Nefro

Question 1

Elementele care au rol in desfasurarea/impiedicarea filtrarii

Answer 1

EndoteliuMBGPodocite

Question 2

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

Answer 2

Endoteliul fenestratMBGCelule epiteliale viscerale diferentiate (podocite)

Question 3

Proteinele ce realizeaza diafragma cu fante

Answer 3

NefrinaPodocinaP-cadherinaAlfa si beta-cateninaProteina asociata CD2 (CD2AP)TRPC6ZO1

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 fantaModificari ale MBGInjurie podocitara directa

Question 5

Ce poate determina injurie podocitara directa?

Answer 5

Infectii viraleMedicamenteToxineActivare locala de SRAA

Question 6

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

Answer 6

Depunerea de fibrinaAgregarea plachetaraInfiltrarea neutrofilelorInjuriile provocate de radicalii liberi

Question 7

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

Answer 7

a = treiab = 10-15%

Question 8

Frecventa NTI ca reactie de HS la medicamente

Answer 8

70% cazuriCel 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)PodocinaAlfa-actinina 4Gena supresoare a tumorii Wilms

Question 10

Proteinuria posturala poate fi semn precoce de leziuni glomerulare grave precum

Answer 10

GNMGSFSNefropatia IgANefropatia diabeticaAmiloidoza

Question 11

Frecventa proteinuriei posturale si valoarea ei

Answer 11

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

Question 12

Proteinuria usoara/tranzitorie poate acompania:

Answer 12

Starile febrileBolile infectioaseICC

Question 13

MO in HIVAN

Answer 13

Colaps glomerularPodocitele 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

SinaptopodinaFactor tumoral Wilms

Question 15

Clinica HIVAN

Answer 15

Proteinurie nefroticaEdemeBCR - posibil rapid progresiva

Question 16

Mutatia APOL1 creste susceptibilitatea la GSFS ca raspuns la insulte precum

Answer 16

HTAHIVLES

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-A1HLA-B8HLA-DR2HLA-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

LESPHSGNPIHipercalciurie idiopatica la copii

Question 21

Ce boli glomerulare secundare pot sa suprapuna si GNRP?

Answer 21

Nefropatia IgAGNMGNPI

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 CIAsociat cu GN primare* GNMC (tip 2 > tip 1)* Nefropatie IgA* GNMAsociat cu GN secundare* GNPI* LES* PHS* Crioglobulinemie

Question 24

Microorganisme ce pot determina GNPI non-streptococica

Answer 24

StaphylococcusS. pneumoniaeLegionellaT. pallidum (sifilis)VaricelaOreionVHB, VHCEBVEchovirusToxoplasmaPlasmodium (malarie)SchistosomaTrichinella

Question 25

Obiective tratament GNMC la copii

Answer 25

Urmarire regulataControl TAAgenti antiproteinuriciCorectia tulburarilor lipidice

Question 26

Caracteristici extraglomerulare ale NL

Answer 26

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

Question 27

Manifestari trombotice asociate NL

Answer 27

Infarct glomerular segmentarMicroangiopatie tromboticaVasculita

Question 28

In ce nefropatii se poate administra rituximab?

Answer 28

GNLMGNMAmiloidoza ALVasculiteGamapatia monoclonala cu semnificatie renala (MGRS)Nefrita lupicaNefropatia CG

Question 29

Ce nefropatii au depozite subepiteliale?

Answer 29

GNM

Question 30

GNRP se poate suprapune glomerulopatiilor secundare precum

Answer 30

Nefropatie IgAGNMGNPI

Question 31

In ce boli mai apare IgA crescut

Answer 31

PHSHepatopatii croniceCancere (mai ales bronsice)SpA seronegativaPsoriazisBCMycosis fungoides

Question 32

Cauze reversibile de BCR

Answer 32

Obstructie de tract urinarHTAStenoza de artera renalaGlomerulonefrite/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 34

Medicatie GNLM

Answer 34

GC doze mariCiclosporina/tacrolimusRituximabCFS + GCLevamisol

Question 35

Medicatie GSFS I

Answer 35

PrednisolonCiclosporina/tacrolimusCFS/clorambucil/AZTAbataceptACTH - gel topic

Question 36

Medicatie GNM

Answer 36

Toti pacientii - IEC (doza maxima tolerata), diuretic, statina, anticoagulantRituximabCiclosporina/tacrolimusCFS + prednisolon oral alternativClorambucil + prednisolon oral alternativGC orali dar NU singuri

Question 37

Medicatie nefropatie IgA

Answer 37

IEC/sartan - toti pacientiiGCAmigdalectomie

Question 38

Medicatie vasculite ANCA+

Answer 38

GC orali doze mari + CFS iv pulsuri - inductieRituximab - varianta de inductieAZT/CFS/MMF/Rituximab - mentinere

Question 39

Cel mai eficient in mentinerea remisiei in vasculite ANCA+

Answer 39

Rituximab la 3 luni in D fixa

Question 40

Medicatie NL

Answer 40

HTA, edemele - tratate mereuRituximab - cazuri refractare severeMMF/AZT - mentinereGC + D mari de CFS/MMF - inductieCFS - la albiMMF - la negri si hispanici

Question 41

Cel mai bun in mentinerea remisiei in NL

Answer 41

Micofenolat