308 Glomerulolar Disease Flashcards
(152 cards)
1
Q
What test will you do to assess risk for diabetic nephropathy?
A
Urine Creatinine: protein ratio
2
Q
50M mine worker presents with 2 months chronic cough, purulent nasal discharge and low grade fever. Treated with co-amoxiclav, however, develops shortness of breath and hemoptysis. PE +purpura on both hands and legs and crackles on right lower lung fields. Labs leukocytosis with neutrophilia, Creatinine 3.2 mg/dl and urinalysis +hematuria and proteinuria. CXR shows right lung nodule and non specific infiltrates. Biopsy of the pulmonary nodule shows neutrophilic microabscesses and necrotizing granuloma. What is the most likely diagnosis? A. Goodpasture's syndrome B. Churg Strauss syndrome C. Granulomatosis with polyangitis D. Microscopic polyangitis
A
C. Granulomatosis with polyangitis
3
Q
Glomerulonephritis that presents with gross hematuria
A
IgA nephropathy
Sickle cell disease
4
Q
Other differentials for microscopic hematuria not necessarily GN
A
BPH Interstitial nephritis Papillary necrosis Renal stones Cystic kidney disease Renal vascular injury
5
Q
Causes of transient proteinuria
A
Fever Exercise Obesity Sleep apnea Emotional stress CHF
6
Q
Proteinuria only seen in upright posture
A
Orthostatic proteinuria
7
Q
True or false. Proteinuria in adults and children with glomerular disase is selective and composed of albumin
A
False. Adults non selective. Albumin and mixture of other serum proteins
8
Q
Most common causes of GN in the western hemisphere
A
Malari
Schistosomiasis
HIV
Hepatitis B and C
9
Q
True or false. In chronic GN, decreased kidney size if often seen
A
True.
10
Q
When does GN occur after a skin infection? After strep pharyngitis?
A
Skin infection: 2-6 weeks
Pharyngitis: 1-3 weeks
11
Q
When does endocarditis associated GN typically occurs
A
Subacute bacterial endocarditis
Untreated for a long time
Negative blood cultures
Right sided endocarditis
12
Q
When goes GB in acute bacterial endocarditis occur
A
10-14 days
13
Q
Most common and serious complication of SLE
A
Lupus nephritis
14
Q
Most varies course of lupus nephritis
A
Class III
15
Q
The only reliable method of identifying morphologic variant of lupus nephritis
A
Renal biopsy
16
Q
Complication of class V lupus nephritis
A
Renal vein thrombosjs
Other thrombotic complications
17
Q
True or false. SLE tends to became quiescent once there is renal failure because of immunosuppressant effects of uremia
A
True
18
Q
When can renal transplant be done in patient with lupus nephritis
A
After 6 months of inactive disease
19
Q
What is the target epitopes for anti GBM disease
A
A3 NC1 domain of collagen IV
20
Q
Most common Glomerulonephritis world
A
IgA nephropathy
21
Q
Single most common cause of chronic renal failure
A
DM nephropathy
22
Q
What is a the characteristic lesion in HIV associated nephropathy
A
FSGS
Collapsing glomerulopathy
23
Q
plasma of water filtered by the glomerular capillaries
A
120-180 L/day
24
Q
True or false. The glomerulus is an imperfect barrier in the case of serum albumin
A
True.
