Glomerular diseases Flashcards by Nayla Mansoor

What does “segmental” vs “global” mean

segmental is only a portion of the glomerulus is involved

global is the entire glomerulus is involved

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What does “focal” vs “diffuse” mean

Focal is some of the glomeruli are involved

Diffuse is all (or most) of the glomeruli are involved

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What are the 3 parts of the filtration membrane

Capillary endothelium
Basement membrane
Podocytes of glomerular capsule

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What are the functions of the kidney

control water balance in the body 
control RBC production 
control blood actidity 
filter blood and pass waste into bladder 
control blood pressure

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What are adult protein levels

average normal physiologic: 80 mg/day

pathologic proteinuria: >150 mg/day

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What is the smallest plasma protein

albumin; makes up 20-40% of physiologic proteinuria
It is filtered more than other plasma proteins, so you’re more likely to get “microalbuminuria” before you reach “proteinuria”

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What is Microalbuminuria

excretion of 30-300mg albumin/day

Macroalbuminuria is >300mg/day

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What is nephrotic range proteinuria

daily excretion >3.5g protein per day

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What is the MCC of pathologic proteinuria

Glomerular disease: altered permeability= injury of all 3 levels of filtration membrane
first to leak out is albumin, then other proteins

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Other pathologic causes of proteinuria include

Overflow proteinuria: overproduction of small proteins overwhelms reabsorption in the proximal tubule
Tubular proteinuria: tubulointerstitial dz causes decreased ability of proximal tubule to reabsorb proteins

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How are glomerular diseases categorized

Nephrotic vs Nephritic

Primary vs Secondary

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All glomerular diseases cause

glomerular damage

hypoalbuminemia (low if blood because excess excreted)

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What is the gold standard definitive dx for glomerular diseases

Biopsy!

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What is Nephritic syndrome

There is an immune response in the capillaries leading to glomerular damage= blood cells pass through

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What are possible findings in nephritic syndrome

Edema (LE>UE) 
Hematuria (coca cola) 
Granular casts 
WBC in urine
Proteinuria (<3.5g=subnephrotic) 
HTN (2/2 NA retention and no filtration) 
Azotemia 
High creatinine 
Oliguria (low urine output, glomerulus cant filter as much) 
Periorbital edema 
pale puffy face 
swollen lips

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What is rapidly progressive glomerulonephritis

severe injury to capillary wall, basement membrane, and bowmans capsule
*very severe, occurs at the end of the “Nephritic syndrome” spectrum and causes renal failure in weeks-months

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What are the primary causes of Nephritic Syndromes

post infectious GMN 
IgA nephropathy 
Henoch-Schonlein purpura 
Pauci-immune glomerulonephritis 
Good Pasteur's

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What is post-infectious GMN

immune mediated glomerular injury due to GABHS (pyogenes)

-immune complexes w/ strep antigens deposited 1-3 weeks after a strep infection

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What are findings in P.I. GMN

oliguria
edema (protein cant stay in the capillary so fluid leaks out)
HTN
**coca cola urine

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Lab findings in P.I. GMN are

UA- RBC, red cell casts, and proteinuria

-ASO titers high (unless they took abx)

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What is the prognosis of P.I. GMN

in kids, good

in adults, not so great- can lead to RPGN or CKD

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How do you treat P.I. GMN

Supportive! anti-HTN, salt restriction, diuretics prn

Steroids do NOT improve outcome

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What is the MC glomerular disease world-wide

IgA nephropathy/ Berger’s disease

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What occurs in IgA nephropathy

IgA deposits in the glomerular mesangium cause an inflammatory response
MC: kids/young adult, M>W

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What are is your classic symptom of IgA nephropathy

coca cola urine 1-3 days after a URI or GI infection

What will IgA nephropathy labs show

hematuria proteinuria high IgA but normal complement levels

What is the prognosis of IgA nephropathy

1/3 remit spontaneously 20-40% develop CKD rest have chronic microscopic hematuria and stable SrCr for life

What is the most favorable prognostic indicator in IgA nephropathy

Proteinuria <1g/day

How can you treat IgA nephropathy

If proteinuria 1-3.5g: STEROIDS | If higher: ACE/ARB

What is target BP in IgA nephropathy

<130/80

What is Henoch-Schonlein purpura

IgA deposits in vessel walls causing systemic small vessel vasculitis (similar to IgA nephropathy) MC in kids with inciting infection, like group A strep

