Glomerular DO

Question 1

what is glomerular disease

Answer 1

any process that causes damage to glomerulus

Question 2

what is tubulointertititial disease

Answer 2

any process that casues damage to the interstitital tissues or tubules
(everything but glomerulus and capillaries)

Question 3

What is AIN

Answer 3

acute interstitial nephritis (aka acute tubulointertitial nephritis or ATIN)

Question 4

what is the presentation of chronic tubulointerstitial nephritis

Answer 4

obstructive, vesicoureteral reflux, analgesic nephropathy, heavy metals, myeloma kidney

Question 5

What are the causes of ATIN

Answer 5

medications #1 cause
RSVP: rifampin, sulfa, and 5 Ps
(PPI, Pain killers (nsaids), Pee pills (diuretics), penicillin and phenytoin)

Question 6

What is the classic triad of ATIN

Answer 6

fever, rash, arthralgia
often with oliguira

Question 7

what is seen on labs with ATIN

Answer 7

often with eosinophilia
pyuria
proteinuria
microscopic hematuria
renal tubular epithelial cell casts or granular casts
WBC casts

Question 8

what is the definitive diagnostic test for ATIN

Answer 8

kidney biopsy

Question 9

what patients get biopsy with ATIN

Answer 9

no improvement when agent discontinued
diagnosis is unclear
progressive kidney dysfunction
im considering steroids
its early disease and thus unclear

Question 10

what is the treatment of ATIN

Answer 10

stop offending drug
supportive (BP control, tx anemiiuas, fluids)
Maybe steroid if persistent

Question 11

what is the prognosis of ATIN

Answer 11

recovery of kidney function in 6-8 weeks, but not always to baseline
risk of progression to CKD
prognosis worst with NSAID induced AIN

Question 12

what is the hallmark of glomerular diseases

Answer 12

proteinuria

Question 13

what are the classifications of glomerular disease

Answer 13

nephritic or nephrotic

Question 14

what is nephritic

Answer 14

‘less severe’
proteinuria < 3g/day
hematuria
RBC casts
edema, hypertension, oliguira
labs: elevated Scr, decreased GFR, increased BUN

Question 15

what is nephrotic

Answer 15

‘more severe’
proteinuria >3g/day
edema
hypoalbuminemia
hyperlipidemia

Question 16

what is the primary presenting sign on physical exam for glomerular disease

Answer 16

edema
acute GFR reduction - hypernatremia - edema

Question 17

what is the workup for glomerular disease

Answer 17

CBC (eosinophilia)
albumin level
BMP (kidney and sodium)
urinalysis
proteinuria (24 hour collection or spot urine protein:creatinine ratio)

Question 18

What is the definitive test for glomerular disease

Answer 18

kidney biopsy

Question 19

what is post-infectious glomerulonephritis, nephritic or nephrotic

Answer 19

nephritic

Question 20

what is Henoch Schonlein Purpura (HSP)

Answer 20

acute, immune-mediated (IgA), small vessel vasculitis
90% of cases in kids < 10 years old

Question 21

if a patient with post-infectious GN presents with palpable purpura on LEs/buttocks what are you thinking

Answer 21

Henoch Schonlein Purpura (HSP)

Question 22

what is the most common nephritic syndrome

Kids and yonger adults (20-30s)

Answer 22

IgA Nephropathy

Question 23

What is thetreatment of post-infectious GN

Answer 23

Self-limiting, treat infection

Question 24

What is the treatment of Anti-GBM GN

Answer 24

plasma exchange + steroids + cyclophosphamide

Question 25

what is the diagnosis of choice for Anti=GBM GN

Answer 25

biopsy: crescent formation and linear IgG deposition inthe basement membrane

Question 26

what is the patho of idiopathic membranoproliferative GN

Answer 26

thickening and splitting onf the BM (tram track appearance)

Question 27

what is the pathophysiology of diffuse proliferative GN

Answer 27

increased glomerular cellularity, thickening of MG capillaries, IgG and C3 deposits most common SLE manifestation

Question 28

what is the classic presentation of HSP

Answer 28

**palpable purpura** arthritis abdominal pain **renal disease (GN)**

Question 29

What is the treatment of HSP

Answer 29

supportive treatment, usually resolves on its own can use steroids

Question 30

what is the treatment of NST

Answer 30

supportive treatments diuresis if necessary pts without AKI - ACEI/ARB for anti-proteinuric and HTN tx if AKI - dialysis if inflam - steroids

Question 31

what are the nephrotic syndromes | there are three

Answer 31

Minimal change disease focal and segmental Glomerulosclerosis membranous nephropathy

Question 32

what is the most common nephrotic syndrome in kids

Answer 32

minimal change disease

Question 33

what is the most common nephrotic syndrome in adults

Answer 33

focal or segmental glomerulosclerosis

Question 34

what is the treatment on minimal change disease

Answer 34

steroids until proteinuria resolves should resolve in 4-8 weeks

Question 35

What is the treatment of focal and segemental glomerulosclerosis

Answer 35

corticosteroids (more likely to fail tx) if fail - immunosuppressant or ACEI/ARB

Question 36

what is the treatment of membranous nephropathy

Answer 36

ACEI/ARB and corticosteroids if fail, add immunosuppressant

Question 37

what is the general treatment for nephrotic syndromes

Answer 37

sodium restriction fluid restriction diuresis

Question 38

when are complications more likely

Answer 38

Nephrotic syndrome (more severe)

Question 39

what is the most ocommon complication of nephrotic syndrome

Answer 39

VTE