Glomerulonephritis Flashcards Preview

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Flashcards in Glomerulonephritis Deck (37):
1

2 broad categories of glomerular disease

primary (intrinsic renal) or secondary (due to systemic disease)
nephrotic vs nephritic syndrome

2

What broad mechanism usually causes GN?

immune mediated mechanisms

other...metabolic/hemodynamic disturbances

3

Primary feature of GN and progression

impairment in selective filtration of blood, resulting in excretion of larger substances like plasma protein and blood cells. GFR eventually decreases leading to renal failure, necessitating dialysis/transplant if refractory to medical therapy

PROTEINURIA AND HEMATURIA

4

How to diagnose GN

- urinalysis (hematuria, proteinuria, RBC casts)
- renal function tests
- needle biopsy of kidney

5

Pathogenesis of nephrotic syndrome

abnormal glomerular PERMEABILITY due to a number of conditions

6

pathogenesis of nephritic syndrome

inflammation of glomeruli due to any causes of GN

7

MCC cause of nephritic syndrome

poststrep glomerulonephritis

8

Lab findings in nephritic syndrome

hematuria
AKI - azotemia, oliguria
proteinuria (mild, less than 3.5g/day)

9

Lab findings on nephrotic syndrome

Urine protein >3.5g/24hr (nephrotic range)
hypoalbuminemia
hyperlipidemia, fatty casts in urine

10

Clinical findings in nephritic syndrome

HTN, edema

11

Clinical findings in nephrotic syndrome

Edema, hypercoagulabe state, increased risk of infxns

12

What are the primary glomerular disorders

minimal change, focal segmental glomerulosclerosis (fsgs), membranous glomerulonephritis, IgA nephropathy (Berger disease), herditary nephritis (Alport syndrome)

13

Minimal change is associated with what two malignancies?

Hodgkin disease and non-Hodgkin lymphoma

14

What does minimal change look like on light and electron microscopy?

light - NO CHANGES/ABNORMALITIES SEEN
electron - fusion of foot processes

15

Prognosis and treatment of minimal change

excellent prognosis with 4-8 week steroid therapy, but relapses occur

16

how does minimal change present?

nephrotic syndrome (MC presentation), most common in children

17

FSGS accounts for _____% of cases of adult nephrotic syndrome

25

18

Prognosis and course of FSGS

fair to poor prognosis, doesn't usually respond well to steroids; renal insufficiency develops within 5-10 years of dx, progressive course

19

Treatment regimen for FSGS

controversial; steroids, immunosuppressive therapy, cytotoxic agents, ACE/ARBs

20

Presentation of membranous glomerulonephritis

usually presents with nephrotic syndrome; glomeruflar capillary walls are thickened

21

Primary and secondary causes of membranous glomerfulnephritis

primary - idiopathic
secondary- infection (hepC, hepB, syphilis, malaria), drugs (gold, captopril, pencillamine)
neoplasm
lupus

22

How does IgA nephropathy (Berger) usually present

asymptomatic recurrent hematuria/mild proteinuria (MCC cause of glomerular hematuria); can present with gross hematuria after infection/exercise
mesangial deposition of IgA and C3 are seen on electron microscopy

23

How does IgA nephropathy affect renal function

RENAL FUNCTION USUALLY NORMAL

24

Features of alport syndrome/herditary nephritis

- x-linked or autosomal dominant
- hematuria, pyuria, proteinuria, high frequency hearing loss without deafness, progressive renal failure

KIDNEY SHIT WITH HEARING LOSS

25

2 MCC causes of ESRD

diabetic nephropathy and hypertensive nephropathy

26

GN usually due to hepC, associated commonly with cryoglobunemia, poor prognosis

membranous GN

27

Poststreptococcal GN occurs after what infection and after how many days, who does it affect most commonly?

occurs after GABS, 10-14 days after infection (even with antibiotic therapy), usually affects children 2-6 years old

28

Features of post strep GN

- hematuria (cola colored urine)
- edema
- HTN
- low complement levels
- proteinuria
- elevated anti-streptolysin O

29

Prognosis of post strep GN and treatment

good prognosis, usually self limiting (alhtough may progress rapidly in adults)

supportive therapy (anti HTN, loop diuretics for edema, abx controversial)

30

Triad of proliferative GN (usually crescentic) + pulmonary hemorrhage + IgG antiglomerular basement membrane antibody

goodpasture syndrome

31

How does goodpasture present?

rapidly progressive renal failure, hemoptysis, cough, and dyspnea....lung disease preceeds kidney disease by days-weeks

32

What does renal biopsy show for goodpasture

linear immunofluorescene pattern

33

How to treat goodpasture

plasmapharesis to remove circulating anti-IgG antibodies
- cyclophosphamide and steroids to decrease formation of new antibodies

34

How does HIV nephropathy present?

proteinuria, edema, hematuria
resembles collapsing FSGS

35

How to treat HIV nephropathy

prednisone, ACE inhibitors, antiretroviral therapy

36

Which glomerular disorder is most commonly associated with development of renal vein thrombosis (RVT)?

membranous nephropathy

37

Symptoms of RVT

nausea, vomiting, fever, FLANK PAIN, HEMATURIA