Nephrology: Glomerular Disease, Nephritis Flashcards
Which is more severe: Nephrotic or Nephrititc ?
Nephritic, more apt to you into renal failure (Have more hematuria than proteinuria whereas the Nephrotics are opposite )
Define Nephritic Syndrome
PHAROH (With Pyuria and Edema)
Proteinuria Hematuria Azotemia Red blood cell casts Oliguria Hypertension
Pyuria
Edema
Define Nephrotic Syndrome
Proteinuria of > 3.5 g/day Hypoalbuminemia Hyperlipidema (Fat Casts and Fat Ovals) Edema Often See Hypercoagubility
Define Asymptomatic Hematuria
Microhematuria with the same characteristics as in the Nephritic Syndrome, but patient lacks the other features
Define intermittent gross hematuria
Macrohematuria with the same characteristics as in the Nephritic Syndrome, but patient lacks the other features
Define Asymptomatic Proteinuria
Proteinuria without the additional features of the nephrotic syndrome
Define Rapidly Progressing glomerulo nephritis
Relentless loss of renal function within weeks or months (creatinine doubles in < 3 months), may have either of the features 1 - 5
Define Pulmonary-Renal Vasculitic Syndrome
As the name suggests, there is vasculitis with involvement of the lungs and the kidney. Usually presents with hematuria or the nephritic syndrome.
Chronic Renal failure
Patient presents with advanced renal failure. Often, the cause can no longer be determined with certainty
Primary Glomerulonephritis means…
That the disease is only present in the kidney and not due to diffuse pathology
Secondary glomerulonephritis refers to …
there is a systemic disease that involves several organs, among them the kidney, and the kidney disease is a glomerulonephritis
What are the four main Primary Glomerulonephritis’ ?
Minimal Change Disease
FSGS
IgA Nephropathy
Membranous nephropathy
List the Major Secondary Glomerulonephritis’
Postinfectious Glomerulonephritis
Membranoproliferative Glomerulonephritis with Hepatitis C
Renal Involvement in Systemic Vasculitis
Anti-GBM disease and Goodpasture’s Syndrome
Lupus Nephritis
Diabetic Nephropathy
Amyloidosis
Henoch-Schönlein Purpura
HIV associated nephropathy
Do minimal change disease, Membranous neuropathy and FSGS present as Nephrotic or Nephritic ? (Primary GN’s)
Nephrotic !
The only Primary GN that show as Nephritic is IgA Nehropathy (shows hematuria)
Membranous Neuropathy is often associated with what other disease state ?
Malignancy
A child presents with a NEPHROTIC syndrome. What do they most likely have ?
Minimal Change Disease
An african american presents with a NEPHROTIC syndrome. What is it likely to be ? ?
FSGS !
40 yo caucasian presents with a NEPHROTIC disease. What is it likely to be ?
Membranous Glomerulopathy
A half asian, half hispanic person presents with a NEPHROTIC disease that actually shows hematuria. What is it it likely to be ?
IgA Nephropathy
What is usually required to diagnose a specific type of primary glomerulonephritis ?
Biopsy !
Histopathology of minimal change disease
looks normal on light microscope
May see binding of the foot processes of podocytes (STARRED ON PPT)
Histopathology of FSGS
LOOK AT SLIDE 41 (STARRED)
Focal: Only in some portion of kidney
Segmental : Involve only a portion of the glomerulus
Glomerulosclerosis: Scarring of glomerulus
Histopathology of Membranous GN
LOOK AT SLIDE 43 (STARRED)
Thick basement membrane with sub-epithelial immune deposits.
PLA2R is target antigen
Membrane looks thick and rigid
SPIKES are seen with Jones Silver Stain * (Slide 45 is STARRED)
Immunofluorescence is GRANULAR (STARRED Slide 46) due to Immune complex deposition ! (Granular is Lumpy Bumpy)
Histopathology of IgA Nephropathy
MESANGIAL IgA deposits. (Immune complexes ?)
Clinical will show “dark urine” due to microhematuria. Often in Asians and Hispanics
Post- Infectious GN is a Secondary GN which commonly occurs after infection with which two pathogens ?
Strep (Group A, Beta Hemolytic –> Pyogenes, Mprotein)
Staph
Does Post Streptococcal GN (PS GN) present at Nephrotic or Nephritic ?
Nephritic ! May have gross hematuria (PHAROH PE)
How can you tell the difference between PS GN and IgA Nephropathy strictly by taking a history ?
PS GN occurs 10 days after a URI (21 after skin)
Resolves after 6 weeks typically
IgA occurs 5 days after URI
Persistent or recurrent hemturia for years
both can show gross hematuria..
What occurs to complement as PS GN progresses ? (Very Important to Know)
It starts out very low in the acute phase but increases steadily as the disease progresses
Immunofluorescence of PS GN will show what kind of pattern ?
Granular
Due to deposition of IgG-Antigen complexes and complement
Electron microscopy will show what findings in PS GN ?
lArge sub endothelial deposits (due to antigen complex deposition)
What four Secondary GN will give you low complement levels ?
PSGN
Membranoproliferative GN
Cryoglubulinemia
Lupus
in Light microscopy, how is PSGN describe ?
Diffuse, proliferative GN
How do you treat PS GN ?
Anti-biotice
Supportive (electrolyte and fluids)
What infectious agent is associated with Membranoproliferative GN ?
HEPATITIS C
Most Membranoproliferative GN is caused by hep c infection now . Was once though to be idiopathic
Membranoproliferative GN with Hep C is also associated with what other blood abnormality ?
Cryoglobulinemia
What is a cryoglobulin ?
Plasma proteins that precipitate in the cold, include Ig and complement components.