Renal: Glomerulonephritis

Question 1

Nephritic or Nephrotic?

AKI w/ proteinuria 1-3 g/d

Hematuria (coca cola)

RBC Casts

Edema

HTN

decreased GFR

Oliguria

Answer 1

nephritic

Question 2

Nephritic or Nephrotic?

Proteinuria > 3 g/d

Hypoalbuminemia

edema

hyperlipidemia

oval fat bodies

Answer 2

Nephrotic

Question 3

Glomerulonephritis presents in nephritic or nephrotic spectrum?

Answer 3

nephritic

Question 4

Focal or diffuse?

< 50% of glomeruli involved…

Answer 4

focal

Question 5

What condition is described below?

nephritic disease

inflammatory process w/ renal dysfunction

often caused by immune complex deposition

Answer 5

glomerulonephritis

Question 6

Which type of glomerulonephritis?

• most severe/clinically urgen
• progressive loss of renal fxn over short period of time
• crescent formation

Answer 6

rapidly progressive glomerulonephritis

Question 7

Glomerular or extraglomerular hematuria?

red/pink

+ clots

(-) proteinuria

normal RBCs

no RBC casts

Answer 7

extraglomerular

Question 8

Glomerular or extraglomerular hematuria?

cola colored

(-) clots

+ proteinuria

dysmorphic RBCs

+ RBC casts

Answer 8

glomerular

Question 9

Serologic tests in addition to UA and microscopy in glomerulonephritis…

Answer 9

Cr
ANA
anti-DS DNA ab
ANCAs
anti-GBM Abs
ASO

Question 10

Tx of glomerulonephritis (4)

Answer 10

tx underly cause and complications (HTN, volume status)

ACE/ARB

Nephrology referral

Question 11

Which GN?

MC primary GN

peak 2nd and 3rd decade of life

IgA deposition –> inflammatory/glomerular injury

Answer 11

IgA Nephropathy

Question 12

Pt. presents w/ the following, concerning for…

gross, recurrent hematuria

URI w/in 1-2 days

Nephritic presentation

Answer 12

IgA Nephropathy

Question 13

What confirms IgA nephropathy?

Answer 13

kidney biopsy

Question 14

Tx of IgA nephropathy w/ persistent proteinuria > 1 g/d, elevated Cr, reduced GFR or HTN

Answer 14

ACE/ARB

Question 15

slow progression to ESRD occurs in wht percentage of IgA nephropathy patients?

Answer 15

50%

Question 16

This condition occurs after GAS infection like pharyngitis or impetigo.

more common in males

Answer 16

Post Strep GN

Question 17

A patient presents with sxs in the nephritic spectrum 1-3 weeks after ST onset.

Answer 17

PSGN

Question 18

Low complement
documented GAS infx

and elevated _____ or positive _____ can indicate PSG

Answer 18

elevated ASO

(+) throat/skin culture

Question 19

Resolution of PSGN generally occurs within…

Answer 19

2 weeks

Question 20

how common are recurrent episodes of PSGN?

Answer 20

rare

Question 21

prognosis of PSGN depends on…

Answer 21

age and severity of sxs

Question 22

This was previously called HSP…

Answer 22

IgA vasculitis

Question 23

this disease:

• deposition of IgA immune complexes
• renal issue occurs 1 month post-URI/systemic sxs

Tetrad:

palpable purpura
arthralgia
abd. pain
renal dz

Answer 23

IgA Vasculitis

Question 24

IgA nephropathy or vasculitis?

• Nephritic MC, but can be nephrotic
• favorable prognosis
• supportive care

Answer 24

IgA Vasculitis

Question 25

This is a rare autoimmune disorder where Abs are directed against the glomerular basement membrane...

Answer 25

Anti-GBM disease

Question 26

Anti-GBM with GN + Pulmonary hemorrhage =

Answer 26

goodpasture syndrome

Question 27

describe the 2 peaks of anti-GBM disease in the lifecycle

Answer 27

3rd decade and 6/7 decade

Question 28

Which peak of anti-GBM is more likely to present with the full constellation of goodpasture syndrome?

Answer 28

3rd decade

Question 29

GN + pulmonary hemorrhage + anti-GBM Abs =

Answer 29

goodpasture disease

Question 30

Onset of RPGN, cough, dyspnea is concerning for...

Answer 30

anti-gbm disease (goodpasture)

Question 31

What two methods confirm anti-gbm disease?

