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65 Cards in this Set
- Front
- Back
What symptom is a major factor for acquiring progressive glomerular sclerosis and renal failure? |
hypertension |
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How much salt in grams should a patient that is on salt restricted diet consume in a day? |
No more than 3.5-5.0g |
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What two types of medications are prescribed to prevent glomerular damage from hypertension?
What symptom would imply that glomerular damage? |
ACE-inhibitors and Angiotensin receptor blockers
Proteinuria |
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What growth factor do ACEI/ARB reduce in the glomerulus? |
TGF-ß |
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How is edema managed in patients with nephrotic syndrome? (2) |
- Sodium restriction - Diuretics |
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How is hyperlipidemia managed in patients with nephrotic syndrome? (2) |
- Diet - Statins |
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How is hypercoagulability managed in patients with nephrotic syndrome?
What is the albumin threshold in grams in urine in which albuminuria is allowed? |
- Anticoagulants
- 2 g/dL |
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What diagnostic technique is necessary for final diagnosis of renal disease? |
Kidney biopsy |
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What 3 microscopic techniques are used to analyze a kidney biopsy? |
1) Light microscope 2) Immunofluorescence 3) Electron microscopy |
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What does it mean that glomerular disease is focal or diffuse? |
Focal means some glomeruli are damaged, but not all. (50% or less)
Diffuse means that practically all glomeruli are damaged. (more than 50%) |
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What is the difference between segmental and global damage? |
Segmental means part of the glomerulus is damaged.
Global means that all of the glomerulus is damaged
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What are the 3 primary diseases that can cause nephrotic syndrome? |
1) Minimal Change Lesion 2) Focal Segmental Sclerosis 3) Membranous Lesion |
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Name 2 secondary diseases that cause nephrotic syndrome? |
1) Diabetic nephropathy 2) Amyloidosis |
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What is the clinical presentation of minimal change disease? (3) |
- Heavy proteinuria - Severe edema - Ascites or pleural effusion |
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What vitals signs are normal in minimal change disease? (2) |
- BP - kidney function |
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What is the common etiology of minimal change disease in children under 10 years old? |
Idiopathic |
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Besides idiopathic, what are other etiologies of minimal change disease? (3) |
- History of allergic reactions - Drugs like NSAIDs or alpha-interferon - Lymphoproliferative malignancy |
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In minimal change disease, why is the glomerulus leaking so much protein? (4) |
- Podocytes are injured - Loss of GBM negative charge - Cytokines - T-cell involvement |
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How does minimal change disease look under light microscopy?
Immunofluorescence?
Electron microscopy? |
LM - normal
IF - normal
EM - Foot process effacement |
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What is the standard treatment for minimal change disease?
What fraction of patients relapse? |
Steroids
2/3 |
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What other drugs can be used for steroid-resistant minimal change disease? (2) |
- Cyclosporine - Rituximab |
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What is injured in Focal Segmental Glomerular Sclerosis (FSGS)? |
Podocytes |
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What is the clinical presentation of FSGS? (4) |
- Nephrotic syndrome - Hypertension - Microscopic hematuria (possible) - Decreased kidney function (possible) |
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In what race is focal segmental glomerular sclerosis more common? |
African Americans |
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What virus can lead to focal segmental glomerular sclerosis?
What illicit drug? |
HIV
Heroin |
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What 4 syndromes can lead to FSGS? (4) |
- Unilateral renal agenesis - Reflux nephropathy - Morbid obesity - Sleep apnea (which leads to hypoxia) |
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How does focal segmental glomerular sclerosis look under light microscopy?
Immunofluorescence?
