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36 Cards in this Set
- Front
- Back
How is proteinuria defined?
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Greater than 150-200 mg of total protein / day
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What are the three groups that proteinuria is divided into?
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Tubular, Overflow and Glomerular
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What does the proximal tubule usually absorb and what does it usually excrete?
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Absorbs and digests low molecular weight proteins and excretes Tamm Horsfall proteins.
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Name 2 examples of Overflow Proteinuria
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Bence-Jones due to MM, hemoglobin with hemolysis, and myoglobin in a muscle injury
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What is selective proteinuria?
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When the normally negative charge of the membrane is neutralized and alubumin can leak through
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What is nonselective proteinuria?
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When the pore sizes are enlarged and more proteins (larger ones) than albumin can leak through
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What does the urine dipstick measure?
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Albumin and is insensitive only becoming + at protein levels of 300-500 mg/day (When the def of proteinuria is 150-200)
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What provides an excellent estimate of 24 hour urine protein excretion without having to preform the actual 24 hour urine test?
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Spot total protein to creatinine ratio
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Name 2 benign glomerular proteinurias
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Transient (stress, fever, heavy exercise) or Orthostatic
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Segmental
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part of a single glomerulus
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Global
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All of a single glomerulus
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Focal
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Less than 50% of the glomeruli in the sample/kidney
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Diffuse
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More than 50% of the glomeruli
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Definition of Heavy Proteinuria
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> 3 gm/day
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Definition of Hypoalbuminemia
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< 3 gm/dL (Serum Albumin)
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Why are pts more susceptibile to infections with nephrotic syndrome?
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Loss of IgG in the urine (Most susceptible to encapsulated orgs like Pneumococcus, Meningococcus and H. influenza)
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FANA
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Lupus
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Name the hypocomplementemic GNs
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Lupus, SBE, Post Infectious, Cryoglobulinemia, Membranoproliferative
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What sort of diet may be beneficial in a nephrotic syndrome?
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Low salt/regulated protein
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Most common GN in kids
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Minimal change
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Associated with infection, NSAIDs and Hodgkin's lymphoma
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Minimal Change
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What is the etiology of Minimal change?
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lymphokine that alters the negative charge of the membrane
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Tx of Minimal Change
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Prednisone (kids respond very well, often within 2 weeks)
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Nephropathy where thromboembolic disorders are most common
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Membranous Nephropathy
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Where do you see deposits in Membranous?
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epithelial side (why there is not much of an inflammatory response)
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Tx of Mild Membranous (mild proteinuria, <4g/day and normal GFR)
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ACEi
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Tx of Moderate Membranous (moderate proteinuria 4-8 and normal GFR)
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ACEi; Prednisone/cytoxan combo
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Tx of Severe Membranous (Heavy Proteinuria > 8 and normal or abnormal GFR)
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ACEi; Prednisone/cytoxan combo
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What is a new development in the tx of FSGS?
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A longer course of high dose prednisone (4-6 months)
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Most common cause of GN worldwide
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IgA nephropathy
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Why is IgA nephropathy often associated with an URI?
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IgA is usually secreted on mucosal surfaces in response to antigen stimuli
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Tx of IgA Nephropathy?
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ACEi/ARB, possible fish oil (steriods/cytoxan for severe cases)
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Usually a pediatric disease associated with IgA deposits found in the kindey, skin and gut
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Henoch-Schonlein Purpura
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RPGN combined with intra-alveolar pulmonary hemorrhage
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Goodpasture's
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Tx of Goodpasture's
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pulse steriods, cytoxan and plasmapharesis (unless creatinine is over 7, then no plasmapharesis )
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RPGN with Ab to site on Type IV collagen
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Goodpasture's
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