L58 + 59 Flashcards Preview

P&T Block 5 Renal > L58 + 59 > Flashcards

Flashcards in L58 + 59 Deck (39)
1

If you saw a hypercellular glomerulus, what would be happening in what you see?

Prolif of intracap glomerular cells
Crescents = prolif of extracap glomerular cells

2

What happens to get sclerosis in the kidney?

GBM collapse + mesangial expansion
Damage to segmental structure
Get scar due to collagen deposition

3

What happens to get hyalinosis in the kidney?

Accum protein in sclerotic areas in BV walls

4

What disease process thickens the GBM itself?

Diabetes (vs immune complex deposition thickening)

5

What is global vs segmental glomerulus damage?

Global - entire thing involved
Segmental - part of tuft involved w/ other part patent

6

Use the name: what is focal segmental glomerulo-sclerosis?

Focal - dotted throughout kidney
Segmental - only part glomerulus affected

7

Which cells are mediators of injury to the glomerulus?

Impt ones: neutrophils + mesangial cells

8

What are the 3 soluble mediators of injury at the glomerulus?

Complement
Fibrinogen
TGF beta

9

Clinical presentation nephritic syndromes

Hematuria - RBC casts
Mild proteinuria
Periorbital edema
Azotemia
Oliguria
HTN + edema

10

Pathogenesis of post-infectious glomerular nephritis?

Strep pyogenes infection: impetigo > pharyngitis
Immune complex pathogenesis

11

Post-infectious GN LM, IF, EM

LM: hypercellular (nephrotic)
GN: granular
EM: sub-epi humps of Ig

12

What other labs will indicate post-strep GN

+ ASO
↓C3

13

What is rapidly progressive GN? What are the categories of disease?

Crescent
Renal failure progressing in wks/mos
Diseases may RESULT in RPGN
1. Immune complex mediated = granular IF
2. Anti-GBM = linear IF
3. Pauci-immune = nothing on IF

14

Treat post-strep GN; what is the complication if not treated?

Will resolve on own if treat 1ary infection in kids
Can progress to RPGN

15

What disease has anti-GBM antibodies?

Goodpature's: T2 HST rxn
Linear IF

16

What diseases have granular IF and can progress to RPGN?

Immune complex disorders
1. Post-strep GN
2. SLE (IgG)

17

What disease are RPGN pauci-immune?

1. Wegener's: c-ANCA
2. Microscopic polyarteritis (small vessel vasculitis) p-ANCA
3. Polyarteritis nodosa
4. Churg Strauss

18

Which diseases that can result in RPGN are reno-pulmonary diseases?

Goodpastures
Wegener's
Microscopic polyangitis

19

What is ANCA?

Anti-neurtophilic cytoplasmic autoantibodies
c-ANCA = cytoplasmic staining
p-ANCA = perinuclear staining

20

What is the ANCA in Goodpastures?

Confounder - doesn't matter!

21

Treat Goodpasture's

Plasmapheresis + steroids + cytotox drug

22

Treat RPGN

Steroids + cytotoxic drugs

23

What are the characteristics of nephrotic syndrome?

Proteinuria > 3.5 g/d
Hypoalbumin
Hyperlipidemia
Edema

24

What is the most common cause of nephrotic syndrome in kids?

1ary
Minimal change disease

25

What is membranous glomerulopathy?

1ary nephropathy- long onset
Ig @ sub-epi
Diffuse thickening of glomerular capillary walls
Idiopathic

26

Membranous glomerulopathy LM, EM, IF

LM: diffuse thickening
EM: sub-epi spike and dome

27

What is minimal change disease? LM, IF, EM

Kids: response to steroids
Lose negative change in GBM
ONLY see on EM: effacement of podocytes

28

Presentation of minimal change disease

Selective proteinuria: lose albumin but not globulins

29

What might minimal change disease progress to?

Focal seg glomerulo-sclerosis

30

Clinico-pathological definition of focal-seg GS

Proteinuria (nephrotic) non-selective
FSGS
- Focal makes biopies hard
Effacement of foot processes

31

Usually FSGS is primary and idiopathic. What are 3 secondary causes?

Focal scarring from another GN
Reflux nephropathy
Disproportion body:renal mass
HIV
Drug induced: heroin

32

Treat FSGS

Not gonna - poor steroid response
Likely progress renal failure
High recurrence in transplant pts

33

What is IgA nephropathy?

Nephrotic - recurrent hematuria
IgA deposits in mesangium -> alternative complement

34

What is a systemic IgA disease that can cause IgA nephropathy, vasculitis, and skin purpura?

Henoch-Schoenlein purpura

35

Presentation Alport's

Males
Nephritis - hematuria w/ RBC casts
Deafness

36

Pathogenesis Alport's

T4 collagen mutation - don't see any of this collagen on skin biopsy
X GBM synthesis

37

What is thin membrane disease?

Asymptom hematuria
EM: diffuse thinning of GBM

38

Is membrano-proliferative glomerulo-nephritis nephrotic or nephritic? Types

Mixed - kids/young adults
1. Immune complex mediated - Hep C/B, SLE
2. Complement - mutations or Abs vs complement regulating proteins
3. W/ thrombotic microangiopathy

39

Does SLE cause nephritis or nephrotic?

Nephritis
IF: look for all Ig, complement components