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nephrology & urology > GN, nephrotic syndrome, PKD > Flashcards

GN, nephrotic syndrome, PKD Flashcards

1
Q

what is glomerulonephritis?

A

damage of the renal glomeruli by deposition of inflammatory proteins in the glomerular membranes as the result of an immunologic response.

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2
Q

60% of glomerulonephritis occurs in who? prognosis?

A

kids 2-12. prognosis only good in kids, worse in adults

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3
Q

Sx: edema in face/eyes in morning and edema of feet/ankles in the evening

A

glomerulonephritits symptoms

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4
Q

what is a common cause of GN

A

post streptococcal infection

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5
Q

what is the major lab to get in GN

A

antistreptolysin O titer

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6
Q

UA reveals oval fat body

A

think nephrotic syndrome (it is a renal tubular cell that has reabsorbed some of the excess lipids in urine)

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7
Q

Over 3.5 gm proteinuria/24 hrs

A

Nephrotic syndrome

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8
Q

Hypoalbumnemia, azotemina, hyperlipemia, C3 levels nml or low

A

Nephrotic syndrome

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9
Q

Maltese crosses and oval fat bodies

A

Nephrotic syndrome

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10
Q

Common cause of nephritic syndrome

A

Post strep throat inf

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11
Q

main difference in nephritic vs neprotic syndrome

A

nephritic is proliferation; nephrotic is membraneuous

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12
Q

eosinophils in urine

A

malignant HBP

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13
Q

SLE

A

Nephritic and nephrotic syndrome

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14
Q

what is the most common form of polycystic kidney disease(PKD)

A

autosomal dominant PKD, it is always bilateral. occurs in the 30s

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15
Q

common sx of autosomal dominant PKD

A

back and flank pain and headaches

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16
Q

tx for autosomal dominant PKD

A

supportive. antibx

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17
Q

UA shows proteinuria, hematuria, pyuria, and bacteriuria

A

PKD

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18
Q

glomerulonephritits symptoms

A

Sx: edema in face/eyes in morning and edema of feet/ankles in the evening

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19
Q

describe UA findings in GN

A
  • hematuria (>3RBC/high power field, they will be misshapened due to passage through glomerulus(acanthocytes).

they are normal shaped when bleeding from bladder or urethra

-RBC casts, proteinuria(1-2 g/24h)

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20
Q

hematuria, RBC casts, proteinuria

A

GN

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21
Q

serum complement (C3) in GN

A

decreased

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22
Q

how to dx GN

A

antistreptolysin O titer

UA

C3

renal bx- determine exact dx or severity( electron microscopy and immunofluorescence)

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23
Q

tx for GN

A
  • steroids and immunosuppressive drugs for inflammation. (none in PSGN)
  • diet: decrease salt and fluid intake
  • dialysis if azotemia
  • ACE inh in chronic

treat hyperkalemia, pulm edema, peripheral edema, acidosis, HTN

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24
Q

benign hematuria

henoch schonlein purpura

mild post infectious GN

IgA nepropathy

hereditary nephritis

A

causes of focal GN in kids

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25
Q

tea or coca cola colored urine

A

hematuria, think GN or nephritic syndrome

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26
Q

bergers disease(Iga nephropathy)

endocarditis

lupus

infectious

strep

A

all causes of GN

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27
Q

main difference between nephrotic syndrome and nephritic syndrome

A

nephrotic has no inflammation

nephritic has inflammation of kidney

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28
Q

explain hyperlipidemia in nephritic syndrome

A

secondary to liver producing increased lipoproteins due to hypovolemia from loss of intravascular volume(edema)

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29
Q

post infectious GN

membranoproliferative GN

A

causes of diffuse GN in kids

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30
Q

IgA nepropathy

hereditary nephritis

SLE

A

causes of focal GN in adults

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31
Q

SLE

membranoproliferative GN

rapidly progressive GN

post infectious GN

vasculitis

A

causes of diffuse GN in adults

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32
Q

hypoalbuminemia

lipiduria

hypercholesterolemia

edema

A

nephrotic syndrome

33
Q

nephrotic syndrome can predispose a pt to what

A

thrombus secondary to loss of proteins C and S and antithrombin III

34
Q

abdominal distention, facial edema/puffy eyelids, scrotal swelling, SOB, wt GAIN, anorexia, malaise, oliguria

A

symptoms of nephrotic syndrome

35
Q

ascites, retinal sheen, skin striae, edema, HTN, orthostatic hypoTN

A

signs of nephrotic syndrome

36
Q

basic tx of nephrotic syndrome

A

meds, diet, anticoagulants if needed, avoid nephrotoxic drugs, steroids in kids

37
Q

symptoms of nephrotic syndrome

A

abdominal distention, facial edema/puffy eyelids, scrotal swelling, SOB, wt GAIN, anorexia, malaise, oliguria