Electron microscopy? |
LM - Focal, segmental sclerosis
IF - normal
EM - foot process effacement |
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What two special stains help visualize FSGS under light microscopy? |
- PAS - Silver |
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What is the primary treatment for FSGS? |
Management with ACEI/ARBs |
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What is the second-line treatment for FSGS? (3) |
- Cyclosporine - Cyclophosphamide - Mycophenolate mofetil |
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What causes the membrane appearance of the glomeruli in membranous nephropathy (MN)? |
Antibody complexes |
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What immune molecules are deposited in membranous nephropathy? (2)
Where specifically are they deposited? |
- IgG and C3
- beneath podocytes |
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What cell in Bowman's capsule are the antibodies attacking in MN? |
Podocytes |
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What specific antigen on podocytes is implicated to be the target to antibodies in MN? |
phospholipase A2 receptor (PLAR) |
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What race is most susceptible to membranous nephropathy? |
Caucasians |
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Are serum complement levels reduced in MN? |
No |
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What immune diseases can be associated with membranous nephropathy? (2) |
- Systemic Lupus Erythematosus - Rheumatoid arthritis |
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What are 3 infections that can be associated with MN? |
- Hep B - Hep C - Syphilis |
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What 3 drugs can be associated with MN? |
- Gold - Penicillamine - NSAIDs |
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What common chronic disease can present with MN? |
Solid tumor cancers |
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How does membranous nephropathy look under light microscopy?
Immunofluorescence?
Electron microscopy? |
LM - Diffusely thick capillary walls, spikes of GBM
IF - Granular capillary wall to IgG and C3
EM - Diffuse subepithelial electron-dense deposits |
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What underlying cause can be part of nephrotic syndrome and would require identification? |
Malignancy |
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What percentage of cases of MN spontaneously recover? |
30% |
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What treatments are indicated for membranous nephropathy? (4) |
- Cyclophosphamide with steroids - Cyclosporine A (if severe) - ACTH - Rituximab |
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What is the most common nephrotic syndrome in children? |
Minimal Change Disease |
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What is the first sign that the kidneys have been damaged by diabetes? |
Microalbuminuria |
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How does GFR change during the course of diabetic nephropathy? |
Increases in first few years, then gradual decline |
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In diabetic nephropathy, what damages the glomerulus? |
hypertension |
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What two pathways are involved in the pathogenesis of diabetic nephropathy? |
- Hemodynamic - Metabolic |
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In the metabolic pathway to diabetic nephropathy, what is the cause of cellular damage? (3) |
- Sorbitol - Fructose - Advanced glycosylated end-products (AGEs) |
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What are the genetic risk factors for diabetic nephropathy? (3) |
- Race (African, Mexican, Native American) - Family history - Polygenetic factors |
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How does diabetic nephropathy look under light microscopy?
Immunofluorescence?
Electron microscopy? |
LM - Diffuse or nodular mesangial expansion, with or without thick capillary walls, arteriolar hyalinosis
IF - Normal
EM - Diffuse or nodular mesangial expansion, thick GBM |
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What are the mesangial nodules in diabetic nephropathy termed in light microscopy? |
Kimmelstiel-Wilson Nodules |
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What molecules are responsible for thickening the GBM in diabetic nephropathy? (7) |
- Glucose - AGEs - Sorbitol - Glucagon - NO - IGF-1 - TGF-ß
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What kind of management is indicated for diabetic nephropathy? (5) |
- Better glycemic control - Moderate protein restriction - Control HTN - Manage CV disorders aggressively - ACEI/ARB |
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Why is protein restricted in diabetic nephropathy? |
Bc amino acids are vasodilatory increasing pressure to glomerulus |
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What is amyloidosis? |
Polymerization of proteins that can form amyloid fibrils |
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Describe the 3 most common forms of amyloid. |
Aß - Alzheimer's plaques
AL - light chain, primary amyloidosis
AA - response to inflammation of a chronic disease, secondary amyloidosis |
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Which light chain is more pervasive in AL-amyloidosis? |
Lambda > Kappa |
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How does AL-amyloidosis present? (9) |
- Fatigue - Weight loss - Bone pain - Cardiomyopathy - Macroglossia (big tongue) - Enlarged kidney - Easy bruising - Peripheral neuropathy - Nephrotic syndrome
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What 4 chronic diseases can present with AA-amyloidosis? |
- Rheumatoid Arthritis - Inflammatory Bowel Disease - Osteomyelitis - Tuberculosis |
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What organ produces the AA phase-reactant protein? |
Liver |
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What is the clinical presentation of AA-amyloidosis? (3) |
- Nephrotic syndrome - GI problems - Hepatosplenomegaly |
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What stain is necessary to see amyloidosis in a glomerulus? |
Apple-green Congo red (using polarized light) |
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What is the treatment for AL-amyloidosis? (2) |
- Chemotherapy - Autologous stem cell transplantation |