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46 Cards in this Set
- Front
- Back
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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!!) |
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Case 1
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Case 1
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Case 1
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Case 1
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Case 1
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Case 1
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What test might be ordered if Post Strep Acute GN suspected, and throat culture was negative (as it usally will be negative here)
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Order ASO
anti-streptolysin-O titer --if elevated indicates sub-optimal clearing of the infection. |
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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 |
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Slide 14
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14
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What type of GN is Post Strep GN?
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its an RPGN
--with decreasing Renal Function in wks to months time period --can have proteinuria in nephrotic range --active urine sedinemts--casts |
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SLIDe 16
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16
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16
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16
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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 |
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What is indication for using Cyclophosphamide for RPGN
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ExtraRenal Dz--vasculitis
Biopsy--Necrotizing GN |
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New Case:
12yr with Hematuria on SPorts Physical> What 2 things to consider first |
Possibly Viral URI 1-2 wks prior
or IgA Nephropathy |
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19
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19
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What is Nephrosis, how used
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Any Nephropathy-
used to indicate a NON-inflam Kid Dz |
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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 |
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22 Case 3
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22
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23
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23
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24
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24
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What is gold standard for renal failure
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GFR
--most impt in long term/chronic --tho BUN/Creat can change a lot in acute phase |
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When Considering Systemic Causes of Nephrotic Syndrome:
DDX for other Dz? (3) |
DM, SLE, Amyloidosis
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When Considering Systemic Causes of Nephrotic Syndrome:
DDX for drug causes? (6) |
Gold, Penicillamine, Probenecid, NSAIDs, heroin, captopril
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When Considering Systemic Causes of Nephrotic Syndrome:
DDX for infectious causes? (6) |
Bacterial Endocarditis,
Hep B Shunts, Syphilis Malaria |
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When Considering Systemic Causes of Nephrotic Syndrome:
DDX for malignant causes? (5) |
Hodgkins
Non Hodgkins Leukemia, Cx from Breast or GI |
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28
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28
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29
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29
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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 |
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What are Tx options for Membranous GN
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High dose Alt. day steroids
---if any Tx at all --Possible comb w/ cytotoxic agens |
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Moving onto another Idiopathic GN:
Minimal Change Disease (MCD). findings on EM |
light loss of tiny foot processes branches
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What is most common idiopathic GN ?
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Membranous,
-MCD is 15% of Idiopathic GNs |
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35
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35
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MCD Treatment?
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Prednisone -- 1mg/kg/d = 80% response
--Failure to Responde , think maybe its early FSGS (focal segmental...) --Consider Cytotoxic agents if no response--ie Cyclophos |
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Moving onto FSGS =
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Focal Segmental Glomerulo-Sclerosis
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What prop of Nephrotic Syndromes is FSGS?
Features? |
15%
-HTN -Hematuria -Renal Insufficiency -Nephrotic Syndrome -Fusion of Foot processes |
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38
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38
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Two lab signs significant for DM/ until proven otherwise?
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Polydypsia dn Polyuria
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What are the 2 major causes of end stage renal dz (ESRD)
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Glomerulonephritis
Diabetic Nephropathy |
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MOving on to Other Systemic Causes of GN?
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HIV GN: treat virus, NO steroids
Systemic Vasculinities --wegeners Anti-GBM-Ab Dz --if lungs too = goodpastures |
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Tx for Anti-GBM-Ab dz
RESUME around slides ~46 |
around 46
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