Test #2 Flashcards
(105 cards)
Nephritic characteristics
hematuria
rbc and mixed cell casts
variable proteinuria
Nephrotic characteristics
Marked proteinuria (>3.5 g/day)
Lipiduria
Fatty casts
Nephritic causes
Post-infectious/proliferative glomerulonephritis
IgA neuropathy/vasculitis (HSP)
Lupus nephritis
Thin basement membrane disease
Nephrotic causes
Systemic disease
- Diabetic neuropathy
- Amyloidosis
Minimal change disease
Focal segmental glomerulosclerosis (FSGS)
Membranous neuropathy
Focal Nephritic Patterns
ex: IgA nephropathy
Inflammatory lesions in <1/2 glomeruli
UA: rbc, ~rbc casts, mild protein
Diffuse Nephritic Patterns
ex: post-strep glomerulonephritis (PSGN)
Affects > 1/2 glomeruli
UA: lots of protein, rbc and rbc casts
Edema, HTN, may have renal insufficiency
Nephrotic Patters
Affects many glomeruli
No inflammation/immune complex deposits
Edema, hyperlipidemia, hypoalbuminemia
Ex: Diabetic neuropathy
Poststreptococcal glomerular nephritis (PSGN)
Most common acute nephritic cause
1-3 weeks post strep/3-6 weeks post GABHS
MOA: Glomerular immune complex disease, viral/parasitic infection (rare)
Poststreptococcal glomerular nephritis symptoms and diagnosis
Often asx; discolored urine w/ sediment, edema, HTN
Hx of strep infection w/in 3-6 weeks
UA: gross hematuria, proteinuria
Streptozyme test: antistreptolysin
Biopsy only to r/o other glomerular dx, late presentations w/o clear strep history
Recurrent hematuria episodes indicate:
IgA nephropathy
Not PSGN
Poststreptococcal glomerular nephritis treatment
Supportive
Sodium and water restriction w/ loop diuretic (edema and HTN)
Dialysis w/ acute renal failure
Recovery begins w/in 1st 2 wks
Late renal complications are rare: HTN, proteinuria, renal insufficiency
IgA Neuropathy/Berger’s Disease
Most common primary GN cause
Rare in blacks; 80% 15-35 yo
MOA: Mesangial depositions of IgA complexes
IgA Nephropathy Presentation
1: Gross recurrent hematuria possibly after URI (synpharyngitic)
- flank pain and fever
2: Microscopic hematuria which may progress, mild proteinuria
3: Nephrotic syndrome: protein and lipid urea, fatty casts
- edema, renal insufficiency, HTN, hematuria
IgA Nephropathy diagnosis and treatment
Dx: kidney biopsy -> IgA deposits in mesangium
-Can also indicates cirrhosis, celiac disease, HIV
Tx: BP control (ACEI)
-Severe/progressive: Corticosteroids +/- immunosuppressants
Henoch-Scholein Purpura (HSP)/IgA vasculitis
Systemic vasculitis from IgA complex deposits in tissue
Most common vasculitis in children (3-15 years)
Generally mild in kids, worse in adults
Henoch-Scholein Purpura symptoms
Tetrad:
1: Palpable purpura w/o thrombocytopenia or coagulopathy
2: Arthritis or arthralgia
3: Abdominal pain
4: Renal disease (GN)
Develops over days-weeks, presentation order varies
Spectrum w/ kids to adults: Kids: mild hematuria +/-proteinuria, adults: severe nephrotic syndrome/renal failure
Henoch-Scholein Purpura diagnosis and treatment
Dx: kidney bx - only w/ uncertain dx or severe renal involvement - marked proteinuria/impaired renal function
Tx: Crescentic GN - pulse IV methylprednisone, then oral prednisone
Rare progression to ESRD -> dialysis and transplant
Rapidly progressive glomerulonephritis (RPGN)
Acute GN w/ rapid progression to ESRD
Morphological crescent formation w/in glomerular vessel wall
-fibrin formation w/ macrophage, T cells, cytokines in Bowman’s space
Types of RPGN
1: Anti-glomerular basement membrane (GBM/Goodpasture syndrome)
- anti-GBM abs in lungs and glomerulus
2: Immune complex RPGN - deposit in glomeruli
- IgA Nephropathy, PSGN, lupus nephritis
3: Pauci-immune RPGN - necrotizing GN and vasculitis
- ANCA positive, systemic vasculitis symptoms
RPGN symptoms
Insidious - fatigue and edema
Acute - macroscopic hematuria, oliguria, edema, renal insufficiency
GBM - pulmonary hemorrhage, hemoptysis, pulmonary infiltrates, dyspnea
RPGN Diagnosis and Treatment
UA: hematuria, rbc casts, proteinuria
Increase BUN/Creat, renal bx to confirm
Serologic assay for type
Tx: Pulse methylprednisolone, PO cyclophosphamide, consider plasmapheresis
-treatment gets more specific w/ bx results
Catch early to minimize irreversible injury
Dark granular and epithelial casts in urine indicate:
Pure acute tubular necrosis
Crystal particles in urine
Crystalluric acute renal failure
wbc and wbc casts in urine:
Acute interstitial nephritis
AG = BC +/-2 = no additional issue
+/-2 = each other => no underlying disorder