gr/24hr, ___,___,___,___,____ (5)

3
HTN
hypercholesterolemia
hypoalbuminemia
edema
microscopic anemia

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Basement membrane syndrome may be caused by a genetic mutation (___), or autoimmune process harming the GBM (___).

Alport’s syndrome

Goodpasture’s syndrome

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Basement membrane syndrome manifestations include: (4)

microscopic hematuria
proteinuria
HTN
decreased renal function

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Glomerular vascular syndrome may lead to ____ or ___

hematuria

proteinuria

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Glomerular vascular syndrome may be caused by: (5)

vasculitis
thrombotic microangiopathy
atherosclerosis 
cholesterol thrombi
HTN

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Common causes for infectious disease associated syndrome include: (5)

SBE
malaria
schistosomiasis 
HIV
HBV/HCV

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Name 6 clinical glomerular syndromes: (6)

acute nephritic syndrome
pulmonary renal syndrome
nephrotic syndrome
basement membrane syndrome
glomerular vascular syndrome
infectious disease associated syndrome

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When classifying acute vs chronic state we can notice that in the acute state it is more common to see ___ and uremic symptoms (___,___,___,___)

lethargy 
nausea
vomiting
fluid edema
drowsiness

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In chronic cases the patients may be ____

asymptomatic

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In acute nephritic syndrome there is an extensive damage to the ___, leading to a decrease in ___ therefor ___ and ___

glomeruli
GFR
fluid retention
electrolytes

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PSGN appears after cutaneous infection (___)- 2-6 weeks after, or throat infection (____) 1-3 weeks after

impetigo

pharyngitis

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PSGN more common in ___ countries, in the ages of ___ and in ___ countries in ___ population with comorbidities. Generally it is more common in ___

developing 
2-14
developed
elder 
men

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The pathology of PSGN includes ___ of the ___ and ___ cells

hypocellularity mesangial endothelial

In PSGN we can find glomerular infiltration of ___, subendothelial granular sediments of ___ and ___ (C3-9, IgM, IgG)

PMN immunoglobulins complements

Systemic symptoms of PSGN include in 50%- (4)

headache malaise anorexia flan pain (due to capsule swelling)

In PSGN patients lab work, 90% of patients will have a depressed ___ test and low levels of ___ together with normal levels of ___

CH50 C3 C4

Testimony of strep infection in PSGN can be: ____ (10-70%), ___ (30%), ___ (70%), ___ (40%). Sometimes RF will be positive together with p-ANCA

Positive culture ASO anti DNAase anti hyaluronidase

Treatment for PSGN includes supportive care- controlling ___ and ___, sometimes to the point of dialysis. Treat also with ___ both the patients and relatives.

HTN edema Abx

SBE (___)

subacute endocarditis

SBE patients mechanism is ___ sediments from circulation with ___ activation

immune complexes | complement

SBE clinic includes ___ (micro/macro), ____, and light ___.

hematuria pyuria proteinuria

Lab work of SBE may reveal: (5)

``` normocytic anemia Cr ESR complement decrease ANCA ```

Treatment of SBE should be focused on ___ the pathogen with prolonged Abx (___ weeks)

eradication | 4-6

In lupus nephritis there is a high correlation between the ___ and the ___ of the disease

pathology | stage

Lupus nephritis can be classified into __ stags: (6)

``` 6 minimal mesangial mesangial proliferation focal nephritis diffuse nephritis membranous nephritis sclerotic nephritis ```

The mechanism in lupus nephritis is based on ____ sediments, leading to an ____ reaction

immune complexes | inflammatory immune

The clinical presentation of lupus nephritis includes mostly ___, but also ___

proteinuria | nephritic symptoms

The best lab result for diagnosing lupus nephritis is ___. Other values may include ___ (70-90%). ___ should be performed only after we see a pathological picture in ____

anti ds- DNA hypocomplementemia biopsy urine sample

class 1/2 (minimal mesangial\ mesangial proliferation) of lupus nephritis: (2)

Good prognosis | no treatment is needed

class 3 of lupus nephritis (focal nephritis)- symptoms may include (4). Mild proliferation usually respond to ___

``` HTN urine casts proteinuria Cr increase steroids ```

class 4 of lupus nephritis (diffuse nephritis) is usually with high titer of ___, low levels ___, hematuria, ___ casts, proteinuria, ___, and renal dysfunction. treatment include: ____+___/____ for 2-6 months

``` anti DNA complement RBC HTN High dose steroids cyclophosphamide mycophenolate ```

class 6 of lupus nephritis (sclerotic nephritis)- most patients will need ____ or ____

kidney transplantation | dialysis

Anti GBM (___) is an autoimmune disease in which antibodies are formed against component of __ in the GBM. In some cases they show together with lung bleeding- ____ syndrome.

