Quiz 1 - Nephritic/Nephrotic

Question 1

3 major causes of Nephritic syndrome

Answer 1

Auto-immune (SLE, Wegener’s)
Post-infectious (strep PSGN)
IgA nephropathy (Berger’s)

Question 2

DDX PHAROH

Answer 2

nephritic
cirrhosis/liver failure
severe HTN
AIN
RCHF
DM
Hemolytic-uremic syndrome

Question 3

Glomerular bleeding characteristics

Answer 3

coca cola
proteinuria
HTN
hx of URI
fever, rash

Question 4

Post-Infectious GN pathophys

HSN III

Answer 4

Ag-Ab complexes lodged in GBM podcytes leads to complement activation

Question 5

Post-Infectious GN serology and light microscopy

Answer 5

Streptozymes (5)
Decreased complement
neutrophuils in glomerulus

Question 6

Treatment of PSGN

Answer 6

1) Treat infection if present (penicillin, erythromycin) (tho won’t nec prevent PSGN)
2) Treat any edema or HTN (conventional: loop diuretics/ furosemide)
3) Limit (but adequate) protein and sodium
4) Bed rest
5) Botanicals– AI: Curcuma and boswelia; Antimicrobials: Echinacea
6) Anti–inflammatories: Quercitin, bromelain
7) Antioxidants; Vit C to bowel tolerance Vit E 800 IU
8) Constitutional hydrotherapy or wet sheet wrap

Question 7

DDX/Variant of Post-Infectious GN

Answer 7

Rapidly Progressing Glomerulonephritis

can –> ARF

“crescentic GN” (Bowman’s capsule compressed)

Question 8

Auto-Immune GN

Answer 8

Wegener’s
Churg-Strauss
Goodpasture’s

Question 9

Berger’s dz/ IgA nephropathy etiology

Answer 9

?

assoc with Celiac, Hep B, alcoholic cirrhosis, sarcoidosis, HIV, SLE, RA, Sjogren’s

Question 10

Berger’s dz/ IgA nephropathy sxs

Answer 10

PHAROH

Question 11

Berger’s dz/ IgA nephropathy dz

Answer 11

kidnex bx= IgA

Question 12

Berger’s dz/ IgA nephropathy Tx

Answer 12

monitor
GF diet
Artemesia (wormwood)
fish oil
S. boulardii
Cordyceps
Rheum palmatum

Question 13

Nephritic Syndrome Tx

Answer 13

1) Avoid sodium, avoid high-potassium foods, low protein diet, low antigen diet (gluten, meat, dairy)
2) Immune amphoterics (Ganoderma, Grifola, Withania, Tinospora)
3) Diuretics may be needed for edema (use with caution)
4) Fish oil (4-12 g/d in divided doses) Donadio NEJM 1994 Nov 3;331(18) 1194-9
5) Treat HTN: goal BP is <125/75 mm Hg in presence of proteinuria >1g/d
Pharmacologic: ACEi
6) Probiotics: decrease uremic toxic production in gut
7) Remove other allergens (environmental, etc)
8) quit smoking, limit/no alcohol
9) maintain healthy weight
10) Conventional approach: corticosteroids, alkyating agents (cyclophosphamide),
calcineurin inhibitors, biologics: rituximab and ocrelizumab

Question 14

Acute GN can progress to…

Answer 14

Chronic

Question 15

Nephrotic Syndrome etiology

Answer 15

damage to podocytes–> lipid and protein wasting

Poorly controlled DM, IgA nephropathy and nephritic conditions,
SLE, amyloidosis, HIV, pre-eclampsia, drugs (penicillamine, NSAIDs, lithium, heroin, gold compounds), Snake bite, cancer (lymphomas and leukemias), FHx of congenital kidney dz (Alport dz, Fabry dz)

Question 16

Nephrotic syndrome presentation

Answer 16

HTN, oliguria, edema, ascites, foamy urine, cough, DOE

> 3.5 g protein/d

Question 17

Minimal change dz

Answer 17

90% kids

Question 18

Focal segmental glomerulosclerosis

Answer 18

young adults, MC in AA

Question 19

Secondary causes of nephrotic syndrome

Answer 19

SLE, diabetic nephropahty, amyloidosis, HIV, HBV, HCV, multiple myeloma

Question 20

DDX Edema states

Answer 20

CHF
liver failure
Pyelo
ATN
multiple myeloma

Question 21

Acute Interstitial Nephritis causes

Answer 21

Drug HSN (abx, NSAIDs), infections

Question 22

Acute Interstitial Nephritis ssxs

Answer 22

Rash

fever, hematuria, oliguria, nausea, vomiting, malaise, flank pain, arthralgia

Question 23

AIN labs

Answer 23

Eosinophiluria
FENa > 1%
WBCs, WBC casts

BX if persisting sx:
infiltration of inflammatory cells into interstitium, glomeruli usually spared (except SLE)

