RENAL SYNDROMES - WALL - IMPORTANT!! Flashcards
(53 cards)
What are the four key diagnostic factors to examine for abnormal kidney function?
Changes in SCr Concentration
Abnormalities in UA
Altered renal homeostatic mechanisms
Abnormal kidney imaging
What are the key questions to ask when looking at kidney disease?
Acute or Chronic Prerenal, Intrinsic, Postrenal Glomerular, Tubular or Vascular Inflammatory or Non-inflammatory Systemic Disease Associated
What are the three categories of intrinsic renal disease?
glomerular
intrinsic
vascular
What are the five glomerular syndromes?
nephrotic syndrome nephritic syndrome mixed nephritic nephrotic syndrome mesangial nephritic syndrome chronic glomerular disease
What are three categories of tubular syndromes?
inflammatory tubular interstitial disease
non-inflammatory tubular interstitial disease
chronic interstitial disease
What are the four categories of vascular syndromes?
prerenal azotemia
renal artery stenosis (uni or bilateral)
hypertensive nephrosclerosis
vasculitis
Describe nephrotic syndrome
abnormal permeability to the glomerular capillary wall to protein, presenting with proteinuria/albuminuria >3g/day. Lipiduria
Neg. dipstick w/ heavy proteinuria means it’s not albumin.
3-4+ Dipstick for protein, Low serum albumin
Peripheral Edema, typically normal GFR and normal BP
What are clinical examples of nephrotic syndrome?
minimal change disease (children)
membranous glomerulopathy (white ppl)
FSGS (black people)
Diabetic Nephropathy: overall most ocmmon cause of nephrotic syndrome
What are volume changes present in nephrotic syndrome?
renal tubular retention of salt and water (esp. dt and CD) - edema, normal BP
expanded tbNa and tbw - Edema ISF
Expanded ISF
Relatively normal plasma volume (normal BP)
What is the basic pathology of nephritic syndromes?
inflammatory changes within glomerulus
infiltration of glomerulus by inflammatory cells
endothelial cell swelling
complement activation, often present
What are urinary findings of nephritic syndrome?
hematuria (always present) dysmorphic RBCs in urine RBC casts non-nephrotic ranged proteinuria (<2 1/2+ protein dipstick
Why do you have mild proteinuria in nephritic syndrome that doesn’t reach nephrotic levels?
Although you have the glomerular injury, the GFR is reduced in nephritic syndromes. So protein is leaked into the urine, but the decreased GFR prevents high proteinuria
What proteins are responsible for creating RBC casts?
tams-horsfall proteins
What are the clinical features of nephritic syndrome?
HTN, reduced GFR, hematuria
why do you have reduced gfr in nephritic syndrome?
inflammatory changes have pro-inflammatory cytokines and mediates, comlement activation and proliferation of mesangial cells, with infiltration of glomerulus by inflammatory cell (mononuclear and PMNs), and endothelial cell swelling. This reduces the surface area for glomerular filtration, leading to decreased GFR
What volume changes are associated with nephritic syndrome?
renal retention of salt and water (bc reduced gfr)
reduced gfr
expanded tbNa and tbw
expanded ecfv, expansion of ecfv and icfv
HTN and possibe pulmonary edema
What are clinical examples of nephritic syndrome?
post-streptococcal glomerulonephritis
RPGN
What are SAlbumin levels in nephritic syndrome?
they are normal because no severe albumin loss because of decreased GFR
What is the basic pathology of mesangial nephritic pattern?
glomerular inflammatory changes restricted to mesangial area of glomerulus
glomerular capillary wall remains unaffected (normal GFR and minimal proteinuria)
hematuria is hallmark
normal BP and Na retention
Glomerular RBC casts
What are clinical examples of mesangial nephropathy?
IgA nephropathy (most common GN worldwide) SLE with immune deposits limited to mesangium
How do you tell between post-strep GN and IgA nephropathy?
while both are associated with previous respiratory infections, the timing is different.
Post-strep is 5-6 days after infxn
IgA Nephropathy is 1-2 after infxn
What is the basic pathology of mixed nephritic and nephrotic syndrome?
Evidence for inflammatory glomerular disease (hematuria, reduced GFR)
Nephrotic Range proteinuria (low serum albumin, and edema formation)
What are clinical examples of mixed nephritic nephrotic syndrome?
diffuse proliferative glomerulonephritis related to SLE
Membranoproliferative Glomerulonephritis most often related to Hep C (tram tracks)!!!!
What is the general pathology of chronic glomerular disease?
Chronically abnormal GFR and abnormal UA
Variable degrees of proteinuria and hematuria
Frequently leads to decreased sized kidneys
Waxy casts (because of dilated tubules)
