Glomerular Disease 1

Question 1

how does glomerular disease present?

Answer 1

Hematuria (quality)

Loss of GFR (temporal change)

Proteinuria (quantity)

Question 2

factors of nephrotic syndrome

Answer 2

Proteinuria >3.5 g/day

Hypoalbuminemia

Edema

Hyperlipidemia (increased hepatic production)

Lipiduria

Hypercaogulabiltiy (loss of anticoag C and S)

Question 3

nephrtitis

Answer 3

mild proteinuria

**Hematuria **(RBCs, RBC casts, dysmorphic RBCs)

HTN

Edema

Question 4

causes of acute glomerulonephritis

Answer 4

IgA nephropathy

Post-infectious GN

Anti-GMB disease / good pastures

small vessel vasculitis

lupus nephritis

membranproliferative GN

(I poop good, small, little, marbels)

Question 5

most common Gn

Answer 5

IgA nephropahty

Question 6

most prominent feature IgA nephropathy

Answer 6

hematuria (50-60% episodic, 30% persistent, 10% acute Gn or nerphtoic syndrome)

Question 7

presentation IgA nephropathy

Answer 7

Dysuria

Loin Pain

Hematuria

co-present w/ URI (synpharrngitic hematuria)

pos HTN

Question 8

Histology IgA nephopathy

Answer 8

LM - messangianl hypercellularity, scelorosis+necrosis with crescents

IF: **Msangial IgA deposition **

EM- mesangional paramesangial elctron dense deposits

Question 9

treatment IgA nephropathy

Answer 9

fish oil may slow

ACE

corticosteroids or other immunosuppresants

Question 10

presentation Henoch-Schonlein Purpura

Answer 10

skin non blanching pupura on legs+buttucks

transient arthraligias

GI (hematochezia)

kidney - hematuria, proteinuria

Question 11

infection presentation post infectious GN

Answer 11

7-14 days post pahryngitis, 14-28 post skin infection (esp A beta hemolytic strep)

Question 12

clinical presentatiion Post strep GN

Answer 12

sudden onset HTN

azotemia

oliguria

edema

tea-colored urine

**Labs: **low C3 comp, ASO elevated, RBC casts in urine, proteinuria

Question 13

histo post strep GN

Answer 13

LM - enlarged hypercell. glomeruli

diffuse mesangial+endocapilary proliferation with PMNs

crescents

**IF **granular capillary wall, mesangial IgG and C3

EM: Mesangial and large subepithelial humb-like deposits

Question 14

causes of rapidly progressive GN

description

Answer 14

classic nephritic syndrome with rapid progression to renal failure

anti GBM / Goodpastures

ANCA asssociated GN (Pauci Immune)

Question 15

histo rapidily progressive GN

Answer 15

crescentic

early segmental necrosis early

Question 16

cause of Anti GBM / goodpastures

Answer 16

circulating anti GBM antibody (antigen is a3chain of type IV collagen)

Question 17

posible presentation of Anti-GBM ./ goodpastures

Answer 17

Males>femailes

pulmonary renal syndome: hemoptysis, pulmonary infiltrates, glomerulonephritis

Question 18

diagnosis/ treatment anti-GBM / goodpastures

Answer 18

antiGBM in blood

Linear IgG and C3 on kidney biospy IF

plasmapheresis, prednisone, cytoxan

Question 19

crescenteric GN with little deposition of immune reactants

Answer 19

Pauci-immune

Question 20

pauci - immune GN possibly associated with

Answer 20

ANCA vasculititis

Question 21

differentiation

microscopic polyangiitis

wegner’s granulomatosis

churg straus

Answer 21

**microscopic polyangiitis: **no granulomatous inflam, no asthma

wegner’s granulomatosis: necrtizing granulomatous inflam, no asthma

**churg strauss: **necrotizing granulomatous inflam, asthma, eosinophilia

Question 22

renal biopsy wegenrs

Answer 22

cresenteric GN without immune deposits

Question 23

treatment for all causes of nephrotic syndrome

Answer 23

ACE/ARBs to lower pressure+reduce proteinuria

Statins reduce lipids

diuretics+salt restriction to improve edema

Question 24

most common cause of nephrotic syndrome in children

Answer 24

minimal change disease

Question 25

adult associations minimal change disease

Answer 25

NSAIDs neoplasms esp Hodgkins Lymphoma Syphilis, HIV

Question 26

histo Minimal change disease

Answer 26

LM: glmeruli intersitium and tubules normal IF negative or mesangial IgM EM: **podocyte foot process effacement (fusion)**

Question 27

treatment minimal change disease

Answer 27

corticosteroids (adults take longer, more remission)

Question 28

most common cause of nephrotic syndrome in cuacasian adults

Answer 28

membranous nephropathy

Question 29

secondary causes membranous nephrpathy

Answer 29

infection (**HBV**) Connective tissue disease (**SLE**) Neoplasms: **carcinoma of lung, colon, stomach or breast, Non hodkin's lymphoma** Drugs

Question 30

presentation membranous nephropathy

Answer 30

heavy proteinuria and nephrotic syndrome HTN and azotemia later renal vein thrombosis in 20%

Question 31

histo membranous nephropathy

Answer 31

LM: **diffuse thickening of GBM, GBM spikes on silver stain** IF: granular GBM deposits of IgG EM: subepithelial depsoits

Question 32

membranous nephropathy outcome

Answer 32

1/3 spontaneous remission 1/3 partial remissions + stable 1/3 slow progressive loss of renal function

Question 33

treatment Membranous neropathy

Answer 33

ok prognosis : ACE or ARB poor prognosis : steroids or other immunosuprresion

Question 34

most common casue of nephrotic syndrome in African americans

Answer 34

focal segmental glomerulosclerosis

Question 35

presentation focal segmental glomerulosclerosis

Answer 35

HTN Hematuria end stage renal disease in 5 years primary = acute onset nephrotic syndrome secondary: slow renal insufficiency+ proteinuria

Question 36

cauases secondary FSGS

Answer 36

Drugs - NSAIDs, heroin infections HIV obesity past glomerular injury loss of renal mass

Question 37

histology focal segmental glomerular sclerosis

Answer 37

LM: glomerular scloeriss with capilalry colapse, hyaline and lipid deposits in bowman's capsule IF: negative or IgM and c3 in mesangium or in segmental scars EM: podocyte foot process effacemen,t segmental sclerosis

Question 38

treatment FSGS

Answer 38

ACE, corticosteroids,

Question 39

presentation membranoproliferative glomerulonephrtiis

Answer 39

proteinuria+hematuria HTN **low C3 complement** variable (nephrotic/asympotomatic preteinuria+hematuria/acute GN)

Question 40

secondary causss PRGN

Answer 40

connective tissue disease (SLE) Cryoglobulinemia Infection: **Hep C, **Hep B, endocarditis, abscesses neoplasm

Question 41

histo MPGN

Answer 41

LM: hypercellular glomeruli, endocapillary prlif, lobular apparing glomeruli IF: granular C3 depotsits EM: subendothelial deposits