SM 205

Question 1

How are renal syndromes classified?

Answer 1

Renal tubules are broadly classified as Glomerular and Tubular diseases

Question 2

What are the two types of Glomerular renal syndromes?

Answer 2

Glomerular renal syndromes are classified as Nephrotic and Nephritic diseases

Question 3

What are the 3 Nephrotic Glomerular diseases?

Answer 3

Minimal Change Disease FSGS Membranous Nephropathy

Question 4

What are the 3 Nephritic Glomerular diseases?

Answer 4

Anti-GBM Disease Immune-complex mediated Glomerulonephritis Pauci-Immune Glomerulonephritis

Question 5

What should be done if Hematuria is found?

Answer 5

Always repeat the urine! If it persists, urological workup If it doesn’t show up on the second urinalysis, treat it as transient and ignore it

Question 6

Is most hematuria gross or microscopic?

Answer 6

Most hematuria is microscopic Gross hematuria suggests papillary necrosis

Question 7

What should be done if Proteinuria is found?

Answer 7

If a small amount is found, repeat to see if it persists; if it doesn’t, treat it as transient due to exercise or infection If persistent or large amounts of protein, quantify with urine albumin/creatinine ratio

Question 8

What are cellular casts?

Answer 8

Cells found in urine that suggest nephrotic syndrome

Question 9

What is the purpose of a kidney biopsy?

Answer 9

Confirm diagnosis and dictate management

Question 10

If the clinical picture and kidney biopsy do not agree, which one should you use to make a diagnosis?

Answer 10

Surprisingly, use the kidney biopsy

Question 11

When is a kidney biopsy indicated?

Answer 11

When the cause of a kidney disease is not obvious

Question 12

What is a characteristic trait of a nephrotic syndrome?

Answer 12

Heavy proteinuria

Question 13

What is a characteristic trait of a nephritic syndrome?

Answer 13

Inflammation and hematuria

Question 14

What are three ways to analyze kidney biopsies?

Answer 14

Light microscopy Immunofluorescence microscopy Electron microscopy

Question 15

What is a characteristic trait of AKI?

Answer 15

Rising serum creatinine

Question 16

What can light microscopy reveal?

Answer 16

Cell proliferation and lesions of the glomeruli

Question 17

What can immunofluorescence microscopy reveal?

Answer 17

Specific Ig mediated diseases and complement mediated diseases

Question 18

What can electron microscopy reveal?

Answer 18

Structural changes and immune complex deposits

Question 19

What is the best microscopy to visualize the thickness of the glomerular membrane, deposits in the basement membrane, and podocyte foot processes?

Answer 19

Electron microscopy

Question 20

What defines a nephrotic syndrome?

Answer 20

Proteinuria > 3g/day Hypoalbuminemia Hyperlipidemia Edema

Question 21

What diseases can cause a nephrotic syndrome?

Answer 21

Minimal Change Disease FSGS Membranous Nephropathy

Question 22

What is the most common cause of nephrotic syndrome in children?

Answer 22

Minimal Change Disease

Question 23

What could cause Minimal Change disease in adults?

Answer 23

Medications like NSAIDS Malignancy

Question 24

How does Minimal Change Disease present?

Answer 24

Sudden-onset edema described as “explosive”

Question 25

What is Minimal Change disease?

Answer 25

Minimal Change disease is the most common cause of nephrotic syndrome in children, and commonly caused by NSAIDS in adults

Question 26

How does Minimal Change disease appear on the 3 different types of microscopy?

Answer 26

Normal on Light Microscopy Negative on Immunofluorescent Diffuse podocyte foot process effacement on EM that appears "flattened"

Question 27

What disease does this kidney biopsy suggest?

Answer 27

Minimal Change Disease due to the "flattened" foot processes

Question 28

How is Minimal Change Disease treated?

Answer 28

Steroids

Question 29

How does FSGS present?

Answer 29

A nephrotoic syndrome secondary to HIV and Heroin that presnts with HTN, edema, and elevated serum creatinine

Question 30

What is needed to diagnose FSGS?

Answer 30

FSGS needs a kidney biopsy to be diagnosed

Question 31

Why is FSGS focal and segmental?

Answer 31

FSGS is focal because only some glomeruli involved Segmental because only a portion of the Glomeruli is involved

Question 32

How does FSGS present on the three types of microscopy?

Answer 32

Need 1 or more leasions on light microscopy Nonspecific staining on immunofluorescence Podocyte foot process effacement on electron microscopy

Question 33

What disease is shown in this kidney biopsy?

Answer 33

FSGS due to only some glomeruli being involved and segmental because only parts of some glomeruli are effected

Question 34

How is FSGS treated?

Answer 34

DIfficult to treat, treat the secondary cause like HIV or obesity or try Calcineurin inhibitor for primary FSGS

Question 35

What is membranous nephropathy?

