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Flashcards in Renal Syndromes Deck (50):
1

acute kidney injury

occurs in hours to weeks

possible recovery of some or all of the lost renal function

implies impaired ability of the kidneys to perform their normal physiologic functions

2

classifications of intrinsic acute renal failure

glomerular (5%)

tubular (85%)

interstitial (10%)

3

baseline parameters defining acute kidney injury

a rise in creatinine of 0.3 mg/dL

a decrease in GFR of 30-50%

4

What is the specific gravity of normal urine?

1.002 - 1.030

5

Major categories of acute tubular necrosis

ischemic in origin (60%)

toxic in origin (40%)

6

What does pigmented cast suggest?

ATN

rhabdomyolysis

7

What does a white cell cast suggest?

allergic interstitial nephritis

pyelonephritis

8

What are the parameters that signify proteinuria?

normal < 150 mg/day

30-300 albumin/day is microalbuminuria (diabetic)

> 300 mg/day is overt nephropathy

> 3000 mg/day is nephrotic syndrome

9

non-nephrotic range proteinuria

~2mg or less with no evidence of any systemic disease and an otherwise normal urine sediment

10

allergic (acute) interstitial nephritis

a rash in the kidneys

acute kidney injury from medication exposure

can also be caused by multiple myeloma, SLE, and sarcoid

stopping the offending agent often is curative, with steroids given if needed

11

clinical presentation of AIN

classic triad of rash, fever, and eosinophilia

can occur 2-3 days of exposure to agent, or after months

urinanalysis shows invariable hematuria, steril pyuria, mild proteinuria and +/- eosinphils

12

treatment for acute interstitial nephritis

remove offending agent

maintain adequate intravascular volume

steroids are believed to be beneficial, but no prospective, randomized trials support them

13

What are the types of glomerular renal syndromes?

nephrotic and nephritic

14

What are examples of nephrotic glomerular renal syndromes?

minimal change disease

FSGS

membranous

15

What are examples of nephritic glomerular renal syndromes?

immune complex mediated

anti-GBM disease

Pauci-immune

16

indications for renal biopsy

acute kidney injury of unknown etiology

nephrotic syndrome of uncertain etiology

nephritis of uncertain etiology

kidney dysfunction in a renal transplant patient

17

nephrotic syndrome

1) > 3.5 gm of proteinuria

2) hypoalbuminemia

3) lipiduria

4) hyperlipidemia

5) edema

18

How is proteinuria used to rule out nephrotic syndrome?

mild proteinuria is under 2 grams, or 1-2+ by dipstick

for neprhotic range proteinuria, there will be greater than 3 grams of protein in the urine a day

19

clinical presentation of glomerulonephritis

fever, malaise

edema

dark, tea colored urin - oliguria

hypertension

increased creatinine, azotemia

blood, protein in the urine (1-2+)

20

immune complex glomerulonephritis

IgA nephropathy

post-infections

systemic lupus erythematosus

membranoproliferative GN

21

IgA nephropathy

most common acute GN, men>women, more prevalent in asians

relapsing and remitting, associated with mucosal irritation - synpharyngitic hematuria

hematuria, proteinuria, and red blood cell casts

increased creatinine

normal complement levels

 

22

treating IgA nephropathy

avoid mucosal infection

treat nephrotic syndrome if present

fish oil is used if risk factors for disease progression

can also use ace-inhibitor or angiotensin receptor blockers

if severe, add on steroids

23

post-infectious GN

any age, usually children, mostly males

clasically, 1-3 weeks after group A beta-hemolytic strep infection

presents with edema and hypertension RBC casts, acanthocytes, hypocomplementemia

24

diagnosis of Post-infectious glomerulonephritis (PIGN)

nephritic syndrome 10-14 days after documented infection

fever, malaise, edema

low serum C3

nephritic urine

rising ASO iters

prognosis is excellent in children

25

treatment of PIGN

treat/clear infection

26

lupus glomerulonephritis (SLE)

any age, usually 20-40

female to male ratio is 9:1

usually associated with other features of SLE, nephritic sediment

diagnose with biopsy

red blood cell casts, +ANA, +ds DNA, low complement levels

treat with steroids, IV cyclophosphamide

27

membranoproliferative GN

any age, usually 5-30

associated with HBV, HCV, HIV, EBV, chronic infections, CLL, B-cell lymphomas

nephritic or nephrotic, low C3 (40%), low C4 (20%)

edema, dyslipidemia, if nephrotic

increased creatinine, hematuria, proteinuria if nephritic

can present with features of both

treat underlying cause - steroids in children and interferon for adults (for Hep C)

28

anti-GBM disease

rare - found mostly in young adult men and older women

pulmonary-renal syndrome caused by autoantibodies that bind to type IV collagen found in the glomerular basement membrane and lung

presents with hemoptysis and renal failure, with a 3 month gap inbetween onset of pulmonary disease and renal disease

associated with hydrocarbon fumes, cocaine, cigarette smoke

treat with plasmapheresis, steroids, or cyclophosphamide

ex. Goodpasture's Disease

29

What are the classifications of glomerulonephritis?

