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31 Cards in this Set

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What is nephrOtic syndrome?
proteinuria > 3.5 g/d
lipiduria with hyperlipidemia
low alb
What is the general treatment for nephrotic syndrome?
protein and salt restriction, diuretics, statins
What is nephrItic syndrome?
acute onset hematuria
low GFR, oliguria
Name 3 nephrOtic glomerulopathies.
Minimal change disease
Membranous glomerulopathies
Membranoproliferative glomerulonephritis
Name 5 nephrItic glomerulonephropathies.
Poststrep glomerulonephritis
Crescentic glomerulonephritis
Berger's disease
Henoch-Schonlein purpura
Multiple myeloma
Describe the UA in nephrOtic syndrome.
High proteinura, +/- hematuria
no cells
fatty casts
free fat droplets, oval fat bodies
Describe the UA in nephrItic syndrome.
proteinura +/-, high hematuria
RBCs and WBCs
RBC and granular casts
Describe the UA in chronic disase.
+/- proteinuria +/- hematuria
+/- cells
waxy and pigmented granular casts
Minimal Change Disease
young children
very responsive to prednisone with excellent Px
Focal Segmental Glomerulosclerosis
similar to MCD.
Idiopathic form normally in young HTNive males.
Also associated with heroin, HIV, diabetes, sickle cell.
Tx - prednisone + cyclophosphamide
Px poor.
Membranoproliferative glomerulonephritis
Type I - slowly progressive
Type II - aggressive. Ab against C3 convertase = C3 nephrotic factor --> decreased C3.
Tx - prednisone +/- plasmapheresis or interferon-a
Px - poor.
Poststreptococcal glomerulonephritis
Follows Group-A beta-hemolytic strep, or any other infxn weeks later.
Labs - urine red cells and casts, azotemia, low C3, high ASO titer.
Imaging - coarse granular IgG or C3 deposits.
Dz normally self-limiting.
Crescentic glomerulonephritis
Progresses to renal failure w/i wks-mos
Can be part of PIGN/systemic dz
Goodpasture's = glomerulonephritis with pneumonitis (lung sx usually first) in men in mid-20s.
+ antiGBM Abs
smooth, linear deposition of IgG
Tx - prednisone + plasmapheresis.
Berger's Disease
Most common worldwide nephropathy.
IgA deposition in mesangium.
Si/Sx - recurrent hematuria with low-grade proteinuria, concurrently with infxn.
25% --> renal failure 75% harmless.
Tx - prednisone for acute flares
Renal involvement in Multiple myeloma
light chains --> tube plugging, hyperCa --> damage, myeloma cells --> invade kidney. susceptibility to encapsulated bacteria --> chronic renal failure.
What kind of nephropathy is seen in diabetes?
1st - microalbuminuria
* can slow progression from here with ACEI and tight glycemic and HTN ctrl.
As dz progresses, only Tx is transplant. Most common cause of ESRDz in US.
Bx - pathognomonic Kimmelstiel-Wilson nodules.
What kind of nephropathy is seen in HIV?
*usually seen in HIV from IV drug use*
Focal Segmental Glomerulonephritis (NEPHROTIC)
Early antiretrovirals may help.
How do you Dx and Tx renal amyloidosis?
Dx - birefringence with Congo red
Tx - transplant, but can recur.
What are the five types of renal involvement in lupus?
I - none
II - mesangial dz
III - focal proliferative
IV - diffuse proliferative
V - mebranous dz
Renal involvement in SLE - Type II
Mesangial disease with focal segmental glomerular pattern.
Tx - usually none.
Renal involvement in SLE - Type III
Focal proliferative dz.
Tx - agressive prednisone +/- cyclophosphamide
Renal involvement in SLE - Type IV
Diffuse proliferative dz
The most severe form of lupus nephropathy.
both nephrotic and nephritic.
LM - wire-loop abnormality.
Tx - prednisone + cyclophosphamide, ?transplant.
Renal involvement in SLE - Type V
Membranous dz.
Looks like other primary membranous nephropathies (nephrotic.)
Tx - ?prednisone
What are the key DDx points for HUS?
Hx of diarrhea, child.
What are the key DDx points for HSP?
Rash, abd pain, arthritis, melena
What are the key DDx points for TTP?
CNS changes, young adult
What are the key DDx points for ITP?
Antiplatelet antibodies.
What are the Si/Sx and Tx in HUS?
PHx of E. coli
Low plt
Hemolysis on periph smear
ARF, hematuria
Tx - supportive
What are the Si/Sx and Tx in HSP?
Normal RBC, plt, and peripheral smear
A/w rash, abd pain, arthritis, melena
Tx - supportive
What are the Si/Sx and Tx in TTP?
Low plt
Hemolysis on peripheral smear
ARF, proteinuria
CNS changes
Tx - plasmapheresis, NSAIDs. DONT GIVE PLATELETS.
What are the Si/Sx and Tx in ITP?
PHx viral infxn
Normal RBC
Low plt
no kidney manifestations
+ antiplt abs
Tx - steroids for bleeding (plt <20,000), splenectomy if refractory.