Glomerular Disease Flashcards
(35 cards)
What are the four nephritic syndromes?
IgA nephropathy
Anti-GBM (goodpastures)
Post streptococcal (post infectious)
Pauci immune (wegener’s, microscopic polyangitis, churgg strauss)
What are the four nephrotic syndromes?
Membranous nephropathy
FSGS
Diabetic nephropathy
Min. Change disease
How do you differentiate nephritic vs. nephrotic?
Urinanalysis
Urine sediment/microscopy
Clinical presentation
How do you sort nephritic syndromes apart?
Complement levels
What happens if you obtain a negative result?
Perform a biopsy if negative
What are symptoms of nephritic syndrome?
Hematuria (rbc casts/dysmorphic RBCs)
Proteinuria (abnormal >200mg/day or ratio of protein to creatinine ratio >.2
Hypertension and renal insufficiency (high creatinine)
What are signs and symptoms of glomerular disease?
Hematuria
Proteinuria
Reduction in GFR (impaired filtration)
Reduced Salt Excretion (HTN, Edema)
What causes nephrotic syndrome?
Glomerular capillary filtration defects
What are the different urine findings seen between nephrotic and nephritic?
Nephrotic:
- Proteinuria: >3.5
- Rbcs: minor
- Casts: Fatty casts, lipid droplets
Nephritic
- Proteinuria: <1-3g
- Rbcs: Signficant
- Casts: RBC casts
Why does hyperlipidemia form in nephrotic syndrome?
Due to the liver producing more beta lipoproteins as a result of decreased oncotic pressure (albumin leaking out)
Also hypercoaguable: due to loss of ATIII and plasminogen in the urine
What is the maltese cross appearance in urine?
It is the suggestion of lipid droplets, consistent with nephrotic syndrome
What do you do if you find a positive protein on your dipstick?
Must quantize the amount
- 24 hour urine or
- Urine Protein to Creatinine ratio
- <.2 nrmal
- .2-3.5: subnephrotic
- 3.5: Nephrotic
Example: urine creatinine 50, urine protein: 200
Ratio: 4
What is the amount of protein excretion limit for childrent?
> 40mg/h
Minimal Change disease clinical clues?
Young adults/Children (85% idiopathic in children, 20% idiopathic adults)
ONLY FOUND ON BIOPSY
-Diffuse epithelial foot process effacement
Can be caused by:
NSAIDS
Hodgkins lymphoma
TREATMENT:
-STEROIDS!!!
Clinical scenario:
- Child
- Normotensive
- Normal Renal Function
- Fat bodies found, 3-4+ protein
Membranous Nephropathy Clinical Clues
Caucasian Adults
INCREASED renal vein THROMBOSIS
-Flank pain, hematuria, high LDH
Etiology:
- Idiopathic
- NSAIDS
- CARCINOMAS!!!!!!!
- SLE
Light microscopy:
-THICKENED Capillary loops
PEAK in 4-6 decade of life
TREATMENT:
- Steroids
- Cyclophosphamide
Clinical features of FSGS
AFRICAN AMERICANS
Hypertensive
Progress to ESRD 5-20 years
Etiology: -Idiopathic -IV heroin -HIV (collapsing FSGS) Adaptive: Reflux nephropathy, Obesity
Treatment:
- Steroids don’t really work
- Immunosuppressive do: CYCLOSPORINE, TACROLIMUS, Mycophenolate mofetil)
Clinical clues of diabetic nephropathy?
Most COMMON IN ADULTS
Leading cause of ESRD
- 30% Type I DM
- 20% Type II DM
-Microalbuninuria followed by heavy proteinuria then DECLINE in renal function
TREATMENT:
-ARB/ACEi (work for a wide range of proteinuric kidney disease)
What are kimmelsteil-wilson lesions?
The lesions seen in NODULAR Glomerulsclerosis seen in diabetic nephropathy
Clinical features of Amyloidosis Nephrotic syndrome?
SEE green birefringence in polarized light
AL: Immunoglobulin origin: Multiple Myeloma
AA: Inflammatory states
Multiple myeloma:
- Renal failure w/ hypercalcemia
- Back pain in elderly
What is the most important finding for nephritic syndrome?
Hematuria
-Greater than 3 RBC per high power field of centifuged sediment
Due to breaks in glomerular capillaries
Are RBC casts always seen in nephritic syndrome?
NO
They are formed in the DCT
What is IgA nephropathy?
Isolated hematuria
-Recurrent after URI
What is Alport’s syndrome?
Cause of Recurrent frank hematuria
Mutation of Collagen Type IV= BM messed up
Get Sensorineural Deafness as well
What characterizes Acute Nephritic Syndrome?
Inflammatory damage
Hematuria, proteinuria, hypertension, azotemia (elevated BUN/Creatinine)
