Glomerular Disease: Nephritic And Nephrotic Syndromes

Front 1

Normal 24 hr urine protein?

Back 1

150mg

Front 2

How does diabetic nephropathy present?

Back 2

Nephrotic Syndrome

Front 3

how many RBC's/hpf are abnormal?

Back 3

> 3

Front 4

Main classifications of Hematuria?

Back 4

Extrarenal
Renal

Front 5

Causes of Extrarenal Hematuria?

Back 5

UTI (common)
Bladder Cancer (uncommon)

Front 6

Causes of Renal Hematuria?

Back 6

Glomerular: GN, Thin BM disease

Non-Glomerular: cysts, stones, cancer, interstitial nephritis

Front 7

Kickers for Non-Glomerular Hematuria?

Back 7

No Significant Proteinuria
No Casts

Front 8

Kickers for Glomerular Hematuria?

Back 8

Oliguria
History of recent infections (not just renal) or other systemic diseases

Front 9

Definition of Oliguria and Anuria?

Back 9

Oliguria < 400mL of urine/day

Anuria < 50-100 mL/day

Front 10

Color of Urine in Glomerular vs Non-glomerular hematuria?

Back 10

G: brown or tea colored

N-G: Red

Front 11

What is in the urine for glomerular hematuria?

Back 11

Blood
Protein**
Dysmorphic RBC's**
Casts**

Front 12

4 Types of Proteinuria?

Back 12

Glomerular (too much filtered)
Tubular (not enough reabsorbed)
Overflow (too much of a plasma protein overwhelms it)
Functional (benign)

Front 13

Who is the main slit-diaphragm protein?

Back 13

Nephrin

Front 14

Kickers for Congential Nephrotic Syndrome of Finnish Type?

Back 14

Mutation in nephrin (NPHS1)
Massive proteinuria and RF
No extrarenal manifestations
ESRD by age 2
Transplant = curative

Front 15

when does the dipstick become positive for protein?

Back 15

When albumin > 300mg/day

Front 16

Common Causes of Proteinuria?

Back 16

Benign: functional, orthostatic

Bad: Glomerular Disease

Front 17

Most common cause of Proteinuria and ESRD?

Back 17

Diabetic Nephropathy

Front 18

Define GN?

Back 18

Intraglomerular Inflammation
Cellular Proliferation
Hematuria

(excludes nonproliferative disorders)

Front 19

Define Nephrotic Syndrome?

Back 19

**Proteinuria > 3.5 g/day (adult)
or > 40mg/day (child)
Hypoalbuminemia**(< 3.5g/dL)
Edema**(generalized-anasarca)
Hyperlipidemia
Lipiduria

Front 20

Complication of Nephrotic Syndrome?

Back 20

Hypercoagulability (membranous GN)
Vit D Def
Inc risk of infection (lose immunoglobulins)
HTN
Inc CV morbidity
Hypovolemia and acute RF (kids)

Front 21

Define Nephritic Syndrome?

Back 21

***Hematuria (casts and dysmorphic RBC's)
***Azotemia
Oliguria
HTN
*Variable Proteinuria

Front 22

What is Azotemia?

Back 22

Elevated BUN (normal = 7-20)

Elevated Cr (normal = .5-1.0 in gals and .7-1.2 in guys)

Front 23

General Mechanism of Glomerular Injury?

Back 23

Initial Insult
Nephron Loss
Nephron Hypertrophy
Afferent Arteriolar Vasodilatation
Inc Glomerular Cap Pressure
Alteration in GBM-->proteinuria

Front 24

Types of Initial Insults?

Back 24

Cell-Mediated Immune Response
Humoral Immune Response
Influx of Circulating Lymphocytes
C' Activation

Front 25

Causes of Primary Idiopathic Nephrotic Syndrome?

Back 25

Minimal Change Disease
Membranous Nephropathy
FSGS
Membranoproliferative GN

Front 26

Causes of Secondary Nephrotic Syndrome?

Back 26

Minimal Change
Membranous nephropathy
FSGS
Membranoprolif GN
Diabetic Nephropathy
Amyloid
Light Chain Deposition Disease

Front 27

Secondary Causes of Minimal Change?

Back 27

NSAIDs
Malignancies (hodgkin's)

Front 28

Rx for Minimal Change?

Back 28

Steroids (prednisone)

Front 29

Most common scenario for Minimal Change?

Back 29

Primary disease
in kids

Front 30

Most common scenario for FSGS?

Back 30

AA Adult
Primary disease

Front 31

Secondary Causes of FSGS?

Back 31

FAT
Sleep Apnea
Sickle Cell
HIV (collapsing FSGS)
Heroin abuse
Meds

Front 32

Most common cause of Primary, Nephrotic Syndrome in Adults?

Back 32

Membranous Nephropathy

Front 33

Typical Scenario for Membranous Nephropathy?

Back 33

5th and 6th decades
Whites

Front 34

Kickers for Membranous Nephropathy?

