- 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

GN, nephrotic syndrome, PKD Flashcards by Mai Wells

what is glomerulonephritis?

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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60% of glomerulonephritis occurs in who? prognosis?

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

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

glomerulonephritits symptoms

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what is a common cause of GN

post streptococcal infection

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what is the major lab to get in GN

antistreptolysin O titer

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UA reveals oval fat body

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

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Over 3.5 gm proteinuria/24 hrs

Nephrotic syndrome

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Hypoalbumnemia, azotemina, hyperlipemia, C3 levels nml or low

Nephrotic syndrome

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Maltese crosses and oval fat bodies

Nephrotic syndrome

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Common cause of nephritic syndrome

Post strep throat inf

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main difference in nephritic vs neprotic syndrome

nephritic is proliferation; nephrotic is membraneuous

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eosinophils in urine

malignant HBP

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SLE

Nephritic and nephrotic syndrome

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

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

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common sx of autosomal dominant PKD

back and flank pain and headaches

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tx for autosomal dominant PKD

supportive. antibx

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UA shows proteinuria, hematuria, pyuria, and bacteriuria

PKD

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glomerulonephritits symptoms

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

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describe UA findings in GN

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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hematuria, RBC casts, proteinuria

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serum complement (C3) in GN

decreased

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how to dx GN

antistreptolysin O titer

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

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tx for GN

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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benign hematuria

henoch schonlein purpura

mild post infectious GN

IgA nepropathy

hereditary nephritis

causes of focal GN in kids

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tea or coca cola colored urine

hematuria, think GN or nephritic syndrome

bergers disease(Iga nephropathy) endocarditis lupus infectious strep

all causes of GN

main difference between nephrotic syndrome and nephritic syndrome

nephrotic has no inflammation nephritic has inflammation of kidney

explain hyperlipidemia in nephritic syndrome

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

post infectious GN membranoproliferative GN

causes of diffuse GN in kids

IgA nepropathy hereditary nephritis SLE

causes of focal GN in adults

SLE membranoproliferative GN rapidly progressive GN post infectious GN vasculitis

causes of diffuse GN in adults

hypoalbuminemia lipiduria hypercholesterolemia edema

nephrotic syndrome

nephrotic syndrome can predispose a pt to what

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

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

symptoms of nephrotic syndrome

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

signs of nephrotic syndrome

basic tx of nephrotic syndrome

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

symptoms of nephrotic syndrome

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

signs of nephrotic syndrome

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

UA in nephrotic syndrome

foamy urine, proteinuria, lipiduria, glycosuria, hematuria

microscopic urinalysis of nephrotic syndrome

RBC casts, granular casts, hyaline casts, fatty casts \*\* oval fat body

foamy urine, proteinuria, lipiduria, glycosuria, hematuria

UA in nephrotic syndrome

RBC casts, granular casts, hyaline casts, fatty casts \*\* oval fat body

microscopic urinalysis of nephrotic syndrome

meds for nephrotic syndrome

ACE inh early in course lots of diuretics

diet management for nephrotic syndrome

sodium and fluid intake restricted not excessive protein and potassium in diet

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

cycophosphamide, cyclosporine, tacrolimus, mycopenolate mofetil

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

causes of nephrotic syndrome

cyclophosphamide, cyclosporine, tacrolimus, mycopenolate mofetil

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

mnemonic for nephritic syndrome

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

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

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

foamy urine

nephrotic syndrome

preferable urine test for nephrotic syndrome

spot protein to creatinine ratio rather than 24 hr urine

vaccination for nephrotic pts

23 polyvalent pneumococcus vaccine

autosomal dominant PKD vs autosomal recessive PKD 1) common one(uni or bilateral?) 2) age 3) more severe?

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

AD PKD and ESRD -associated with increased risk of what

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

what is an early sign of abnormal kidney function

nocturia reflects early impairment of urinary concentration

what occurs with pts with long term renal diseases or ESRD? what race is common

acquired form of cystic kidney d/s blacks

common symptoms of AD PKD

back pain, flank pain and HA

pain and hematuria most common initial presenting symptoms of what

PKD

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

PKD

CBC findings in PKD

anemia

diagnostic choice for PKD

ultrasonography

is there early detection for PKD

yes genetic testing for PKD1 and PKD2

tx for PKD

supportive ACE for HTN low protein high intake of fluids antibx for infections

antibiotics that can penetrate the cyst wall (PKD)

bactrim, FQ, chloramphenicol, vancomycin

normal GFR

100-130

red cell casts

GN(nephritic syndrome)

tx for GN

high dose corticosteroids!

protein \>3.5 day protein \< 3.5 day

\>3.5 is nephrotic syndrome \< 3.5 is nephritic syndrome

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

50%

granular or muddy brown casts

ATN

broad waxy casts

ATN

WBC casts

infections, pyelonephritis

epithelial casts

ATN

tea colored urine

hydronephrosis occurs when in kids adults can also be caused by what else

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

hydronephrosis symptoms

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

how to diagnose for hydronephrosis

ultrasonography or CT scan to detect dilation of renal calcyces and/or ureter increase BUN and Cr provide evidence of secondary renal failure.

tx for hydronephrosis

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)

complications of leaving hydronephrosis from urinary obstruction untreated

HTN acute or chronic renal failure sepsis

GN, nephrotic syndrome, PKD Flashcards

(79 cards)