Nefro

Question 1

Elementele care au rol in desfasurarea/impiedicarea filtrarii

Answer 1

Endoteliu
MBG
Podocite

Question 2

Din ce este alcatuita bariera de filtrare glomerulara (diafragma cu sita)?

Answer 2

Endoteliul fenestrat
MBG
Celule epiteliale viscerale diferentiate (podocite)

Question 3

Proteinele ce realizeaza diafragma cu fante

Answer 3

Nefrina
Podocina
P-cadherina
Alfa si beta-catenina
Proteina asociata CD2 (CD2AP)
TRPC6
ZO1

Question 4

Citoscheletul de actina poate fi modificat prin:

Answer 4

Anomalii ale proteinelor citoscheletale (alfa actinina 4 -> GSFS ereditara)
Leziuni/anomalii ale proteinelor diafragmei cu fanta
Modificari ale MBG
Injurie podocitara directa

Question 5

Ce poate determina injurie podocitara directa?

Answer 5

Infectii virale
Medicamente
Toxine
Activare locala de SRAA

Question 6

Leziuni imune ce pot aparea la nivel glomerular si antreneaza leziuni secundare

Answer 6

Depunerea de fibrina
Agregarea plachetara
Infiltrarea neutrofilelor
Injuriile provocate de radicalii liberi

Question 7

Glomerulopatiile sunt a …(a) cauza de BRT si reprezinta … (b) din cazuri

Answer 7

a = treia
b = 10-15%

Question 8

Frecventa NTI ca reactie de HS la medicamente

Answer 8

70% cazuri
Cel mai des
* penicilina
* AINS
* IPP

Question 9

Unele sindroame nefrotice mostenite implica mutatii ale unor gene ce codifica proteine podocitare precum

Answer 9

Nefrina (tipul finlandez)
Podocina
Alfa-actinina 4
Gena supresoare a tumorii Wilms

Question 10

Proteinuria posturala poate fi semn precoce de leziuni glomerulare grave precum

Answer 10

GNM
GSFS
Nefropatia IgA
Nefropatia diabetica
Amiloidoza

Question 11

Frecventa proteinuriei posturale si valoarea ei

Answer 11

> 50% din pacientii cu functie renala normala
Masoara de obicei < 1g/zi

Question 12

Proteinuria usoara/tranzitorie poate acompania:

Answer 12

Starile febrile
Bolile infectioase
ICC

Question 13

MO in HIVAN

Answer 13

Colaps glomerular
Podocitele sunt
- marite de volum (hipertrofice)
- hiperplazice
- vacuolate grosier (contin picaturi de absorbtie ale proteinelor)
Capilarele adiacente - diferite grade de colaps + plicaturare a peretilor

Question 14

Markeri specifici podocitelor

Answer 14

Sinaptopodina
Factor tumoral Wilms

Question 15

Clinica HIVAN

Answer 15

Proteinurie nefrotica
Edeme
BCR - posibil rapid progresiva

Question 16

Mutatia APOL1 creste susceptibilitatea la GSFS ca raspuns la insulte precum

Answer 16

HTA
HIV
LES

Question 17

Mutatia APOL1 protejeaza impotriva

Answer 17

Bolii somnului (tripanosomiazei africane)

Question 18

Ce gene MHC pot creste susceptibilitatea la glomerulonefrita primara?

Answer 18

HLA-A1
HLA-B8
HLA-DR2
HLA-DR3

Question 19

Cu ce se asociaza HLA-DQA1?

Answer 19

GNM idiopatica cu ac anti-PLA2R

Question 20

Hematuria cu/fara proteinurie subnefrotica poate duce la descoperirea timpurie a unei glomerulopatii potential grave precum

Answer 20

LES
PHS
GNPI
Hipercalciurie idiopatica la copii

Question 21

Ce boli glomerulare secundare pot sa suprapuna si GNRP?

Answer 21

Nefropatia IgA
GNM
GNPI

Question 22

GNRP cu model liniar

Answer 22

GNRP anti-MBG (idiopatica mediat de Ac)
Goodpasture

Question 23

GNRP cu model granular

Answer 23

GNRP idiopatica mediata de CI
Asociat cu GN primare
* GNMC (tip 2 > tip 1)
* Nefropatie IgA
* GNM
Asociat cu GN secundare
* GNPI
* LES
* PHS
* Crioglobulinemie

Question 24

Microorganisme ce pot determina GNPI non-streptococica

Answer 24

Staphylococcus
S. pneumoniae
Legionella
T. pallidum (sifilis)
Varicela
Oreion
VHB, VHC
EBV
Echovirus
Toxoplasma
Plasmodium (malarie)
Schistosoma
Trichinella

Question 25

Obiective tratament GNMC la copii

Answer 25

Urmarire regulata Control TA Agenti antiproteinurici Corectia tulburarilor lipidice

Question 26

Caracteristici extraglomerulare ale NL

Answer 26

NTI (75%) Tromboza de vena renala Stenoza de artera renala

Question 27

Manifestari trombotice asociate NL

Answer 27

Infarct glomerular segmentar Microangiopatie trombotica Vasculita

Question 28

In ce nefropatii se poate administra rituximab?

Answer 28

GNLM GNM Amiloidoza AL Vasculite Gamapatia monoclonala cu semnificatie renala (MGRS) Nefrita lupica Nefropatia CG

Question 29

Ce nefropatii au depozite subepiteliale?

Answer 29

GNM

Question 30

GNRP se poate suprapune glomerulopatiilor secundare precum

Answer 30

Nefropatie IgA GNM GNPI

Question 31

In ce boli mai apare IgA crescut

Answer 31

PHS Hepatopatii cronice Cancere (mai ales bronsice) SpA seronegativa Psoriazis BC Mycosis fungoides

Question 32

Cauze reversibile de BCR

Answer 32

Obstructie de tract urinar HTA Stenoza de artera renala Glomerulonefrite/vasculite sistemice

Question 33

Prevalenta BCR in functie de varsta

Answer 33

<65 ani = 1.5% 65-74 ani = 15.9% 75-84 ani = 30.9% >85 ani = 33.4%

Question 35

Medicatie GNLM

Answer 35

GC doze mari Ciclosporina/tacrolimus Rituximab CFS + GC Levamisol

Question 36

Medicatie GSFS I

Answer 36

Prednisolon Ciclosporina/tacrolimus CFS/clorambucil/AZT Abatacept ACTH - gel topic

Question 37

Medicatie GNM

Answer 37

Toti pacientii - IEC (doza maxima tolerata), diuretic, statina, anticoagulant Rituximab Ciclosporina/tacrolimus CFS + prednisolon oral alternativ Clorambucil + prednisolon oral alternativ GC orali dar NU singuri

Question 38

Medicatie nefropatie IgA

Answer 38

IEC/sartan - toti pacientii GC Amigdalectomie

Question 39

Medicatie vasculite ANCA+

Answer 39

GC orali doze mari + CFS iv pulsuri - inductie Rituximab - varianta de inductie AZT/CFS/MMF/Rituximab - mentinere

Question 40

Cel mai eficient in mentinerea remisiei in vasculite ANCA+

Answer 40

Rituximab la 3 luni in D fixa

Question 41

Medicatie NL

Answer 41

HTA, edemele - tratate mereu Rituximab - cazuri refractare severe MMF/AZT - mentinere GC + D mari de CFS/MMF - inductie CFS - la albi MMF - la negri si hispanici

Question 42

Cel mai bun in mentinerea remisiei in NL

Answer 42

Micofenolat