Answer 31

anti-GBM Abs in serum or biopsy can be double positive with (+) ANCA

Question 32

How is anti-GBM treated?

Answer 32

plasmapheresis + prednisone/cyclophosphamide

Question 33

This is a complex-mediated glomerular disease directed by Anti-ds DNA Abs. Suspicion via abn. UA and/or elevated Cr and nephritic presentation. confirmed with renal bx

Answer 33

lupus nephritis

Question 34

Who do you refer to with lupus nephritis?

Answer 34

nephro, rheum

Question 35

Pauci-immune GN is associated with what lab which produce tissue and vascular damage?

Answer 35

ANCA

Question 36

Which three diseases are pauci-immune GN?

Answer 36

GPA MPA EGPA

Question 37

pauci-immune GN is characterized by what in renal histology?

Answer 37

absence of immune deposits in kidney

Question 38

Which pauci-immune GN? - ANCA associated, small-medium vessels - Necrotizing granulomatous inflammation - Crescentic necrotizing GN and RPGN - Nasal/Oral inflammation - Saddle nose deformity

Answer 38

Granulomatosis w/ Polyangiitis (GPA)

Question 39

What differentiates microscopic polyangiitis from GPA?

Answer 39

no granuloma spares upper respiratory tract

Question 40

Which pauci-immune GN? -Associated w/ asthma and eosinophilia

Answer 40

eosinophilic granulomatosis with polyangiitis

Question 41

What are the three phases of EGPA?

Answer 41

Prodrome: atopy, allergic rhinitis, asthma eosinophilic infiltrative Vasculitic: systemic, small medium vessels

Question 42

Absence of treatment in Pauci-Immune GN renders a poor prognosis. What two drugs can be used and what type of approach to managing the disease?

Answer 42

multi-disciplinary approach (nephro, neuro, rheum, pulm, cards, GI) CS and cytotoxic agents

Question 43

Which Pauci-immune GN? (+) C-ANCA Upper respiratory sx Lower respiratory sx GN

Answer 43

GPA

Question 44

Which Pauci-immune GN? (+) P-ANCA No granuloma spares upper respiratory tract

Answer 44

MPA

Question 45

Which Pauci-immune GN? (+) P-ANCA Asthma Eosinophilia

Answer 45

EGPA

Question 46

Most renal masses (65-70%) are...

Answer 46

simple renal cysts

Question 47

On US, you see a round, sharply demarcated mass with smooth walls. The mass is anechoic, there is no enhancement with contrast

Answer 47

Simple renal cyst

Question 48

Polycystic Kidney Disease causes an irreversible decline in kidney function. what is the etiology?

Answer 48

inherited, autosomal

Question 49

Which type of PKD? (+) FHx - PKD1 or PKD2 gene - most common genetic cause of CKD

Answer 49

autosomal dominant PKD

Question 50

Which type of PKD? - massive bilateral kidney enlargement - Progressive decline in GFR - deterioration in 4th decade - 50% will have ESRD by 60 yo

Answer 50

ADPKD

Question 51

As cysts accumulate fluid, enlarge and compress what structures, which leads to decreased renal fxn?

Answer 51

parenchyma

Question 52

Describe the kidney function timeline from age 15 to age 60 in ADPKD...

Answer 52

15: normal 30: hyperfiltration 40: impairment 60: failure

Question 53

In addition to hepatic cysts, what are three manifestations of ADPKD?

Answer 53

HTN Abd./Flank Pain Hematuria Hx UTI/nephrolithiasis

Question 54

What is the initial modality for ADPKD and what can be used when that isn't conclusive?

Answer 54

US initial CT/MRI if inconclusive

Question 55

What confers definitive dx of ADPKD?

Answer 55

genetic testing

Question 56

What is the definitive treatment of ADPKD?

Answer 56

transplant

Question 57

What are 4 components to managing ADPKD prior to transplant?

Answer 57

BP/salt control Supportive tx/tx of complications Tolvaptan Dialysis

Question 58

Autosomal recessive PKD is primarily a disease of what population?

Answer 58

infants and children

Question 59

What two organ systems are affected by ARPKD

Answer 59

kidneys hepatobiliary tract

Question 60

In addition to bilaterally enlarged kidneys, what else can be found with ARPKD?

Answer 60

congenital hepatic fibrosis +/- ESRD or respiratory distress

Question 61

US can detect ARCKD after what week?

Answer 61

24 weeks