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36 Cards in this Set

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