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70 Cards in this Set
- Front
- Back
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Focal
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<50% of glomeruli contain the lesion
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Diffuse or Global
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most of the glomeruli(>50%) contain the lesion
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Segmental
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only a part of the glomerulus is affected by the lesion-most focal lesions are also segmental, such as focal segmental glomerulosclerosis
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Proliferation
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an increase in the cell number of one or more of the resident glomerular cells, with or without and inflammatory cell infiltration
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Membranous Changes
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capillary wall and matrix thickening
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Crescent Formation
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epithelial cell proliferation and mononuclear cell infiltration in Bowman's Space
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Symptom: Dark urine, tea or cola colored
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Significance: Hematuria
Mechanism: fragile capillaries, increased intracapillary pressure |
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Symptom: puffiness, edema of face or legs
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Significance: Fluid Retention
Mechanism: mineralocorticoid excess, decreased GFR |
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Symptom: Shortness of Breath
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Significance: fluid overload
Mechanism: mineralocorticoid excess, decreased GFR |
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Symptom: Headache, malaise, visual changes, blindness
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Significance: hypertension, volume overload, CNS edema
Mechanism: mineralocorticoid excess, decreased GFR, CNS swelling, retinal ischemia |
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Symptom: Abdominal pain
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Significance: Swelling of kidneys and adjacent tissues
Mechanism: inflammation |
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Symptom: Anorexia, nausea, vomiting
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Significance: Adbominal inflammation, CNS edema, uremia
Mechanism: inflammation, GI edema, CNS edema, increased intracranial pressure, uremia |
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Epithelial Cells
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podocytes-support the basement membrane
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Endothelial Cells
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line the cap lumen
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Mesangial Cells
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skeletal framework
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Parietal Epithelial Cells
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cover Bowman's capsule
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Initial Findings of Glomerular Disease
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nonspecific-HTN, edema, fatigue, proteinuria, hematuria
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Clinical Manifestations of Altered Glomerular Filtration
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proteinuria, decrease in BM permeability, decrease in GFR, salt retention
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Normal 24 hour protein loss
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<50mg-will be increased in glomerular injury such as nephrotic syndrome
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RBC casts or dysmorphic RBCs seen in...
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proliferative glomerularnephritis or acute interstitial nephritis
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Features of Acute Nephritic Syndrome
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nephronal hematuria temporally associated with acute renal failure
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Features of Rapidly Progressive Glomerulonephritis
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nephronal hematuria with renal failure developing over weeks to months and diffuse glomerular crescent formation
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Features of Nephrotic Syndrome
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Massive proteinuria, variable edema, hypoalbuminemia, hyperlipidemia and hyperlipiduria
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Nephrotic Syndrome with Bland Sediment
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Pure Nephrotic Syndrome
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Nephrotic Syndrome with active Syndrome
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Mixed Nephrotic/Nephritic syndrome
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60% of Post Streptococcal Glomerulonephritis occur in...
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kids age 2-12 y/o
prognosis is excellent in kids and worse in adults |
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Clinical Features of Post Streptococcal Glomerulonephritis
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hematuria-tea colored urine, oliguria or anuria, edema of face and eyes in the morning, edema of feet and ankles in the evening
HTN is common Proteinuria in the non-nephrotic range |
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Lab findings in PSGN
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Rise in BUN/creatinine
ASO titer is increased in 30% UA reveals RBC casts, red and white blood cells and proteinuria |
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Tx of Acute Nephritic Syndrome/PSGN
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salt and fluid intake should be decreased, dialysis if azotemia is present, tx any hyperkalemia, pulmonary edema, acidosis, HTN or infection that is present, avoid nephrotoxins
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HTN goal for Acute Nephritic Syndrome/PSGN pts
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<130/80
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Causes of Focal GN in Children
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benign hematuria
Henoch Schonlein purpura Mild postinfectious GN IgA nephropathy Hereditary Nephritis |
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Causes of Focal GN in adults
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IgA nephropathy
Hereditary nephritis SLE |
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Causes of Diffuse GN in Children
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Postinfectious GN
Membranoproliferative GN |
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Causes of Diffuse GN in adults
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SLE
Membranoproliferative GN Rapidly Progressive GN Post Infectious GN Vasculitis |
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What is associated with low serum complement?