How does Henoch-Schonlein present symptomatically

palpable purpura in LE and buttocks Arthralgias abdominal Sx (nausea, colic, melena) low GFR

How do you treat Henoch-Schonlein purpura

plasma exchange | DMARDS (anti-rheumatic drug)

What is Pauci-immune GMN

Associated with small vessel vasculitides (Wegener's granulomatosis, Churg-Strauss, microscopic polyangiitis)

What are symptoms of Pauci-immune GMN

``` fever malaise weight loss purpura -If w/ Wegener's, nodular lesions and respiratory tract Sx ```

What do Pauci-immune GMN labs show

ANCA antibodies hematuria proteinuria

How do you treat Pauci-immune GMN

high dose steroids | DMARDS (rheum)

What is the prognosis of Pauci-immune GMN

with Tx: 75% complee remission | w/o Tx: poor prognosis

What is Good Pasteur's syndrome

Basement membrane injury 2/2 anti-GBM antibodies (usually s/p URI) leading to Glomerulonephritis + pulmonary hemorrhage -peak 2-3 or 6-7 decade

What are Sx of Good Pasteur's syndrome

hemoptysis dyspnea RPGN

What will Good Pasteur's diagnostics show

labs: anti-GBM antibodies- hemosiderin macrophages in sputum CXR: pulmonary infiltrate

How do you treat Good Pasteur's

- Plasma exchange (remove abs) | - Immunosuppressive drugs (steroids, DMARDS) s new abs dont form, and decrease inflammaiton

What is Nephrotic syndrome

Increased basement membrane permeability causing protein to leak out

What components are essential in diagnosing Nephrotic syndrome

``` Proteinuria >3.5g/d Hypoalbuminemia (<3g) bland urinary sediment (+/- oval fat bodies) Peripheral edema HLD ```

What are Sx of Nephrotic syndrome

**Peripheral edema | dyspnea (pulm. edema, pleural effusion, diaphragm compromise form ascites)

When does peripheral edema develop

when serum albumin <2g | Na retention 2/2 renal disease

What will Nephrotic Syndrome look like on UA

Proteinuria (few cellular elements or casts microscopically) Oval fat bodies 2/2 HLD

What will Nephrotic syndrome blood panel show

Hypoalbuminemia (<3g) Hypoproteinemia (<6g) HLD (liver compensates for low albumin by making lipids) low Vit. D, zinc, and copper

When can protein malnutrition occur

when urinary protein loss >10 g/d

How do you treat Nephrotic syndrome

- increase diet protein - salt restrict/thiazides/loops (edema) - diet and exercise, aggressive statins (HLD) - Anticoags if with renal vein thrombosis, PE, or recurrent thromboemboli

Why are patients with Nephrotic syndrome hypercoagulable

Because one of the things that leaks out is AT-III (anti-thrombin III), as well as protein C and S without these, you are more prone to clot

What are secondary causes of Nephrotic syndrome

Minimal change disease membranous nephropathy focal segmental glomerulosclerosis

What is Minimal change disease

increased glomerular permeability due to foot processes thinning out

Who is minimal change disease mostly seen in

kids! 80% of proteinuria in kids in kids, M>F in adults, M=W

How do you treat Minimal change disease

oral steroids w/ prolonged taper (adults up to 16 wks) | -likely relapse after stopping steroids, but rarely progress to ESRD

Most complications from minimal change disease arise from

long term steroid therapy!

What is the MCC of primary nephrotic syndrome in adults

Membranous nephropathy- an idiopathic immune mediated glomerulonephropathy causing immune complexes to deposit into capillary walls= increased permeability

How does membranous nephropathy present

``` edema frothy urine (from protein) venous thromboemboli (low AT-III, pro C&S) ```

How do you treat membranous nephropathy

ACE/ARB to decrease urine protein (if BP >125/75)

What is the prognosis of membranous glomerulonephropathy

if subnephrotic, good | if nephrotic, 30% recover spontaneously- the rest need steroids + 6 months of conservative care if w/ renal failure

What is focal segmental glomerulosclerosis

podocyte injury leads to increased permeability | Sx is proteinuria (and nephrotic syndrome Sx)

What causes FSGS

primary renal dz: idiopathic, or genetic alterations in africans secondary: obesity, HTN, HIV, analgesic/biphosphate exposure, or chronic urinary reflux

How do you treat FSGS

Diuretics Statins ACE/ARB If it's a primary cause: steroids w/ 16 week taper

Glomerular diseases Flashcards

(63 cards)