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Flashcards in GN supportive care Deck (32):
1

what are the best therapies for edema caused by GN?

salt restriction
bed rest
support stockings
diuretics

2

what is the goal blood pressure for a patient with proteinuria and a GFR less than 60?

130/80

3

what are the first line therapies for hypertension in GN?
why are they good?

ACEI's and ARB's
help stop protein loss in proteinurea
(delay loss of renal function)

4

what are good second line drugs for hypertension in GN?
what else are they good at treating specifically?

diltiazem and verapamil (nondihydropyridine Ca blockers)
help with proteinurea loss

5

what nonpham therapy helps with GN?

protein diet restriction
less than 0.8 g/kg/day

6

what is the primary cause and secondary causes of minimal change neuropathy?

primary = unknown
secondary:
1. NSAIDs
2. Lupus
3. T cell autoimmune disorders

7

who is most commonly affected by minimal change mephropathy?

children

8

what is the clinical presentation of minimal change nephropathy

edema following infections
(minimal change nephropathy)

9

what is a very rare effect of vaccinations

minimal change nephropathy

10

minimal change nephropathy is very responsive to what type of treatment?
what percent of pt's are urine free with this treatment after how long?

corticosteroids

50% have protein free urine after a week
90% after 4 weeks

11

what is the first line drug and dosing for minimal change nephropathy

prednisone
60mg/m2 daily for 4-6 weeks
followed by prednisone 40 mg/m2 daily or every other day for 4-6 weeks

12

if protein loss stops within 1-4 weeks of corticosteroid treatment, what is diagnosis? what must be done if it does not work?

minimal change nephropathy
biopsy

13

what condition is most likely to lead to end state renal disease?

focal segmental glomerulosclerosis

14

who is at greatest risk for FSGS?

African americans (4x's greater risk due to more robust immune sytem)

15

what are 3 characteristics of FSGS

1. focal = found in some glomeruli, not all
2. segmental = involves a portion of the glomeruli
3. sclerosis = leads to scarring

16

what is often seen in nonsclerotic glomeruli of FSGS?

fusion of the foot process

17

what has a greater prevalence of nephrotic range proteinuria: minimal change disease or FSGS?

minimal change

18

what is the primary cause of FSGS?

circulating factor that deposits in kidney causing immune reaction

19

what has been linked to secondary FSGS?

1. Heroin
2. Obesity
3. Genetic mutation
4. HIV
5. Anabolic Steroids
6. Rituxan
7. Pamidronate

20

what is treatment for FSGS?

Always an ACEI or ARB
1. prednisone 1-2 mg/kg/day for 4 months
2. long term cyclosporine
3. mycophenolate, cyclophosphamide
4. plasmapheresis

21

why does plasmapheresis work in FSGS

pulls out a percentage of circulating factor

22

what is the recurrence for FSGS in kidney translpants

30%
(if get it after 2 100% chance in 3rd)

23

what GN occurs frequently in elderly patients

membranous nephropathy

24

if diagnosed with FSGS what occurance gives a poor prognosis for kidney transplant

ESRD in less than one year

25

what is the MOA of membranous nephropathy

membranes INSIDE the kidney begin to overgrow and damage kidney

26

what antigen is identified with membranous nephropathy?

PLA2R antigen on podocytes

27

what treatment is very effective in membranous nephropathy

Anti-PLA2R specific antibodies antibodies

28

what do antigens cause?

an immune response

29

membranous nephropathy can be treated with what non-pharm treatment

plasmapheresis

30

what are presentation symptoms of membranous nephropathy?

heavy proteinuria > 3.5 gm/day
IgG in urine
lipiduria and oval fat bodies in urine
ascities
hypercoaguable state

31

what are the 2 optimal treatments for membranous nephropathy

1. steroids
2. chlorambucil

32

what is an alternative if chlorambucil is not tolerated?

cyclophosphamide