immune complex

anti-GBM

pauci-immune

30

pauci-immune GN

normal complement levels, no specific immunofluorescence pattern

caused by granulomatosis with polyangiitis, microscopic polyangiitis, or Churg-Straus

31

rapidly progressive glomerulonephritis

double serum creatinine or halving of creatinine clearance in 3 months or less

pathology often reveals crescentic GN - infiltration of Bowman's space with mononuclear cells in a characteristic crescentic pattern

often accompanied with endocapillary proliferation, focal necrosis, and tubulointerstitial cellular inflammation

32

signs of nephrotic syndrome

> 3.0 gm protein/day

severe edema

hypoalbuminemia

hyperlipidemia

lipiduria

33

minimal change disease

90% of nephrotic syndrome in children - explosive edema

selective proteinuria and non-selective proteinuria, selective thought to be less damaging

effacement of foot processes

symptoms include swelling of feet, history of cancer, medication exposure, dyslipidemia, proteinuria, oval fat bodies (maltese crosses) in sediment

kidney biospy to diagnose

treat with steroids and manage nephrotic syndrome

34

complications of nephrotic syndrome

edema

thromboembolic complications

infection

hyperlipidemia

35

treatment of nephrotic syndrome

treat underlying cause, if identified

control blood pressure

in diabetes, control B.S.

use ACE-inhibtors

control lipids

stop smoking

sodium restriction

36

tubulointerstitial diseases

often associated with subnephrotic (< 1-2 grams) range proteinuria and perhaps some renal insufficiency

creatinine is stable or increasing slowly

no active systemic disease symptoms of concern

often the result of an old renal inury

does not require biopsy or specific treatment

37

What are some common conditions that cause transient small amounts of proteinuria?

exercise, fever, and infection

38

What are the ranges of albumin in the urine, and what do they suggest?

30 mg to 300 mg - microalbuminuria in a diabetic

>300 mg - overt nephropathy

> 3000 mg - nephrotic range proteinuria

39

acute nephritic syndrome

represents the clinical sequelae of acute glomerular inflammation

hematuria, red blood cell casts in the urine, dysmorphic red blood cells, proteinuria, along with varying degrees of renal insufficiency, hypertension, and some edema are the clinical features

40

kidney disease with low complement levels

PIGN

SLE

41

granulomatosis with polyangitis (GPA - formerly known as Wegener's Granulomatosis)

often presents as a pulmonary renal syndrome, pulmonary involvement ranges from a chronic sinusitis to hemoptysis

usually affects older individuals

symptoms include fever, weight loss, nose ulcerations, lung findings, hematuria, proteinuria, and red blood cell casts

+ANCA (usually C-ANCA, PR3 pattern)

kidney biopsy for diagnosis

42

treatment of GPA

small vessel vasculitis

degree of immunosuppression depends on the degree of organ involvement and damage

treatment ranges from low dose steroids or cellcept (an oral immunosuppressant) to high dose steroids and cyclophosphamide

43

treatment of microscopic polyangiitis

degree of immunosuppression depends on the degree of organ involvement and damage

treatment ranges from low dose steroids or mycophenolate mofetil (cellcept - an oral immunosuppressant) to high dose steroids and cyclophosphamide

44

microscopic polyangitis

pulmonary renal syndrome, with pulmonary involvement in the lower lung

can present acutely or chornically

usuall affects older individuals

symptoms include fever, wieght loss, lung findings, hematuria, proteinuria, and red blood cell casts

+ ANCA (usually P-ANCA, MPO patter, but C-ANCA also frequent)

kidney biopsy for diagnosis

45

Churg-Strauss

common in patients with asthma and eosinophilia with blood and protein in their urine

wheezing on lung exam if asthma is not controlled

eosinophils

hematuria, proteinuria, and red blood cell casts

+ ANCA up to 60% of the time (usually p-ANCA)

kidney biopsy to diagnose

46

treatment of Churg-Strauss

usually steroids control most maniestations, but if serious organ damage occurs, treatment can include high dose steroids and cyclophosphamide (like WG)

47

focal segmental glomerulosclerosis

idiopathic but can also be secondary to other conditions

men > women

African-American > White

assicated with HIV, heroin, obesity, sleep apnea, reflux

swelling usually appears over a prolonged time

dyslipidemia, proteinuria

oval fat bodies "maltese crosses" in urine

kidney biopsy to diagnose

48

treatment of FSGS

treat underlying disease

nephrotic syndrome treatment

if idiopathic, try steroids, immunosuppresants, or chemotherapy

49

membranous nephropathy

any age, uncommon in children

associated with cancer, medications (NSAIDs, gold, penicillamine), viral infections (Hep B, C, and HIV), and lupus

edema, dyslipidemia, proteinuria, oval fat bodiies "maltese crosses" in sediment

kidney biopsy to diagnose

thickened GBM, subepithelial deposits on EM

prognosis worse in men

50

treatment of membranous nephropathy

treatment depends on the amount of proteinuria

can vary from watchful waiting to steroids to chemotherapy (chlorambucil, cyclophosphamide) to modulate the immune system