Answer 35

A primary nephrotic syndrome that can be associated solid tumors like lung cancer and NSAIDS and slow onset edema

Question 36

How is the edema in Membranous Nephropathy and Minimal Change disease differentiated?

Answer 36

Although both are nephrotic diseases, Membranous Nephropathy involves slow onset edema while Minimal Change disease is "explosive" and rapid

Question 37

What does Membranous Nephropathy present with on the three types of microscopy?

Answer 37

Thickened GBM on light microscopy Granular IgG on Immunofluorescence Subepithelial immune deposits on Electron microscopy

Question 38

What glomerular disease presents as "spikes and holes" on silver stain?

Answer 38

Membranous Nephropathy

Question 39

What glomerular disease can stain with +PLA2R?

Answer 39

Membranous Nephropathy

Question 40

What glomerular disease is shown on these slides?

Answer 40

Membranous nephropathy

Question 41

What is the treatment for Membranous Nephropathy?

Answer 41

RAAS blockade, immune modulation, or a known secondary cause

Question 42

What are the characteristics of Nephritic Syndrome?

Answer 42

Proteinuria \< 3gm/day Sequelae of glomerular inflammation Renal Insufficiency HTN Edema

Question 43

How does proteinuria vary between Nephrotic and Nephritic syndromes?

Answer 43

Nephrotic syndromes have \> 3gm/day while Nephritic syndrome have \< 3gm/day

Question 44

How does Rapid Progressive Glomerulonephritis present on biopsy?

Answer 44

Crescent glomeruli

Question 45

What are the types of Nephritic syndrome?

Answer 45

Immune-complex mediated Pauci-immune Anti-glomerular Basement Membrane Disease

Question 46

What does this glomeruli biopsy show?

Answer 46

Crescent lesion indicative of nephritic disease

Question 47

What is the pathophysiology of anti-GBM disease?

Answer 47

Auto-antibodies against Type IV collagen in the basement membrane, that can also involve lung involvement (Goodpasture's), as well as Malaise, Weight Loss, Hemoptysis

Question 48

What lab finding is specific for anti-GBM disease?

Answer 48

Anti-GBM antibodies

Question 49

What does anti-GBM disease look ike on biopsy?

Answer 49

Diffuse crescentic glomerulonephritis on light microscopy

Question 50

What is the treatment for Anti-GBM disease?

Answer 50

Very aggressive: steroids + cyclophosphamide + plasmapheresis

Question 51

What infection does post-infectious glomerulonephritis tend to follow?

Answer 51

Strep pneumo

Question 52

Describe the onset of post-infectious glomerulonephritis?

Answer 52

10-14 days after strep pharyngitis, with gross hematuria, fever, malaise, and HTN

Question 53

How does PIGN show up on labs?

Answer 53

Low C3/C4, +ASO titer, elevated Creatinine

Question 54

What presents as "starry sky" on immunofluorescence biopsy?

Answer 54

PIGN

Question 55

What is the treatment for PIGN?

Answer 55

Supportive (antibiotics for infection) or steroids if severe

Question 56

What is Lupus Nephritis?

Answer 56

An immune complex glomerulonephritis common in younger women with Lupus that causes malaise and edema

Question 57

What does lupus nephritis look like on labs?

Answer 57

+ANA, +anti-dsDNA, low C3/C4

Question 58

How is Lupus Nephritis managed?

Answer 58

Supportive if low systemic inflammation Steroids + cyclophosphamide if active inflammation

Question 59

What is IgA nephropathy?

Answer 59

A common glomerulonephritis secondary to IBD or cirrhosis that causes hematuria at the same time or shortly after a URI

Question 60

What does IgA nephropathy look like on biopsy?

Answer 60

Mesangial proliferation, +IgA

Question 61

How is IgA nephropathy treated?

Answer 61

ACEi/ARB if mild Steroids and immunosuppressants if severe

Question 62

What type of kidney disease is associated with Hepatitis C?

Answer 62

Membranoproliferative Glomerulonephritis (MPGN)

Question 63

What causes a "tram-track" apperance on silver stain?

Answer 63

Membranoproliferative Glomerulonephritis

Question 64

What causes necrotizing crescentic glomerulonephritis on bipsy?

Answer 64

Granulmoatosis with Polyangiitis

Question 65

What causes palpapble purpura?

Answer 65

Granulomatosis with Polyangiitis

Question 66

What causes +c-ANCA and PR-3 on labs?

Answer 66

Granulomatosis with Polyangiitis

Question 67

What is MPA?

Answer 67

Microscopic polyangiitis is a pulmonary-renal syndrome that causes hemoptysis, lower resporitary tract infections, and palpable purpura Has necrotizing crescentic glomerulonephritis like GPA and positive MPO on labs

Question 68

What diesease has strong overlap between Nephritic and Nephrotic disease?

Answer 68

Lupus Nephritis and MPGN