Glomerular Disease

Question 1

Nephrotic syndrome

Answer 1

1. Proteinuria > 3.5 g/day
2. Hypoalbuminemia
3. Edema

Question 2

microalbuminuria

Answer 2

150-300g /day protein

Question 3

overt proteinuria

Answer 3

over 300g/day protein

Question 4

What are the complications of proteinuria

Answer 4

1. (Mainly with nephrotic)
   - edema
   - progressive renal failure
   - hyperlipidemia
   - coagulopathy
   - immune compromise
   - malnutrition
2. Increased risk of CV disease and death

Question 5

Treatment proteinuria

Answer 5

1. Treat underlying cause
2. Moderate protein diet (1g/kg/day)
3. ACEi/ARB
4. Edema: low sodium, stockings, furosemide
5. Hyperlipids: diet, statins
6. Immune: vaccinations
7. Coagulopathy: DVT prophylaxis, vigilance

Question 6

Overflow proteinuria

Answer 6

1. Caused by an overwhelming amount of protein
2. Ie. multiple myeloma
3. Negative urine dip for albumin
4. positive SPEP/UPEP for light chains
5. Increased protein:cr ratio

Question 7

Primary causes of nephrotic sydnrome

Answer 7

1. Minimal change disease
2. Membranous GN
3. FSGS

Question 8

Secondary causes of nephrotic sydnrome

Answer 8

1. Diabetes

2. Amyloidosis

Question 9

Collapsing variant of FSGS

Answer 9

Associated with HIV

Question 10

Spikes on kidney biopsy

Answer 10

Membranous

Question 11

Children/NSAID use

Answer 11

Minimal Change Disease

Question 12

Causes of transient proteinuria

Answer 12

Fever, exercise, orthostatic, CHF

Usually less that 1 g per day

Question 13

Thunderclap edema

Answer 13

FSGS

Question 14

Kimmelstiel-Wilson nodules

Answer 14

Diabetic nephropathy

Question 15

Linear IF stain

Answer 15

Anti-GBM/ goodpastures

Question 16

Granular IF stain

Answer 16

1. SLE
2. IgA
3. Post-Infectious
4. Membranoproliferative

Question 17

Pauci-Immune IF stain

Answer 17

ANCA vasculitis

Question 18

C-ANCA

Answer 18

vasculitis of micro vessels

Question 19

P-ANCA

Answer 19

vasculitis of small and medium vessels (aka Granulomatosis with polyangitis aka wegeners)

Question 20

Nephritic syndrome

Answer 20

1. Active sediment (dysmorphic RBC and protein)
2. Hypertension
3. Sub-acute kidney injury

Question 21

Isolated hematuria ddx

Answer 21

IgA nephropathy

Thin basement membrane disease

Question 22

Mechanism pauci immune vasculititis

Answer 22

Neutrophil activation

Question 23

Synpharyngitic hematuria

Answer 23

IgA nephropathy

Question 24

Active urine sediment plus nephrotic range proteinuria ddx

Answer 24

Membranoproliferative

Lupus

Post infective

Question 25

Nephritic syndrome work up

Answer 25

``` ANCA Anti GBM C3/c4 ANA Hep b/c, HIV serology Cryoglobulins Strep titters ```

Question 26

Causes of membranous nephropathy

Answer 26

NSAIDs Lupus Cancer Hepatitis

Question 27

Treatment of children with nephrotic syndrome

Answer 27

Treat empirically first

Question 28

Work up nephrotic syndrome

Answer 28

``` Diabetes: fasting glucose, HBA1C Overflow: SPEP/UPEP Lupus/immune: ANA, c3/c4 Viral: hepb/c Biopsy ```

Question 29

Minimal change disease

Answer 29

Hx: most common in children Causes: lymphoma, lupus, hepatitis, HIV, NSAIDs, lithium IX: normal histology, diffuse podocyte effacement on electron microscopy Tx: empirical steroids

Question 30

Membranous nephropathy

Answer 30

Hx: most common cause in adults, hx of clotting, edema Causes: cancer, lupus, RA, sarcoid, hep, malaria, NSAIDs IX: spikes on biopsy, IF shows string of pearls from IgG deposition Tx: ACEi, diuretics

Question 31

FSGS

Answer 31

EPi: young males with hypertension, African Americans Causes: Primary: genetic? Secondary: hyper filtration states (obesity and pregnancy) lymphoma, sickle cell, lupus, HIV, parvovirus, bisphaosphanates, IV drugs Hx: HTN IX: segmental sclerosis Tx: corticosteroids

Question 32

Amyloid

Answer 32

``` Causes: Primary: multiple myeloma, idiopathic Secondary: RA/ chronic inflammatory diseases Px: systemic symptoms IX: SPEP, biopsy ```

Question 33

Diabetic nephropathy

Answer 33

Epi: MOST COMMON CAUSE Hx: 5-25 years post diagnosis diabetes, often insidious onset IX: shows mesangial expansion, thickened basement membranes Tx: control diabetes, blood pressure, lipids, smoking,

Question 34

Anti GBM

Answer 34

Hx: sick patient, rapid onset, may have lung involvement/hemoptysis IX: shows linear immunofluorescence, anti GBM antibodies Tx: plasmapheresis and corticosteroids

Question 35

Immune complex Glomerulonnephritis

Answer 35

Causes: post-infective, IgA nephropathy, lupus IX: granular immunostain Tax: steroids

Question 36

Pauci immune Glomerulonnephritis

Answer 36

Causes: granulomatosis with polyangitis, micro polyarteritis, Churg-Strauss Hx: may have pulmonary renal symptoms if Wegeners, asthma if churg Strauss IX: c, p ANCA: dots on IF stain

Question 37

Membranoproliferative Glomerulonnephritis

Answer 37

Causes: viral infection (hep/HIV), cancer, endocarditis Path: complement activation, mesangial deposition IX: tram tracks