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77 Cards in this Set
- Front
- Back
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Which renal syndrome is defined by hypercellularity between nephrotic and nephritic syndrome? |
Nephritic syndrome |
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What is the most common glomerular nephritis in the world? |
IgA nephropathy |
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In response to what type of acute disease is IgA produced typically? |
Upper respiratory infections |
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What cells are over-proliferating in IgA nephropathy?
What do these cells in turn produce? |
Mesangial cells
ECM |
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Which vasculitis is associated with IgA nephropathy? |
Henoch-Schönlein Purpura |
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What is the clinical presentation of IgA nephropathy? (3) |
- Hematuria 1-2 days after URI - Asymptomatic hematuria or proteinuria - Henoch-Schonlein Purpura |
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How does IgA Nephropathy look under light microscopy?
Immunofluorescence?
Electron microscopy? |
LM - Variable
IF - Granular mesangial deposits of IgA and C3 (necessary for Dx)
EM - Mesangial deposits |
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Do capillaries show immunofluorescence when staining for IgA nephropathy? |
No |
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What is the treatment for IgA Nephropathy? |
No proven effective treatment |
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What supplement may be helpful for vasculitis? |
Fish oil |
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What is the management for IgA nephropathy? |
Long-term corticosteroids |
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What conditions indicate a poor prognosis for IgA nephropathy? (4) |
- HTN - Obesity - Severe proteinuria - High Creatinine
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What 2 pathogens are associated with Infection-Associated Glomerulonephritis? |
- Streptococcus - Staphylococcus |
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What are 4 common sites of infection that can lead to Infection-Associated Glomerulonephritis? |
- Lung - Upper respiratory tract - Skin - Heart valves |
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What gender is more susceptible to Infection-Associated GN? |
Males (x2) |
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What strain of strep is associated with Poststreptococcal GN (PSGN)? |
Group A Strep pyogenes |
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How is incidence of PSGN reduced? |
Antibiotics |
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Where do immune complexes affix to in PSGN? (2) |
subendothelia and mesangium |
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What compliment is consumed by PSGN? |
C3 |
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What is the clinical presentation of PSGN? (3) |
- HTN - Edema - Hematuria (coke urine) (nephrotic syndrome possible) |
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What titers in blood will be elevated in PSGN? |
- Antistreptolysin O - Anti-DNAse B - Antihyaluronidase |
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How is PSGN treated? |
Treat the infection with antibiotic and treat nephritic syndrome with sodium restriction and loop diuretics |
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How does Poststreptococcal Glomerulonephritis look under light microscopy?
Immunofluorescence?
Electron microscopy? |
LM - Hypercellular with PMNs, capillaries obliterated
IF - Stains spotty for IgG and C3
EM - Humps against GBM |
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What does crescentic presentation of the glomerulus mean? |
Break in the GBM |
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What pathogens are responsible for Endocarditis-associated GN? (3) |
- Staph aureus and epidermidis - Strep viridans and pyogenes - Enterococcus |
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In what subset of the population is endocarditis-associated GN most common? |
I.V. drug users |
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What is the clinical presentation of endocarditis-associated GN? (7) |
- Fever - Arthralgias - Anemia - Purpura - New heart murmur - Nephritic syndrome - Low C3 and C4 |
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What is the treatment for endocarditis-associated GN? |
I.V. antibiotics for 4-6 weeks unless crescentic |
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Describe membranous proliferative glomerulonephritis. (3) |
Response to continuous chronic immunoglobulinemia - Thick GBM - Cell proliferation - Tram-tracking |
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What is the most common chronic antigenemic disease? |
Hepatitis C |
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Why do antigens get stuck in GBM? |
Mesangial cells are trying to engulf immuno-complexes |
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What is the clinical presentation for Membranous Proliferative GN? (2) |
- Mixture of nephritic and nephrotic syndrome - HTN |
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What indicates Type I MPGN? |
subendothelial deposits |
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What indicates Type II MPGN? |
dense deposits in the GBM |
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Besides Hepatitis C, what are other chronic diseases that can lead to MPGN? (4) |
- Hepatitis B - Cryoglobulinemia - SLE - Lymphoma |
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How does Membranous Proliferative Glomerulonephritis look under light microscopy?
Immunofluorescence?