25
what is the physical radius of albumin compared to the pores in the GBM and slit pore membranes
albumin has a physical radius of 3.6 nm while pores in the GBM and split ore membranes have a radius of 4 nm
26
how much albumin is voided in the urine daily
8-10 mg of albumin in daily voided urine
27
hematuria suspicous for GN
3-5 RBC in the spun sediment from first voided morning urine is suspicious
28
GN which presents with gross hematuria
IgA nephropathy and sickle cell disease
29
differential of microscopic hematuria
malignancy of urinary tract, BPH, interstitial nephritis, papillary necrosis, hypercalciuria, renal stones, cystic kidney disease, or renal vascular injury
30
found in the urine sediment which points more likely to glomerulonephritis
RBC casts, dysmorphic RBC
31
proteinuria in microalbuminuria
30-300 mg in 24 hrs
32
represents frank proteinuria and more advanced renal disease
more than 300 mg in 24 hours
33
Urine assays for Albuminuria/Proteinuria. Normal
24hr urine: 8-10 mg ACR less than 30 mg/g Dipstick proteinuria none 24hr urine protein less than 150 mg in 24 hr
34
24hr urine: 8-10 mg ACR less than 30 mg/g Dipstick proteinuria none 24hr urine protein less than 150 mg in 24 hr
24hr urine 30-300 mg ACR 30-300 mg/g Dipstick proteinuria trace to 1+ 24hr urine protein none
35
Urine assays for Albuminuria/Proteinuria. Proteinuria
24hr urine more than 300 mg ACR more than 300 Dipstick proteinuria 3+ 24hr urine protein more than 150
36
defined sustained proteinuria
more than 1-2 g/ 24 hrs
37
define benign proteinuria
less than 1 g/ 24 hrs
38
examples of functional or transient proteinuria
fever, exercise, obesity, sleep apnea, emotional stress, and CHF
39
True or false. Proteinuria in adults is nonselective containing albumin and other serum proteins whereas in children it is selective
True,
40
Patterns of clinical glomerulonephritis (6)
acute nephritic syndromes, pulmonary renal syndromes, nephrotic syndromes, basement membrane syndromes, glomerular vascular syndromes, infectious disease associated syndromes
41
stain used in renal biopsy to enhance basement membrane structure
Jones methenamine silver
42
stain used in renal biopsy to identify collagen deposition and assess the degree of glomerulosclerosis and interstitial fibrosis
Masson's trichrome
43
When do you say that the lesion is focal
less than 50% glomeruli involved
44
When do you say that the lesion is diffuse
more than 50% glomeruli involved
45
injury involving most of the glomerulus
global
46
injury involving portion of the tuft
segmental
47
refers to glomeruli showing increased cellularity
proliferative
48
refers to cellularity in the capillary tuft
endocapillary
49
when cellular proliferation extends into the Bowman's space
extracapillary
50
formed when epithelial podocytes attach to Bowman's capsule in setting of glomerular injury
synechiae
51
extension of the synechiae when fibrocellular fibrin collections fills all or part of Bowman's space
?
52
acellular, amorphous accumulations of proteinaceous material throughout the tuft with loss of capillaries and normal mesangium
sclerotic glomeruli
53
Examples of acute nephritic syndromes
Post strep GN, Subacute bacterial endocarditis, lupus nephritis, anti GBM disease, IgA nephropathy, Henoch Schonlein purpura etc
54
prototypical for acute endocapillary proliferative glomerulonephritis
postreptococcal glomerulonephritis
55
strain of streptococci which antedate glomerular disease in poststrep GN
M types of streptococci
56
M types streptococci seen in impetigo
47, 49, 55, 2, 60, 57 = higher number impetigo
57
M types streptococci seen in pharyngitis
1,2,3,4, 25,49, 12 = lower number pharyngitis
58
how many weeks does post strep GN develop after pharyngitis
1-3 weeks
59
how many weeks does post strep GN develop after impetigo
2-6 weeks
60
associated with subendothelial deposits or humps
post strep GN
61
nephritogenic antigen demonstrated inside the subepithelial humps on renal biopsy on poststrep GN
streptococcal pyrogenic exotoxin B (SPEB)
62
treatment of poststrep GN
supportive
63
What is the prognosis of poststrep GN
good in adulthood; worse in elderly with 60% progressing to ESRD
64
when does complete resolution of hematuria occurs in patients with poststrep GN
Within 3-6 week of the onset of nephritis
65
True or false. Endocarditis associated glomerulonephritis is a complication of SBE particularly in patients who remain untreated for a long time, have negative blood cultures or have right sided endocarditis
True.
66
why is glomerunephritis unusual in acute bacterial endocarditis
because it takes 10-14 days for immune complex mediated injury
67
what is the gross appearance of the kidneys in patients with endocarditis- associated glomerulonephritis
subcapsular hemorrhages with a flea beaten appearance
68
what is the primary treatment of endocarditis associated glomerulonephritis
4-6 weeks of antibiotics
69
what is the prognosis of SBE glomerulonephritis
guarded
70
common and serious complication of SLE
lupus nephritis
71
most common clinical sign of renal disease in SLE
proteinuria
72
antibodies that correlated best with presence of acute lupus nephritis
anti dsDNA
73
Class of lupus nephritis with most varied course
Class III
74
Class of lupus nephritis. Normal glomerular histoloy
Class I
75
Class of lupus nephritis. Mesangial immune complexes with mesangial proliferation
Class II
76
Class of lupus nephritis. Focal lesions with scarring.
