Flashcards in Approach to Glomerular Disease Deck (23):
What kind of sediment has RBC casts, RBCs, WBCs, and variable proteinuria in range of 2-6 gms?
nephritic urinary sediment
RBC casts are pathognomonic of active glomerulonephritis
What kind of sediment has heavy proteinuria, oval fat bodies, fatty casts and free fat droplets?
nephrotic urinary sediment
What are Palmer's five clinical syndromes affecting the glomerulus?
acute glomerulonephritis (abrupt onset of nephritic)
asymptomatic hematuria and proteinuria
What are key differences between the presentations of nephritic syndrome and nephrotic syndrome?
nephritic is primary Na retention, nephrotic is secondary
HTN more common in nephritic
circulatory congestion (CHF) only in nephritic
GFR more severly reduced in nephritic
What is chronic glomerulonephritis?
progressive renal failure insidious in onset with varying degrees of hematuria, proteinuria and HTN
Difficult to determine what primary cause was
What lab and physical findings are present with chronic glomerulonephritis?
What specific organisms are people with nephrotic syndromes more vulnerable to?
encapsulated gram positives
How can acute glomerulonephritis be distinguished from RPGN?
GFR declines more rapidly in RPGN
acute often associated with preceding inf and can spontaneously resolve
What creatinine change means a patient has RPGN?
rise of over 2 in 3 months
What are secondary causes that can cause MCD?
NSAIDs - patients usually have acute interstitial nephritis too
If the sample obtained from a patient with FSGS has no areas of sclerosis, what can be the only clue to the diagnosis?
areas of tubular atrophy and interstitial fibrosis
What genes have been indicated to be involved in the familial form of FSGS?
alpha actinin 4
TRPC6 ion channel
formin family of actin regulatory proteins
What finding is associated with a particularly poor prognosis for FSGS?
massive proteinuria (>10/24 hrs)
What is HIVAN?
more common in black men
nephrotic syndrome, kidney insufficiency, and rapid progression to ESRD
viral inf of visceral epithelial cells
can have collapsing variant of FSGS or not
What are big differences with the physical findings present in HIVAN?
no edema or HTN
Kidneys are LARGE
tubulocystic lesions and tubuloreticular bodies on EM
What is frequently seen in association with dense deposit disease?
What is the third type of MPGN?
similar to type 1
subepithelial deposits prominent - also has subendothelial
complex disruption of GBM with large lucent areas
What finding is common to all types of MPGN?
via classic pathway in type 1
via alternate pathway in type 2
What is the main cause of AA amyloidosis?
develops secondary to chronic inflammatory states
What is AF amyloidosis?
abnormalities of transthyretin
also fibrinogen A alpha chain
What do RF, RPR tests and SPEP, UPEP tests look for in the evaluation of patients with glomerular disease?
RF indicates Hep C
RPR tests for syphilis
SPEP, UPEP look for AL amyloid
What is the progression of diabetic nephropathy?
Stage 1: renal hypertrophy and hyperfunction
Stage 2: clinically silent renal disease - BM thickening, mesangial expansion, GFR still high and no albuminuria
Stage 3: incipient nephropathy - microalbuminuria, nl GFR, no HTN
Stage 4: Overt diabetic nephropathy - decreased GFR and HTN
Stage 5: ESRD