Electron microscopy? |
LM - Global hypercellularity, clover-leafs, tram-tracking
IF - Course granular stain to C3 or smooth capillary borders to IgG
EM - Large subendothelial deposits |
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What causes tram-tracking in MPGN? |
Cells are recruited to the GBM to help clear complexes leading to 2 layers on the GBM |
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In MPGN, what side of the GBM are the antigen-antibody complexes? |
Blood side |
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What abnormal protein leads to Type II MPGN? |
C3 nephritic factor (C3Nef) (which normally stabilizes C3-Convertase so its never deactivated) |
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How does Type II MPGN differ from Type I under EM? |
Type II MPGN EM has thick GBM |
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What is the treatment for Type I MPGN? |
Treat underlying disease and long-term corticosteroids for nephrotic syndrome |
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What is the treatment for Type II MPGN? |
- Factor H replacement - Eculizumab |
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What gender is more likely to have Lupus nephritis? |
Females (x10) |
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What races are more susceptible to Lupus nephritis? |
non-whites |
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What parts of the immune system are involved in lupus nephritis? |
All parts, humoral, cell-mediated, compliment |
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What compliment factors are low in lupus nephritis? |
C3 and C4 |
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What is the clinical presentation of lupus nephritis? (8) |
- Malaise - Fever - Weight loss - Rash - Alopecia - Arthralgia - Serositis - Miscarriages |
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What are renal manifestations of Lupus Nephritis? (5) |
- Proteinuria - Hematuria - RPGN - Tubular damage - HTN
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Describe the 6 classes of light microscopy pathology for Lupus Nephritis? |
Class I: normal Class II: mesangial hypercellularity Class III: focal endocapillary proliferation Class IV: diffuse endocapillary proliferation Class V: membranous lesion Class VI: scarred-out glomerulus |
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What is unique about immunofluorescence of lupus nephritis compared to other GN diseases? (2) |
- Many types of antigens - Nephron staining |
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What is the inductive treatment for lupus nephritis? (2) |
- High-dose I.V. corticosteroids and cyclophosphamide
- High-dose I.V. corticosteroids and mycophenolate mofetil |
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What is the maintenance treatment for lupus nephritis? |
Low-dose corticosteroids or cyclosporine for at least 2 years |
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What is Rapidly Progressive Glomerulonephritis (RPGN)? |
Nephritic syndrome with rapidly declining kidney function |
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What is the hallmark of RPGN pathology? (2) |
necrosis and glomerular crescents |
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How many types of types of RPGN are there? |
4 |
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What defines Type I RPGN? |
- Autoantibodies to alpha-3 chain of collagen IV in GBM and lung alveoli
- Goodpasture's syndrome |
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What is the clinical presentation of type I RPGN? (5) |
- Nephritic syndrome - Anti-GBM antibodies - Progressive oliguria - Hemoptysis - Significant iron deficient anemia |
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Which glomerular diseases can lead to type II RPGN? (5) |
- Lupus nephritis - IgA nephropathy - Endocarditis-associated GN - Hep C-associated GN - Post-strep GN |
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What kind of deposits cause necrosis in type II RPGN? |
Immune-complexes |
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What makes type III RPGN unique among the other types? |
No immune deposits |
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What antibody denotes type III RPGN? |
antineutrophil cytoplasmic antibodies (ANCA) |
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What is the cause of type III RPGN? |
Small-vessel vasculitis |
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What are two types of small-vessel vasculitis that may lead to type III RPGN? |
- Microscopic polyangiitis
- Granulomatosis polyangiitis |
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Against what antigen are the ANCAs in microscopic polyangiitis? |
myeloperoxidase (MPO) |
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Against what antigen are the ANCAs in Granulomatosis with polyangiitis? |
proteinase 3 (PR3) |
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Which subtype of ANCA stains for microscopic polyangiitis?
Which for granulomatosis with polyangiitis? |
MPA: p-ANCA
GPA: c-ANCA |
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What is the most common crescentic GN? |
- Type III RPGN |
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What are symptoms of type III RPGN? (5) |
- Fever - Malaise - Arthralgia - Anorexia - Weight-loss |
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What signs are seen in the ENT of a patient with type III RPGN? (5) |
- nasal crusting - sinusitis - otitis media - persistent rhinorrhea - oronasal ulcers |
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What is seen on skin of patients with type III RPGN? |
palpable purpura |
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Which type of RPGN has linear deposits visible on IF?
Granular?
No deposits? |
Type I = linear deposits
Type II = granular deposits
Type III = no deposits |
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In anti-GBM disease, what is visible under light microscopy?
Immunofluorescence?
Electron microscopy? |
LM - Diffuse crescentic and necrotizing GN
IF - Global linear GBM to IgG
EM - no electron deposits |
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What molecule stains in IF for type III RPGN? |
Fibrin |
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What creatinine level signifies that recovery from RPGN is unlikely? |
> 5.0 mg/dL creatinine |
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Which type of RPGN has the fastest progression of all the types? |
Type III |
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What is the treatment for RPGN? |
I.V. immunosuppressants and then plasmapheresis |
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What two drugs can be used for maintenance therapy after clearing RPGN? (2) |
- Azathioprine - Methotrexate |