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MACS3
membranoproliferative acute post infection glomerulonephritis cryoglobulinemia SLE, SBE, Shunt Nephritis |
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______ is less common than ______ but leads to PSGN in as many as 50% of infected individuals
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streptococcal pyoderma
pharyngitis |
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In PSGN, _______ and _______ may continue for 1-2 years
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proteinuria and hematuria
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In adults, coarse granular capillary deposits of IgG, C3 and hump like deposits with PSGN is...
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more likely and indicative of chronic renal failure
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Tx for PSGN
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no specific tx, unless the infection has not been treated yet
Sodium restriction if symptomatic Immunosuppressants are not helpful Most will recover spontaneously |
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Other causes of Glomerulonephritis
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Right sided Endocarditis
Non-strep post infectious GN Endocarditis/Staph aureus Visceral Abscess Shunt Nephritis SLE, Henoch-Schonlein purpura, essential mixed cryoglobulin |
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Presentation of Subacute Bacterial Endocarditis
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hematuria, pyuria, mild proteinuria, or rapidly progressive glomerulonephritis
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Lab Findings of Sub Acute Bacterial Endocarditis
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elevated sed rate
hypocomplementemia +Rheumatoid factor cryoglobulinemia anemia |
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Physical Exam Findings of Subacute Bacterial Endocarditis
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embolic infarcts/abscesses
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Tx of Subacute Bacterial Endocarditis
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Antibiotics 4-6 weeks
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GN Associated Shunt Nephritis
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cutaneous infections, vascular prostheses
Tx: eradication of infection |
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Lupus Nephritis
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25-30% of nephrotic syndrome
peaks in 4th to 5th decades C3 levels are depressed Manifests as hematuria and proteinuria |
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Lupus nephritis is characterized by...
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thickened capillary loops and mesangial hypercellularity, mesangial ring deposits
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50-60% of Lupus Nephritis will progress to
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ESRF in 10 years
no proven tx and transplanted kidney is often affected |
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SLE as Nephrotic Syndrome with Active Sediment
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young females usually
+ANA with inflammation of multiple organs hematuria, proteinuria, RBC casts, HTN, low serum complement, anti ds DNA, increased creatinine |
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Tx of Class I SLE
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no renal tx
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Tx of Class II SLE
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maybe steroids
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Tx of Class III SLE
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steroids and maybe cytotoxics or mycophenolate
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Tx of ClassIV-V SLE
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cytotoxics
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Tx of Class VI SLE
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dialysis/transplant
do well with dialysys and often doesn't recur with transplant |
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Essential Mixed Cryoglobulinemia
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nephrotic syndrome with active urine sediment
-middle aged women -most have decreased complement and +RF 50% are Hep C positive |
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Manifestations of EMC
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vasculitis
purpura, fever, arthralgia, weakness, Raynaud's, renal, proteinuria, IgG and IgM complexes, synovitis and HTN |
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Five Symptoms of EMC
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Hematuria
Palpable Purpura Proteinuria Increased Rheumatoid Factor Low C4 Levels |
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Diffuse glomerular crescent formation on biopsy=
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Rapidly Progressive Glomerulonephritis
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Goodpasture's Syndrome
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pulmonary renal syndrome
associated with pulmonary hemorrhage |
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RPGN affects...
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men 6 times more than women
-occurs in two peaks: 2nd decade for men and 6th and 7th decade for men |
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Goodpasture's usually presents as...
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hemoptysis and dyspnea with hematuria and mild decline in GFR
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Goodpasture's has a positive association with...
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smoking
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Dx of Goodpasture's Syndrome
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azotemia and anti-GBM antibodies
normal complement linear flourescence of immunoglobulin |
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Tx of Goodpasture's Syndrome
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high dose oral prednisone
cyclophosphamide plasmapheresis |
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Wegeners Granulomatosis
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fever, rhinorrhea, nasal ulcers, sinus problems, hemoptysis, mild proteinuria
non-immune RPGN |
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Dx test for Wegeners Granulomatosis
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C-ANCA
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Polyarteritis Nodosa
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-pts 50-60 years old
-CRF dialysis dependent |
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Dx test for Polyarteritis Nodosa
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P-ANCA
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Pauci-immune crescentic glomerulonephritis
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-Wegener's or polyarteritis
-due to mononuclear cell-mediated immune reaction |
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Tx of Non-Immune RPGN
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Steroids
Cytotoxic Drugs Plasmapharesis -if resistant disease or relapse use azathioprine or mycophenolate |