Back 34

Immune Complex disease
higher incidence of renal vein thrombosis

Front 35

Secondary Causes of Membranous Nephropathy?

Back 35

Malignancy
SLE class V
RA
Hep B and C
Drugs (penicillamine, gold, captopril)
Syphilis

Front 36

Lab Features distinguishing Focal from Diffuse GN?

Back 36

Both have active urine sediment
Diffuse causes RF, focal doesn't
Diffuse has variable proteinuria while focal has low-grade

Front 37

Types of Focal GN's?

Back 37

IgA
SLE class II and III
Henoch Schonlein Purpura
Hereditary Nephritis (alport's)

Front 38

Types of Diffuse GN's?

Back 38

Poststrep
Bacterial Endocarditis
Membranoprolif
SLE Class IV
Rapidly Progressive (goodpasture's and ANCA ass.)

Front 39

Worldwide, what is the most common cause of primary GN?

Back 39

IgA nephropathy

Front 40

Who gets IgA Neph?

Back 40

White and Asians
20-30 yo
Males> females

Front 41

How does IgA Nephropathy present?

Back 41

Episodic Gross Hematuria (50-60% and often w/ Upper Resp Infection...not after)
Persistent microscopic Hematuria (30%)
Acute GN (10%)

Front 42

W/in 5-25 years how many IgA neph pts progress to ESRD?

Back 42

20-40%

Front 43

Rx for IgA Nephropathy?

Back 43

No Cure
n-3 fatty acids (fish oil)
Corticosteroids
ACE-I

Front 44

what is systemic IgA nephropathy?

Back 44

Henoch Schonlein Purpura

Front 45

5 kickers for H-S-P?

Back 45

Arthralgias
Purpura
Abd Pain
GI Bleeding
Hematuria (nephritis)

Front 46

Typical scenario for HSP?

Back 46

first 2 decades of life (peak at 4-5yo)
Acute onset, self-limited
Renal issues usually resolve

Front 47

Main Sx's of Poststrep GN

Back 47

Abrupt Onset
GROSS hematuria
Oliguria
Azotemia
HTN
Edema

Front 48

Typical scenario for Poststrep GN?

Back 48

2-10yo's
2 weeks after throat infection, longer for skin infections
Spontaneous Recovery
Hematuria possibly for 6 months

Front 49

Kickers for Rapidly Progressive GN?

Back 49

Rapid Decline (2months)
Rare
Crescents!
Classified based on how they're mediated?

Front 50

Types of Rapidly Progressive GN?

Back 50

Immune Complex Mediated
Anti-GBM Ab's
Pauci Immune (ANCA)

Front 51

Who are the Immune-mediate rapid progressor GN's?

Back 51

IgA
Cryoglobulinemia
Lupus
Acute postinfectious
Membranoprolif

Front 52

Types of AntiGBM RPGN's?

Back 52

Anti-GBM disease
Goodpasture's

Front 53

Types of Pauci-Immune RPGN's?

Back 53

Wegener's
Microscopic Polyarteritis
ANCA-ass crescentric GN

Front 54

Anti-GBM and Goodpasture's typical presentation?

Back 54

3rd or 6th decade
60-70% have goodpastures (smokers)
White Males (rare in AA's)
Systemic Sx's

Front 55

Ab's in Anti-GBM/goodpasture's are directed against...?

Back 55

Alpha-3 Chain of Type IV Collagen

Front 56

Predisposing Factors to Anti-GBM/Goodpasture's?

Back 56

Genetic
Environmental (smoking)

Front 57

Rx for Anti-GBM/Goodpastures?

Back 57

Corticosteroids + Cyclophosphamide + plamas exchange w/ albumin in 14 days

not real good prognosis

Front 58

What is the most commonly involved organ in SLE?

Back 58

KIDNEY (50-75%)
w/in 3 yrs of SLE Dx

Front 59

Classes of Lupus Nephritis?

Back 59

Class I: minimal change (< 5%)
Class II: mesangial disease (10-25%)
Class III: focal prolif GN (20-35%)
Class IV: diffuse prolif GN (35-60%)
Class V: membranous nephropathy (10-15%)
Class VI: chronic sclerosing

Front 60

Rx for Lupus Nephritis?

Back 60

Corticosteroids
Azathioprine
Cyclophosphamide
Mycophenolate mofetil (cellcep)

Front 61

When do you see Low Serum C' Levels and GN?

Back 61

SYSTEMIC:
SLE (75-90%)
Subacute Bacterial Endocarditis (90%)
Cryoglobulinemia (85%)

RENAL:
Acute Poststrep GN (90%)
Membranoprolif GN (90%)

Front 62

When do you see Normal Serum C' Level and GN?

Back 62

SYSTEMIC
Vasculitis
HSP

RENAL:
IgA
RPGN (ANCE or AntiGBM)

Front 63

The majority of kids with nephrotic syndrome...?

Back 63

Have minimal change (most of the rest have FSGS) and respond to steroids (good Px)