Class III
77
Class of lupus nephritis. Diffuse proliferation
Class IV
78
Class of lupus nephritis. Thickened basement membrane
Class V
79
Class of lupus nephritis. Global sclerosis
Class VI
80
aggressive lesion in lupus nephritis has the worst renal prognosis
crescents on biopsy
81
define remission in lupus nephritis
near normal renal function and proteinuria less than 330 mg/dL per day
82
Lupus nephritis class predisposed to renal vein thrombosis and other thrombotic complications
lupus nephritis class V
83
when can patient with lupus nephritis have renal transplantation
After 6 months of inactive disease
84
targets epitopes for anti GBM disease
quaternary structure of a3 NC1 domain of collagen IV
85
True or false. Goodpasture's syndrome in younger age groups are usually explosive
True.
86
What is the prognosis of anti GBM glomerulonephritis
good prognosis with treatment
87
what is the treatment of anti GBM disease
plasmapharesis, oral prednisone and cyclophosphamide
88
one of the most common forms of glomerulonephritis worldwide
IgA nephropathy
89
Differential IgA with Henoch Schonlein purpura
HSP has prominent systemic symptoms, younger age, preceding infection and abdominal complaints
90
two most common presentations of IgA nephropathy
recurrent episodes of macroscopic hematuria during or immediately following an upper respiratory infection often accompanied by proteinuria or persistent asymptomatic microscopic heamturia
91
True or false. IgA nephropathy is a benign disease. Renal faillure seen only 25-30% over 20-25 years
True,
92
True or false. A group of patients with small vessel vasculitis and glomerulonephritis have serum ANCA
True.
93
two types of antibodies in ANCA small vessel vaculitis
anti proteinase (PR3) and anti myeloperoxidase (MPO)
94
ANCA positive vasculitis
granulamotosis with polynagiitis, microscopic polyangitis, Churg- Strauss syndrome
95
what is the induction therapy for ANCA small vessel disease
glucocorticoids and either cyclophosphamide or rituximab
96
given to induce remission in ANCA associated vasculitis
monthly pulse IV cyclophasphamide
97
patients with this disease present with fever, purulent rhinorrhea, nasal ulcers, sinus pain, polyarthrias/arthritis, cough, hemoptysis, shortness of breath, microscopic hematuria
granulomatosis with polyangitis
98
patients with this disease present with peripheral eosinophilia, cutaneous purpura, mononeuritis, asthma, and allergic rhinitis
Churg Strauss Syndrome
99
defined morphologically with dense deposits forming ribbons in the GBM
Dense Deposit Disease (DDD)
100
Formerly called MPGN type II
Dense Deposit Disease (DDD)
101
Recent disease classification that is defined by the glomerular accumulation of C3 with little or no immunoglobulin and encompasses dense deposit disease
C3 glomerulopathy
102
what is the prognosis of C3 glomerulopathy
poor with 50% progressing to ESRD
103
immune mediated glomerulonephritis characterized by thickening of the GBM with mesangioproliferative changes
MPGN or mesangiocapillary glomerulonephritis
104
Type of MPGN assocaitred with persistent hepatitis C infections, autoimmune disease like lupus
type I
105
most proliferative type of MPGN
type I
106
associated with tram tracking on renal biopsy
Type I MPGN
107
Characterized MPGN type II
low serum C3, dense thickening of the GBM containing ribbons of dense deposits and C3
108
MPGN characterized by focal proliferation with widened segments of the GBM that appear laminated and disrupted
Type III MPGN
109
True or false. Fifty percent of patients with MPGN develop ESRD 10 years after diagnosis and 90% have renal insufficiency after 20 years
True,
110
glomerulonephritis associated with plasmodium falciparum
mesangioproliferative glomerulonephritis
111
characterized by expansion of the mesangium, sometimes assocaited with mesangial hypercellularity, single contoured capillary walls and mesangial immune deposits
mesangioproliferative glomerulonephritis
112
classic presentation of nephrotic syndrome
heavy proteinuria, minimal hematuria, hypoalbuminemia, hypercholesterolemia, edema and hypertension
113
True or false. All patients with hypercholesterolemia secondary to nephrotic syndrome should be treated with lipid lowering agents because they are at increased risk for cardiovascular disease
True.