Question 24

AIN Tx

Answer 24

discontinue case
Renafood
anti-inflammatories
‘roids

Question 25

Acute Tubular Necrosis causes

Answer 25

aminoglycosides, amphotericin B, lithium, cisplatin, contrast dye, cisplatin

Question 26

ATN imaging

Answer 26

Muddy brown casts | RTE and RTE casts with tubular fragments

Question 27

ATN Tx

Answer 27

Silybum marianum, gingko biloba, Cordyceps, Urtica seed, CoQ10, selenium, Vit C

Question 28

Obstructive Nephropathy causes

Answer 28

renal stone, prostate dz, carcinoma of cervix, colon, bladder

Question 29

Obstructive Nephropathy labs

Answer 29

Azotemia and HTN | Hematuria or pyuria, but often benign UA

Question 30

Obstructive Nephropathy labs

Answer 30

Azotemia and HTN | Hematuria or pyuria, but often benign UA

Question 31

Analgesic nephropathy

Answer 31

Common overuse seen with chronic pain conditions (HA, myalgia, arthritis) CT: small kidneys, papillary calcifications

Question 32

Analgesic nephropathy Tx

Answer 32

1) Prevent renal scarring (irreversible!) if early stages: Treat the cause! 2) Tubular dysfunction may require K and Ph restriction, Na, Ca and bicarbonate supplementation 3) Chelation therapy for heavy metals 4) Natural analgesics, HP and physical medicines for chronic pain syndromes 5) Anti-inflammatories such as tumeric, boswellia, bromelain (eg, BCQ®) 6) Renal protectives: nettle seed, Salvia miltiorrhiza 7) Renal anti-oxidants: Ginseng, Coptis, Vaccinium, Quercetin, Vit C, Alpha Lipoic acid 8) Fish oil 8-12 g/d

Question 33

Pre-Renal ARF causes

Answer 33

Hemorrhage, dehydration, trauma, peritonitis, sepsis, drugs, anaphylaxis, renal artery stenosis, CHF, PE (decreased vol, changes in vasc R, low CO)

Question 34

Pre-Renal ARF labs

Answer 34

BUN:creatinine >20:1 | FENa <1%

Question 35

Intrinsic ARF causes

Answer 35

Acute Tubular Necrosis Acute Interstitial Nephritis PSGN, RPGN Acute pyelonephritis Vascular diseases: vasculitis, polyarteritis nodosa, cortical necrosis/intravascular coagulation Progressing nephrotic syndrome (multiple causes)

Question 36

Intrinsic ARF labs

Answer 36

BUN:creatinine <10:1 FENa >1%

Question 37

Post-Renal ARF causes

Answer 37

urinary flow FROM both kidneys obstructed incr nephron intraluminal back pressure and dec GFR stones, malignancy, medications

Question 38

Post-Renal ARF tx

Answer 38

Rapidly treat the obstruction with catheterization or stent

Question 39

Chronic Renal Failure Causes

Answer 39

Glomerulopathies (focal segmental, diabetic, sickle sell) Tubulo-interstitial nephropathies (Drug HSN, toxicity, chronic PN) Polycystic kidneys Obstructive nephropathy (prostate dz, nephrolithiasis) HTN nephrosclerosis, renal artery stenosis

Question 40

CRF pathophys

Answer 40

Loss of functioning nephrons uremia, progressive inability to regulate fluids and electrolytes (HTN and edema), loss of vit D activation, loss of erythropoietin (chronic anemia)

Question 41

CRF sxs

Answer 41

HTN, edema, osteodystrophy, anemia of chronic disease, uremia

Question 42

CRF dx

Answer 42

GFR < 60 mL per min per 1.73 m2

Question 43

CRF Tx

Answer 43

maintain Ca/P balance limit Na and protein tx HTN Panax ginseng, Rheum off (Increases creatinine clearance), Ginkgo Urtica Seed tincture 1-2 ml TID (renal protective, dec prot loss)