glomerular disease

Question 1

What is the cutoff between nephrotic and nephritic syndromes in terms of proteinuria?

Answer 1

-nephritic has less than 3.5 g of protein per day in 24 hr urine collection

Question 2

What are the key labs/associations for nephrotic syndrome?

Answer 2

• > 3.5 g/ day of protein in 24 hr urine collection
• low albumen
• hyperlipidemia
• high risk of infection (lost immunoglobulins)
• increased risk of thromboembolism due to loss of ATIII

Question 3

What disease is similar to IgA nephropathy? What are key lab findings?

Answer 3

henoch schonlein purpura is similar. find increased serum IgA and mesangial cell proliferation

Question 4

What is the treatment for IgA nephropathy?

Answer 4

ACE-I and statins for persistent proteinuria; consider steroids if nephrotic syndrome appears

Question 5

What is the clinical presentation of goodpasture’s syndrome?

Answer 5

dyspnea, hemoptysis, myalgias, hematuria with IgG abs on against the glomerular and alveolar basement membranes

Question 6

What is alport syndrome? Findings under microscope?

Answer 6

• X-linked disease with associated high frequency hearing loss (and cataracts)
• due to a mutation in type IV collagen in the basement membrane
• Split basement membrane on EM

Question 7

What are the three categories of rapidily progressive glomerulonephritis?

Answer 7

1. anti-GBM (aka Goodpastures)
2. immune complex deposition disease
3. Pauci-immune- ANCA positive diseases like granulomatosis with polyangitis, churg-struass, mycroscopic polyangitis

Question 8

What renal diseases are associated with low complement?

Answer 8

SLE, post strep glomerulonephritis, cryoglobulinemia, membranoproliferative glomerulonephritis, endocarditis

Question 9

What is the most common cause of nephrotic syndrome in adults in the US? What conditions is it associated with?

Answer 9

FSGS
associateud with HIV and drug use, sickle cell- but often idiopathic
also most common in Af. americans and hispanics

Question 10

When are ACE-Is and statins helpful in glomerular disease?

Answer 10

-reduce proteinuria. listed for lupus nephritis, alport syndrome, IgA nephropathy, membranous glomerulonephritis
ACE-I obviously also helpful for diabetic nephropathy

Question 11

What is membranous nephropathy and what are associated conditions?

Answer 11

nephrotic, associated with hepatitis B and C, tumors, SLE, NSAIDs/penicillamine. this is due to immune complex deposition in the subepithelial space (“spike and dome” appearance)

Question 12

What is membranoproliferative glomerulonephritis?

Answer 12

• also due to immune complex deposition
• 2 types
• subendothelial- associated with Hep B and C
• intramembranous associated with C3 nephritic factor (too much complement activation)
• Also asociated with SLE, subacute bacterial endocarditis
• “tram track” appearance

Question 13

What is the tx for membranoproliferative glomerulonephritis?

Answer 13

steroids with ASA or dipyramidole may delay progression of renal disease