114
Causes 70-90% of nephrotic syndrome in children
Minimal change disease or nil lesions
115
how many percent does MCD cause nephrotic syndrome in adults
10-15%
116
characteristic of MCD
effacement of foot process on electron microscopy
117
who are called primary responders in patient with minimal change disease
remission or less than 0.2 mg/24h of proteinuria after single course of prednisone
118
who are called frequent relapser
two or more relapses in 6 months after taper
119
when an adult patient with MCD called steroid resistant
no response after 4 months of therapy
120
how long can adults have a remission in MCD
after a course of 20-24 weeks
121
what is the prognosis of MCD in adult
less favorable when acute renal failure or steroid resistance occurs
122
refers to a pattern of renal injury characterized by segmental glomerular scars that involve some but not all glomeruli
focal segmental glomerulosclerosis FSGS
123
the pathologic changes of FSGN are most prominent where
prominent in glomeruli located at the corticomedullary junction
124
most common cause of nephrotic syndrome in the elderly
membranous glomerulonephritis
125
what is the characteristic of membranous glomerulonephritis
uniform thickening of the basement membrane along the peripheral capillary loops
126
true or false. 20-30% of membranous glomerulonephritis is associated with malignancy
True,
127
has the highest reported incidences of renal vein thrombosis, pulmonary embolism, and deep vein thrombosis
membranous glomerulonephritis
128
sensitive indicator for the presence of diabetes but correlates poorly with the presence or absence of clinically significant nephropathy
thickening of the GBM
129
nodules associated with diabetic nephropathy
nodular glomerulosclerosis or Kimmelstiel- Wilson nodules
130
True or false. Renal biopsies from patients with types 1 and 2 diabetes are largely indistinguishable
True.
131
earliest manifestation of diabetic nephropathy
microalbuminuria or albuminura range of 30- 300 mg/24 hr
132
differential light chain deposition disease from cast nephropathy
light chain deposition disease cause nephrotic syndrome with renal failure; produce kappa light chains that do not have the biochemical features necessary to form amyloid fibrils
133
rare glomerulopathy characterized by glomerular accumulation of non branching randomly arranged fibrils
Fibrillary Glomerulonephritis
134
characteristic of renal amyloidosis
deposition of beta pleated sheets of serum amyloid protein
135
deficiency in Fabry's disease
deficient lysosomal alpha galactosidase
136
what is the effect of Fabry's disease
excess deposition of globotriaosylceramide
137
glomerulopathy what revels enlarged visceral epithelial cells packed with small clear vacuoles
Fabry's disease
138
chronic glomerulosclerosis leading to renal failure associated with sensorineural deafness
Alport's syndrome
139
some patients with this disease develop lenticonus of the anterior lens capsule, dot and fleck retinopathy
Alport's syndrome
140
True or false. Thin basement membrane disease have a benign course
True,
141
characterized by persistent or recurrent hematuria but no associated proteinuria, hypertension or loss of renal function or extrarenal disease
thin membrane disease TMD
142
what the renal biopsy picture of patient with HIV associated nephropathy
FSGS revealing a collapsing glomerulopathy
143
viral infection that can cuase endocapillary proliferative glomerulonephritis
dengue hemorrhagic fever and measles
144
viral infection that cause mesangial proliferative glomerulonephritis
Hanta virus, parvovirus, mumps, EBV,
145
viral infection that cuase focal glomerulonephritis or DPGN
coxsackie virus
146
schistosoma associated with clinical renal disease
schistosoma mansoni
147
glomerular lesson in Class I nephritis from schistosoma
Class I mesangioproliferative
148
glomerular lesson in Class II nephritis from schistosoma
extracapillar proliferative
149
glomerular lesson in Class III nephritis from schistosoma
membranoproliferative
150
glomerular lesson in Class IV nephritis from schistosoma
focal segmental glomerulonephritis
151
glomerular lesson in Class V nephritis from schistosoma
amyloidosis
152
classes of schistosoma nephritis associated with IgA immune deposits and progress despite antiparasitic or immunosuppressive therapy
Class III and IV
