• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/65

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

65 Cards in this Set

  • Front
  • Back

What symptom is a major factor for acquiring progressive glomerular sclerosis and renal failure?

hypertension

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

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

What growth factor do ACEI/ARB reduce in the glomerulus?

TGF-ß

How is edema managed in patients with nephrotic syndrome? (2)

- Sodium restriction


- Diuretics

How is hyperlipidemia managed in patients with nephrotic syndrome? (2)

- Diet


- Statins

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

What diagnostic technique is necessary for final diagnosis of renal disease?

Kidney biopsy

What 3 microscopic techniques are used to analyze a kidney biopsy?

1) Light microscope


2) Immunofluorescence


3) Electron microscopy

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%)

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



What are the 3 primary diseases that can cause nephrotic syndrome?

1) Minimal Change Lesion


2) Focal Segmental Sclerosis


3) Membranous Lesion

Name 2 secondary diseases that cause nephrotic syndrome?

1) Diabetic nephropathy


2) Amyloidosis

What is the clinical presentation of minimal change disease? (3)

- Heavy proteinuria


- Severe edema


- Ascites or pleural effusion

What vitals signs are normal in minimal change disease? (2)

- BP


- kidney function

What is the common etiology of minimal change disease in children under 10 years old?

Idiopathic

Besides idiopathic, what are other etiologies of minimal change disease? (3)

- History of allergic reactions


- Drugs like NSAIDs or alpha-interferon


- Lymphoproliferative malignancy

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

How does minimal change disease look under light microscopy?



Immunofluorescence?



Electron microscopy?

LM - normal



IF - normal



EM - Foot process effacement

What is the standard treatment for minimal change disease?





What fraction of patients relapse?

Steroids





2/3

What other drugs can be used for steroid-resistant minimal change disease? (2)

- Cyclosporine


- Rituximab

What is injured in Focal Segmental Glomerular Sclerosis (FSGS)?

Podocytes

What is the clinical presentation of FSGS? (4)

- Nephrotic syndrome


- Hypertension


- Microscopic hematuria (possible)


- Decreased kidney function (possible)

In what race is focal segmental glomerular sclerosis more common?

African Americans

What virus can lead to focal segmental glomerular sclerosis?





What illicit drug?

HIV





Heroin

What 4 syndromes can lead to FSGS? (4)

- Unilateral renal agenesis


- Reflux nephropathy


- Morbid obesity


- Sleep apnea (which leads to hypoxia)

How does focal segmental glomerular sclerosis look under light microscopy?



Immunofluorescence?



Electron microscopy?

LM - Focal, segmental sclerosis



IF - normal



EM - foot process effacement

What two special stains help visualize FSGS under light microscopy?

- PAS


- Silver

What is the primary treatment for FSGS?

Management with ACEI/ARBs

What is the second-line treatment for FSGS? (3)

- Cyclosporine


- Cyclophosphamide


- Mycophenolate mofetil

What causes the membrane appearance of the glomeruli in membranous nephropathy (MN)?

Antibody complexes

What immune molecules are deposited in membranous nephropathy? (2)



Where specifically are they deposited?

- IgG and C3



- beneath podocytes

What cell in Bowman's capsule are the antibodies attacking in MN?

Podocytes

What specific antigen on podocytes is implicated to be the target to antibodies in MN?

phospholipase A2 receptor (PLAR)

What race is most susceptible to membranous nephropathy?

Caucasians

Are serum complement levels reduced in MN?

No

What immune diseases can be associated with membranous nephropathy? (2)

- Systemic Lupus Erythematosus


- Rheumatoid arthritis

What are 3 infections that can be associated with MN?

- Hep B


- Hep C


- Syphilis

What 3 drugs can be associated with MN?

- Gold


- Penicillamine


- NSAIDs

What common chronic disease can present with MN?

Solid tumor cancers

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

What underlying cause can be part of nephrotic syndrome and would require identification?

Malignancy

What percentage of cases of MN spontaneously recover?

30%

What treatments are indicated for membranous nephropathy? (4)

- Cyclophosphamide with steroids


- Cyclosporine A (if severe)


- ACTH


- Rituximab

What is the most common nephrotic syndrome in children?

Minimal Change Disease

What is the first sign that the kidneys have been damaged by diabetes?

Microalbuminuria

How does GFR change during the course of diabetic nephropathy?

Increases in first few years, then gradual decline

In diabetic nephropathy, what damages the glomerulus?

hypertension

What two pathways are involved in the pathogenesis of diabetic nephropathy?

- Hemodynamic


- Metabolic

In the metabolic pathway to diabetic nephropathy, what is the cause of cellular damage? (3)

- Sorbitol


- Fructose


- Advanced glycosylated end-products (AGEs)

What are the genetic risk factors for diabetic nephropathy? (3)

- Race (African, Mexican, Native American)


- Family history


- Polygenetic factors

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

What are the mesangial nodules in diabetic nephropathy termed in light microscopy?

Kimmelstiel-Wilson Nodules

What molecules are responsible for thickening the GBM in diabetic nephropathy? (7)

- Glucose


- AGEs


- Sorbitol


- Glucagon


- NO


- IGF-1


- TGF-ß



What kind of management is indicated for diabetic nephropathy? (5)

- Better glycemic control


- Moderate protein restriction


- Control HTN


- Manage CV disorders aggressively


- ACEI/ARB

Why is protein restricted in diabetic nephropathy?

Bc amino acids are vasodilatory increasing pressure to glomerulus

What is amyloidosis?

Polymerization of proteins that can form amyloid fibrils

Describe the 3 most common forms of amyloid.

- Alzheimer's plaques



AL - light chain, primary amyloidosis



AA - response to inflammation of a chronic disease, secondary amyloidosis

Which light chain is more pervasive in AL-amyloidosis?

Lambda > Kappa

How does AL-amyloidosis present? (9)

- Fatigue


- Weight loss


- Bone pain


- Cardiomyopathy


- Macroglossia (big tongue)


- Enlarged kidney


- Easy bruising


- Peripheral neuropathy


- Nephrotic syndrome


What 4 chronic diseases can present with AA-amyloidosis?

- Rheumatoid Arthritis


- Inflammatory Bowel Disease


- Osteomyelitis


- Tuberculosis

What organ produces the AA phase-reactant protein?

Liver

What is the clinical presentation of AA-amyloidosis? (3)

- Nephrotic syndrome


- GI problems


- Hepatosplenomegaly

What stain is necessary to see amyloidosis in a glomerulus?

Apple-green Congo red


(using polarized light)

What is the treatment for AL-amyloidosis? (2)

- Chemotherapy


- Autologous stem cell transplantation