Glomerular diseases Flashcards Preview

Foundations II Exam 5 (Jess) > Glomerular diseases > Flashcards

Flashcards in Glomerular diseases Deck (37):
1

What level is pathologic proteinuria?

150 mg or more over 24 hrs

2

Are we more likely to see microalbuminuria or proteinuria first clinically? Why?

microalbuminuria
because it is the smallest plasma protein= more readily filtered

3

What is the protein amount that is defined as nephrotic dz?

greater than or equal to 3.5 g of protein

4

What is primary vs secondary glomerular dz?

Primary- something wring in the glomerulus

Secondary- something outside of the glomerulus

5

Gold standard for dx of glomerular dz?

Biopsy

6

What do glomerular diseases cause?

hypoalbuminemia due to urinary loss of proteins

7

What is Nephritic syndrome?

inflammatory process a/w immunologic response leads to renal glomeruli damage

8

Clinical findings in Nephritic syndrome?

edema
hematuria= "Coca Cola colored"
occasional WBCs
proteinuria
HTN
azotemia
elevated creatinine
oliguria

9

What is Rapidly Progressive Glomerularnephritis?

-Severe injury to the glomerular capillary wall, GBM, and bowman's capsule

-most severe and clinically urgent end of the nephritic spectrum

-leads to renal failure

10

What causes Post Infectious Glomerularnephritis?

Group A beta-hemolytic strep

(immune mediated glomerular injury)

11

Typical presentation of pt w/ Post Infectious Glomerularnephritis

-oliguria
-edematous
-variable hypertensive

-Coca Cola urine
-UA w/ RBCs, red cell casts, proteinuria
-ASO titers are high

12

How do you treat Post Infectious Glomerularnephritis?

Supportive:
anti-hypertensives (ACE/ARBs)
salt restriction
diuretics

No steroids

13

MC primary glomerular dz?

IgA Neuropathy
"Berger's disease"

14

What happens in IgA Neuropathy
"Berger's disease"?

IgA deposition in the glomerular mesangium --> inflammatory response

15

Normal hx of a pt w/ IgA Neuropathy
"Berger's disease"? Labs?

usually follows a URI or GI infection
-"coca-cola colored" urine 1-3 days after illness onset

hematuria
proteinuria
increased IgA
complement levels nl

16

When do you give corticosteroids in pt w/ IgA Neuropathy-"Berger's disease"?

if proteinuria 1.0-3.5 g/d

17

How does Henoch-Schonlein purpura classically present?

Palpable purpura in the lower extremities and buttock area w/ arthralgias and abdominal sx (nausea, colic, melena)

18

What are the small vessel vasculitides seen w/ Pauci-immune glomerulonephritis (ANCA-associated)

S/S of these?

-Wegener granulomatosis
-Churg-Strauss dz
-microscopoc polyangitis

S/S= fever, malaise, weight loss, purpura

19

What lab will you order for pt with probable Pauci-immune glomerulonephritis ?

ANCA (anti-neutrophil cytoplasmic antibodies)

20

Tx of pt w/ Pauci-immune glomerulonephritis ?

high dose corticosteroids
DMARDS

21

Another name for Anti-glomerular basement membrane glomerulonephritis?

what is it?

Goodpasture syndrome

glomerulonephritis + pulmonary hemorrhage
(basement membrane injury from anti-GBM antibodies)

22

S/S of Goodpasture syndrome?

-onset preceded by URI in 20-60%
-hemoptysis & dyspnea
-RPGN

23

What do you see in labs/CXR in Goodpasture syndrome?

-sputum shows hemosiderin-laden macrophages
-anti-GBM antibodies

CXR: pulmonary infiltrates

24

Tx of Goodpasture syndrome?

-Plasma exchange therapy to remove antibodies
-immunosuppressive drugs to prevent new formation of antibodies

25

What happens to the basement membrane in Nephrotic syndrome?

significantly increased basement membrane permeability

26

What are essential components of dx of Nephrotic syndrome?

-urine protein >3.5 in 24 hrs
-hypoalbuminemia (< 3)
-bland urinary sediment
-peripheral edema
-hyperlipidemia

27

What is the hallmark finding in Nephrotic syndrome?

Peripheral edema

(also dyspnea)

28

What will UA and blood show in Nephrotic syndrome?

UA: proteinuria, (can see oval fat bodies)

Blood: decreased albumin and total protein= characteristic
(also hyperlipidemia in >50%)

29

What do you need to consider when treating Nephrotic Syndrome?

-Protein loss
-Edema (restrict salt, thiazide or loop)
-Hyperlipidemia
-Hypercoagulable state

30

What is Minimal Change dz? Who is it seen in?

-Increased level of glomerular permeability, foot process effacement

-mainly in children

31

How do you treat Minimal Change dz?

-Oral corticosteroids w/ prolonged taper
(relapse is common upon discontinuation)

32

What is Membranous Nephropathy?

MC cause of primary nephrotic syndrome in adults

idiopathic immune mediated

immune complex deposition in glomerular capillary walls results in increased permeability

33

Clinical presentation of pt w/ Membranous nephropathy?

-asymptomatic
-edema w/ frothy urine
-high incidence of venous thromboembolism

34

Tx of Membranous nephropathy in pt with elevated BP?

If they don't spontaneously recover within 6 months what do you give?

reduce urine protein levels with ACE or ARB if BP > 125/75

Corticosteroids

35

What is Focal Segmental Glomerulosclerosis? How does it occur?

Increase permeability due to podocyte injury

Primary: idiopathic (African descent)
Secondary: obesity, HTN, chronic urinary reflux

36

Clinical presentation of pt with Focal Segmental Glomerulosclerosis?

Proteinuria

37

Tx of pt w/ Focal Segmental Glomerulosclerosis?

-diuretics for edema
-ACE/ARB for HTN and proteinuria
-statins for hyperlipidemia

-high dose corticosteroids for primary cause patients