glomerular BM disease collagen Goodpasture's

In anti GBM disease when performing biopsy, we can see focal or segment ___ followed by ___ and crescent formation in the bowman space, meanwhile development of ___ and ___. In immunofluorescence ___ will show.

``` necrosis proliferation nephritis IS fibrosis IgG ```

A typical anti GBM patient could be a ___ years old ___ with a sharp drop of ___ levels, ___, dyspnea, and ___.

20 man hemoglobin hematuria

Beside young men, other typical anti-GBM patients may be in their ___ decade of life. In this case the disease is ___ with __ renal prognosis. Oliguria usually suggest ___ prognosis.

6-7 asymptomatic worse bad

Anti GBM calls for an urgent kidney ___ . Serum AB against GBM- mostly ___________.

biopsy | alpha 3 NC1 domain of collagen type 4

In vasculitis associated variant of anti GBM 10-15% of patients will have ____ AB against ___- it is a vasculitis variant of ___. ____ levels will be normal

pANCA MPO Goodpasture's complement

Treatment for anti GBM includes 8-10 courses of __, in the first 2 weeks ___ should be given as well.

plasmapheresis prednisone cyclophosphamide

Anti GBM has a bad prognosis when the patients has >___% of and advanced ___ in the biopsy, ___>5-6 mg/dL, ___, a need for urgent dialysis.

crescents fibrosis Cr oliguria

IgA nephropathy is defined by an episodic ___ and mesangial deposition of ___. It is one of the most common forms of ___. More common in ___ in their __ decade of life

``` hematuria IgA GN men 2-3 ```

The mechanism of IgA nephropathy is ___ deposition in the ___

IgA | glomeruli

IgA nephropathy can present in 2 ways: ____ episodes during/after ___ (usually also with ___). or- prolonged ___ ____

``` macrohematuria URTI proteinuria asymptomatic microhematuria ```

Diagnosis of IgA nephropathy requires kidney ___

biopsy

Treating IgA nephropathy includes ___. When RPGN-> ___,___,___

ACEi steroids cytotoxic plasmapheresis

In benign IgA nephropathy __% of patients will go through complete remission. When the disease is progressive- renal failure will occur in ___% of patients ___ years after. Risk factors include: (5)

``` 5-30 25-30 20-25 HTN proteinuria>6 months sex old age bad biopsy ```

ANCA small vessel vasculitis is defined by ___ with ___ and positive ___

GN vasculitis ANCA

In ___ it is more common to see ____ and in ____ and ___ it is more common to see ___

``` Wegener's cANCA microscopic polyangiitis Churg Strauss syndrome pANCA ```

In all of the ANCA small vessel vasculitis treatment includes a combination of ___, ___, and ___ in the acute phase, followed by maintenance of ___/___ for a year.

``` plasmapheresis steroids cyclophosphamide cyclophosphamide azathioprine ```

Wegner's granulomatosis = _____

granulomatosis with polyangiitis

in granulomatosis with polyangiitis patients are usually with: ___, purulent rhinorrhea, nasal ulcers, ___, polyarthralgia/____, cough, ___, dyspnea, micro-____ and proteinuria.

``` fever sinusitis arthritis hemoptysis hematuria ```

In Wegener's CXr we may see- ___, ___ and sometimes ___

Pulmonary nodules infiltrations cavitation

In granulomatosis with polyangiitis biopsy we will see a mixed tissue of: ____ and ____

noncaseating granulomas | small vessel vasculitis

When Wegner's is active the biopsy will show- ____ without immune deposition

segmental necrotizing glomerulonephritis

Risk factors for granulomatosis with polyangiitis include: ___ exposure and ___ deficiency

Silica | alpha 1 antitrypsin

Microscopic polyangiitis is similar to WG but without ___/___ involvement. Also, we will not find ___ in biopsy and the damage is limited to the ____

lung sinusitis granulomas capillary/venules

Churg Strauss syndrome is defined by ___ with ___. Other symptoms may include: (4)

``` small vessel vasculitis eosinophilia purpura mononeuritis multiplex allergic rhinitis/asthma ```

MPGN= ____

membranoproliferative glomerulonephritis

MPGN is defined by GN mediated by the ___ system, characterized by thickening of the ___ with ___ changes. in 70% we will see ____. The idiopathic forms are usually seen in young adults or ___

``` immune GBM mesangial proliferative hypocomplementemia children ```

How many types of MPGN are there?

Type 1 MPGN is associated with prolonged infection of ___, autoimmune disease (___/___), and ___. It is the most ___ form

HCV SLE cryoglobulinemia proliferative

In type 1 MPGN biopsy we may find ___+____ , ____ between the BM and the endothelial cells (double contour). In 50% of cases there will be low levels of ___

lobular segmentation mesangial proliferation mesangial interposition C3

Type 2 MPGN is mostly ___. There is a ___ of the GBM with ribbons of dense deposits of ___

Idiopathic dense thickening C3

Type 3 MPGN is usually ___, possibly with ____ deposition along the widened segments of the ___

Focal sub epithelial GBM

Type 1 MPGN is caused by ___ deposition from a circular/in situ source. Type 2/3 are associated with ___- Ab activating ___

immune complex nephritic factors C3

The clinical presentation of MPGN includes: (5)

``` proteinuria hematuria pyuria systemic symptoms low C3 ```

Treating MPGN includes- ___ in patients with proteinuria. ___ or ___could also be benefitable

RAAS inhibitors steroids plasmapheresis

The prognosis of MPGN- __% of patients will develop ESRD within __ years, 90% will reach CKD within ___ years. Risk factors- ___, ___, ___.

``` 50 10 20 HTN nephrotic syndrome renal insufficiency ```

Class 5 of lupus nephritis is characterized as ___

membranous nephritis

In class 5 lupus nephritis there is an increased risk for___ complications including in the __

thromboembolic | renal vein

308 - Glomerular Diseases (nephritic) Flashcards

(82 cards)