38
Q

signs of nephrotic syndrome

A

ascites, retinal sheen, skin striae, edema, HTN, orthostatic hypoTN

39
Q

UA in nephrotic syndrome

A

foamy urine, proteinuria, lipiduria, glycosuria, hematuria

40
Q

microscopic urinalysis of nephrotic syndrome

A

RBC casts, granular casts, hyaline casts, fatty casts

** oval fat body

41
Q

foamy urine, proteinuria, lipiduria, glycosuria, hematuria

A

UA in nephrotic syndrome

42
Q

RBC casts, granular casts, hyaline casts, fatty casts

** oval fat body

A

microscopic urinalysis of nephrotic syndrome

43
Q

meds for nephrotic syndrome

A

ACE inh early in course

lots of diuretics

44
Q

diet management for nephrotic syndrome

A

sodium and fluid intake restricted

not excessive protein and potassium in diet

45
Q

what to give frequent relapsers or steroid non responders in nephrotic syndrome

A

cycophosphamide, cyclosporine, tacrolimus, mycopenolate mofetil

46
Q

primary renal disease, SLE, post infectious diseases, DM, NSAIDs, lithium, toxins, pregnancy, multiple myeloma

A

causes of nephrotic syndrome

47
Q

cyclophosphamide, cyclosporine, tacrolimus, mycopenolate mofetil

A

what to give frequent relapsers or steroid non responders in nephrotic syndrome

48
Q

mnemonic for nephritic syndrome

A

PHAROH

proteinura, hematuria, azotemia, RBC casts, oliguria, HTN

49
Q

key things on how to differeniate post infectious GN and IgA nephropathy

A

PI GN presents 2-6 wks after an infection and has a low C3

IgA nephropathy presents a few days after an infection and has a normal C3

50
Q

foamy urine

A

nephrotic syndrome

51
Q

preferable urine test for nephrotic syndrome

A

spot protein to creatinine ratio rather than 24 hr urine

52
Q

vaccination for nephrotic pts

A

23 polyvalent pneumococcus vaccine

53
Q

autosomal dominant PKD vs

autosomal recessive PKD

1) common one(uni or bilateral?)
2) age
3) more severe?

A

1) AD PKD (usually bilateral)
2) ADPKD in pts over 30 y.o

ARPKD in infants and young kids with renal failure, liver fibrosis, and portal HTN

3) ARPKD, can lead to death in the first few years of life

54
Q

AD PKD and ESRD

-associated with increased risk of what

A

1/2 of pts with AD PKD will have ESRD requiring dialysis by age 60

increased with increased risk of cerebral aneurysm, especially with pts with a +FH

55
Q

what is an early sign of abnormal kidney function

A

nocturia

reflects early impairment of urinary concentration

56
Q

what occurs with pts with long term renal diseases or ESRD?

what race is common

A

acquired form of cystic kidney d/s

blacks

57
Q

common symptoms of AD PKD

A

back pain, flank pain and HA

58
Q

pain and hematuria most common initial presenting symptoms of what

A

PKD

59
Q

HTN, hepatic cysts, cerebral artery anerysms, diverticulosis, and MVP additional findings in what

A

PKD

60
Q

CBC findings in PKD

A

anemia

61
Q

diagnostic choice for PKD

A

ultrasonography

62
Q

is there early detection for PKD

A

yes genetic testing for PKD1 and PKD2

63
Q

tx for PKD

A

supportive

ACE for HTN

low protein

high intake of fluids

antibx for infections

64
Q

antibiotics that can penetrate the cyst wall (PKD)

A

bactrim, FQ, chloramphenicol, vancomycin

65
Q

normal GFR

A

100-130

66
Q

red cell casts

A

GN(nephritic syndrome)

67
Q

tx for GN

A

high dose corticosteroids!

68
Q

protein >3.5 day

protein < 3.5 day

A

>3.5 is nephrotic syndrome

< 3.5 is nephritic syndrome

69
Q

percentage of people will have ESRD by 60 years old in PKD

A

50%

70
Q

granular or muddy brown casts

A

ATN

71
Q

broad waxy casts

A

ATN

72
Q

WBC casts

A

infections, pyelonephritis

73
Q

epithelial casts

A

ATN

74
Q

tea colored urine

A

GN

75
Q

hydronephrosis occurs when

in kids

adults

can also be caused by what else

A

secondary to an obstruction of the urinary tract.

in kids, occurs at the UPJ

in adults, due to BPH, neurogenic bladder, tumor, aortic anerysm, renal calculi

high output urinary flow and vesicouretal reflux

76
Q

hydronephrosis symptoms

A

may be asymptomatic or have back/flank pain, decreased urine output, abd pain, or UTIs

77
Q

how to diagnose for hydronephrosis

A

ultrasonography or CT scan to detect dilation of renal calcyces and/or ureter

increase BUN and Cr provide evidence of secondary renal failure.

78
Q

tx for hydronephrosis

A

surgically correct obstruction; use lithotripsy if calculi

stent placement

percutaneous neprostomy tube placement to relieve pressure if urinary outflow tract is not sufficiently cleared or obstruction

foley or suprapubic catheters may be required for lower urinary tract obstructions (ex BPH)

79
Q

complications of leaving hydronephrosis from urinary obstruction untreated

A

HTN

acute or chronic renal failure

sepsis

nephrology & urology (6 decks)

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