Glomerular Disease and such...

Question 1

Causes of heme-negative red urine

Answer 1

Meds – Doxorubicin, Chloroquine, Ibuprofen
Dyes – Beets, Blackberries, Food Coloring
Metabolites – Bile, Melanin, Porphyrin

Question 2

Main risk factors for urologic malignancy?

Answer 2

Age, Gross hematuria, Smoking, Env. Exposure

Question 3

Urine dipstick for hematuria is positive…now what?

Answer 3

Microscopic exam. If over 3 RBCs/hpf with no obvious cause, refer to urologic evaluation

Question 4

Extraglomerular source of hematuria. Color? Clots? Proteinuria? RBC Details?

Answer 4

Red/Pink
Maybe
Less than 500 mg/day
Normal RBC morphology w/out Casts

Question 5

Glomerular source of hematuria. Color? Clots? Proteinuria? RBC Details?

Answer 5

Red, Smoky brown, or Coca-Cola
No clots
Can be over 500 mg/day
Dysmorpic possibly with Casts

Question 6

Best way to rule out renal mass as a cause for hemato.?

Answer 6

Multiphasic CT Urography

If any indicator, move forward with cystoscopy

Question 7

Most common renal biopsy discoveries

Answer 7

IgA nephropathy, thin BA disease, NORMAL

Question 8

Pathogenesis of IgA Nephropathy (Bergers disease)

Answer 8

Two hit hypothesis –> abberantly glycosylated IgA1

Question 9

Pathology of Bergers Disease

Answer 9

Mesangial Proliferative GN with IgA deposits on IF

Question 10

Three types of proteinuria?

Answer 10

Glomerular, Tubular, Overflow

Question 11

What is glomerular proteinuria?

Answer 11

Increased filtration of macromolecules across glomerular capillary wall

Question 12

What is tubular proteinuria?

Answer 12

Excretion of low-molecular weight proteins (like beta2-microglobulin, Ig Light Chains, and albumin break down products).

Question 13

What is overflow proteinuria?

Answer 13

Increased excretion of low-mol weight proteins due to Ig light chains of multiple myeloma, lysozyme of AML, or myoglobin in rhabdo

Question 14

Nephrotic Levels of Urine Protein?

Answer 14

Over 3.5 g

Question 15

Elevated urinary albumin excretion is defined as

Answer 15

Over 30 microgram/mg

Question 16

Difference between microalbuminuria and macroalbuminuria?

Answer 16

Micro – 30-300mg

Macro – Over 300mg

Question 17

Preferred method of measuring urine albumin

Answer 17

Urine Albumin/Creatinine

Helps overcome the limits of variations in urine volume

Question 18

Relationship of albuminuria and DM

Answer 18

Type 1 – Often earliest sign of diabetic nephropathy

TII – Usually present at diagnosis, can reflect CV disease or nephropahy

Question 19

Shortcoming of the urine dipstick

Answer 19

Can’t detect microalbuminuria or globin (in myeloma)

Question 20

Three symptoms common in nephrotic syndrome

Answer 20

Proteinuria over 3g per 24 hours
Edema due to hypoalbuminemia
Hyperlipidemia (increased albumin, increased LDL chol)

Question 21

Four examples of primary nephrotic syndrome

Answer 21

Membranous GN
Lipoid Nephrosis
Focal Segmental Glomerular Sclerosis
Membranoproliferative GN

Question 22

Four main examples of secondary nephrotic syndrome

Answer 22

DM
Amyloidosis
Myeloma
SLE

Question 23

Six Complications of Nephrotic syndrome (from protein loss)

Answer 23

Hypercoagulation (Loss of Anti-thrombin, proteinC,S)
Infections, esp. G+ (Loss of IgG, Complement)
Anemia (EPO)
Malnutrition (Albumin)
Hypothyroidism (Thyroid Binding Globulin)
Vit D Deficiency (VitD Binding Protein)

Question 24

Two main contraindications for renal biopsy

Answer 24

Solitary kidney, Marked coagulopathy

Question 25

Pathogenesis of Membranous GN

Answer 25

In situ formation about antigen-antibody complex Usually Phospholipase A2 target antigen Membrane width increase, sub-epithelial deposits on EM

Question 26

Clinical Presentation/Treatment of Membranous GN

Answer 26

Proteinuria or nephrotic syndrome Increased incidence of renal vein thrombosis Tx - ACEi to reduce proteinuria. If persistent, severe neph. syndrome, Steroids + Cyclophosphamides

Question 27

Pathogenesis of lipoid nephrosis

Answer 27

Primarily related to abnormalities in cellular immunity | Effacement of foot processes

Question 28

Clinical presentation/Treatment of Lipoid Nephrosis

Answer 28

Usually presents w/ nephrotic (most common in children) | Tx - Usually steroids, can relapse, Cyclophosphamide if dependent

Question 29

Pathogenesis of Focal Segmental Glomerular Sclerosis

Answer 29

1. Primary - like Lipoid Nephrosis 2. Genetic Abnormalities in structural proteins 3. Adaptive sclerotic response to primary glomerular injury

Question 30

Clinical presentation of Focal Segmental Glomerular Sclerosis?

Answer 30

Proteinuria+Nephrotic Syndome Much higher incidence in African Americans Less response to steroids than Lipoid Nephrosis

Question 31

What tends to be seen with Nephritic syndrome

Answer 31

Hematuria, Oliguria, Azotemia, HTN, Edema

Question 32

Three primary types of nephritic syndrome?

Answer 32

MPGN Type I and II | C3 Glomerulopathy

Question 33

Three important infectious correlations with nephritic syndrome

Answer 33

Post streptococcal GN Staphylococcal Infection HIV assocaited nephropathy

Question 34

Important features in rapidly progressive glomerulonephritis

Answer 34

Acute kidney injury w/ hematuria, proteinuria, and HTN | Crecenteric glomerulonephritis on biopsy

Question 35

Three types of RPGN

Answer 35

Linear glomerular BM Deposits (Goodpastures) Granular Immune Complexes (SLE, cryoglob) No Immune Complexes (If only renal, Renal - pauci immune)

Question 36

RPGN associated with cANCA (PR3)?

Answer 36

Wegener's granulomatosis

Question 37

RPGN associated with pANCA (MPA)

Answer 37

Micro-PAN

Question 38

Mutations associated with primary Thrombotic Microangiopathy

Answer 38

TTP -- ADAM TS13 HUS -- Shiga toxin Can also be drug induced, from complement overactivity

Question 39

Primary treatment for TTP

Answer 39

Plasmaphoreses

Question 40

Three labs/scans that suggest chronic, rather than acute, kidney damage

Answer 40

Anemia Very high PTH Small kidneys

Question 41

Urine tests suggestive of a glomerular process? Suggestive of non-glomerular?

Answer 41

Glom -- RBC Casts | Non -- Clots in the urine