Approach to Glomerular Disease Flashcards Preview

Block 6 - Renal > Approach to Glomerular Disease > Flashcards

Flashcards in Approach to Glomerular Disease Deck (23):
1

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

2

What kind of sediment has heavy proteinuria, oval fat bodies, fatty casts and free fat droplets?

nephrotic urinary sediment

3

What are Palmer's five clinical syndromes affecting the glomerulus?

chronic glomerulonephritis
nephrotic syndrome
acute glomerulonephritis (abrupt onset of nephritic)
RPGN
asymptomatic hematuria and proteinuria

4

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

5

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

6

What lab and physical findings are present with chronic glomerulonephritis?

nonspecific urinalysis
small kidneys

7

What specific organisms are people with nephrotic syndromes more vulnerable to?

encapsulated gram positives

8

How can acute glomerulonephritis be distinguished from RPGN?

GFR declines more rapidly in RPGN
acute often associated with preceding inf and can spontaneously resolve

9

What creatinine change means a patient has RPGN?

rise of over 2 in 3 months

10

What are secondary causes that can cause MCD?

NSAIDs - patients usually have acute interstitial nephritis too
Hodgkins

11

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

12

What genes have been indicated to be involved in the familial form of FSGS?

podocin
nephrin
alpha actinin 4
TRPC6 ion channel
CD2AP
formin family of actin regulatory proteins

13

What finding is associated with a particularly poor prognosis for FSGS?

massive proteinuria (>10/24 hrs)

14

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

15

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

16

What is frequently seen in association with dense deposit disease?

partial lipodystrophy

17

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

18

What finding is common to all types of MPGN?

hypocomplementemia
via classic pathway in type 1
via alternate pathway in type 2

19

What is the main cause of AA amyloidosis?

develops secondary to chronic inflammatory states

20

What is AF amyloidosis?

familial
abnormalities of transthyretin
also fibrinogen A alpha chain

21

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

22

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

23

How can microalbuminuria be detected?

urine spot test
albumin/creatinine ratio between 30-300
over 300 is now macroalbuminemia