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46 Cards in this Set

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What is most common worldwide, primary, glomerulonephrophathy?
What kind of glomerulonef (GN) does it cause
IgA nephropathy
--most freq form of acute GN
--Is Nephritic (check thiS!!)
Case 1
Case 1
Case 1
Case 1
Case 1
Case 1
What test might be ordered if Post Strep Acute GN suspected, and throat culture was negative (as it usally will be negative here)
Order ASO
anti-streptolysin-O titer
--if elevated indicates sub-optimal clearing of the infection.
What kind of strep usually causes this?

How treated if causing Acute GN?
Group A beta-hemolytic step
--1-2wks post URTI

--This is what you treat. Keep kidneys in mind--no NSAIDs
--consider other supportive, ie FLuids
Slide 14
14
What type of GN is Post Strep GN?
its an RPGN
--with decreasing Renal Function in wks to months time period
--can have proteinuria in nephrotic range
--active urine sedinemts--casts
SLIDe 16
16
16
16
What Tx do 50-75% of RPGNs respond to?
IF not?
High Dose Pulse Steroid
-ie Cyclophosmphamide
--but depending on underlying cause it can go to Dialysis
What is indication for using Cyclophosphamide for RPGN
ExtraRenal Dz--vasculitis
Biopsy--Necrotizing GN
New Case:
12yr with Hematuria on SPorts Physical>
What 2 things to consider first
Possibly Viral URI 1-2 wks prior
or
IgA Nephropathy
19
19
What is Nephrosis, how used
Any Nephropathy-
used to indicate a NON-inflam Kid Dz
What are indications in labs for Nephrotic Syndrome?
Main Physical Finding
(a subset of Nephrosis)
-Proteinuria: 24 hr urine > 3.5 gm/d
Blood: High Lipids (ie LDL to maintain osmol) Low Albumin, as its now all in pee
-Peripheral Edema
22 Case 3
22
23
23
24
24
What is gold standard for renal failure
GFR
--most impt in long term/chronic
--tho BUN/Creat can change a lot in acute phase
When Considering Systemic Causes of Nephrotic Syndrome:
DDX for other Dz? (3)
DM, SLE, Amyloidosis
When Considering Systemic Causes of Nephrotic Syndrome:
DDX for drug causes? (6)
Gold, Penicillamine, Probenecid, NSAIDs, heroin, captopril
When Considering Systemic Causes of Nephrotic Syndrome:
DDX for infectious causes? (6)
Bacterial Endocarditis,
Hep B
Shunts,
Syphilis
Malaria
When Considering Systemic Causes of Nephrotic Syndrome:
DDX for malignant causes? (5)
Hodgkins
Non Hodgkins
Leukemia,
Cx from Breast or GI
28
28
29
29
Membranous GN
-40% of Idiopathic Nephrotic Syns
Findings?
Can low Pr, ie Non-nephrotic range proteinuria
-GFR normal or near normal
-Urine Sediment Unremarkable
---spont. remissions/exacerbations
----but 20% progress to end stage renal Dz
What are Tx options for Membranous GN
High dose Alt. day steroids
---if any Tx at all
--Possible comb w/ cytotoxic agens
Moving onto another Idiopathic GN:
Minimal Change Disease (MCD).
findings on EM
light loss of tiny foot processes branches
What is most common idiopathic GN ?
Membranous,
-MCD is 15% of Idiopathic GNs
35
35
MCD Treatment?
Prednisone -- 1mg/kg/d = 80% response
--Failure to Responde , think maybe its early FSGS (focal segmental...)
--Consider Cytotoxic agents if no response--ie Cyclophos
Moving onto FSGS =
Focal Segmental Glomerulo-Sclerosis
What prop of Nephrotic Syndromes is FSGS?
Features?
15%
-HTN
-Hematuria
-Renal Insufficiency
-Nephrotic Syndrome
-Fusion of Foot processes
38
38
Two lab signs significant for DM/ until proven otherwise?
Polydypsia dn Polyuria
What are the 2 major causes of end stage renal dz (ESRD)
Glomerulonephritis
Diabetic Nephropathy
MOving on to Other Systemic Causes of GN?
HIV GN: treat virus, NO steroids
Systemic Vasculinities --wegeners
Anti-GBM-Ab Dz --if lungs too = goodpastures
Tx for Anti-GBM-Ab dz
RESUME around slides ~46
around 46