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63 Cards in this Set
- Front
- Back
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If the charge of the glomerular basement membrane is altered, what type of glomerular proteinuria results?
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Selective proteinuria
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Nonselective proteinuria is characterized by?
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Damage to the membrane, increasing the pore sizes so that protein can pass through
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This type of proteinuria is benign and common in adolescents.
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Orthostatic proteinuria
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What is nephrotic syndrome characterized by?
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proteinuria
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What is nephritic syndrome characterized by?
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hematuria
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What are the causes of secondary nephrotic disease?
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Amyloidosis
Lupus Diabetic nephropathy |
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HIV and heroin use cause which type of glomerular patholgy?
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Focal sclerosis
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What are some of the characteristics of nephrotic syndrome?
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Heavy proteinuria (>3g/day)
Hypoalbuminemia (<3g/dL) Edema |
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What is the main complication of nephrotic syndrome?
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Thromboembolic events
DVTs, PEs, renal vein thrombosis |
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What is the mechanism behind the complications caused by heavy proteinuria (>g/day)?
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Hypercoagulability due to loss of anticoagulant proteins (protein S & C, antithrombin 3) and retention of procoagulant proteins
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What is the mechanism behind the increase risk of infections in patients with nephrotic syndrome?
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IgG is lost in the urine, thus a decreased ability to fight encapsulated organisms
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High cholesterol and triglycerides are complications of which syndrome and why?
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Nephrotic syndrome due to increased synthesis of LDL and VLDL, with no change in HDL synthesis
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What is the treatment for nephrotic syndrome?
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Salt restriction to reduce edema
Loop diuretics, regulate protein intake, ACE inhibitors/ARBs, blood pressure control NSAIDs are a last resort |
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What are the risks for an increased rate of renal disease progression?
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Elevated creatinine, hypertension, amount of proteinuria, age and male sex
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What are the other treatments for nephrotic syndrome that are immune related?
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Prednisoe, cytotoxic drugs, calcineurin inhibitors, mycophenolate mofetil
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What is the most common nephrotic disease in children?
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Minimal change nephropathy
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What are the characteristics of minimal change nephropathy (MCN)?
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Children usually present with proteinuria and edema, but without hypertension and hematuria or elevated creatinine.
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Children that have a history of eczema or asthma are at an increased risk for which nephropathy?
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Minimal change nephropathy
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What is the etiology of minimal change nephropathy?
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Lymphokines altering the GBM charge
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What is the treatment for minimal change nephropathy?
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Prednisone is the first line therapy, however relapses tend to occur and second line therapy includes CNIs, cyclophosphamide, and mycophenolate mofetil
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What is the most common nephropathy in adults?
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Membranous nephropathy
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Membranous nephropathy can present with edema and proteinuria, but may also present with _________.
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PE, DVT
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Thromboembolism is most likely to occur with which nephropathy?
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Membranous nephropathy
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What are the pathological characteristics of membranous nephropathy?
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Deposits on the epithelial side of the GBM (podocytes), which a subsequent thickening of the membrane
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Carcinomas are an important secondary cause of which nephropathy?
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Membranous nephropathy
(10% of adults with this nephropathy have concurrent carcinomas) |
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What is the clinical presentation of focal sclerosis?
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Edema, HTN, elevated creatinine
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What nephritic disorder is the most common worldwide cause of glomerulonephropathy?
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IgA Nephropathy
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What are the pathological characteristics of IgA nephropathy?
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IgA deposits in mesangial cells with associated hypercellularity and matrix expansion
Abnormal galactosylation of the hinge region of IgA1 Associated with URIs |
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What are the stimuli for ADH release?
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Changes in plasma osmolarity
Non-osmotic signals from baroreceptors, indicating decreased ECV Pain and esophageal stimulation |
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What does urine osmolality generally indicate?
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Presence or absence of ADH
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What does a high urine osmolality indicate?
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ADH is present
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What does a low urine osmolality indicate?
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ADH is absent
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What urinary index does the kidney use to determine the volume status
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Urine sodium
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What does high urine sodium (>10mEq/L) indicate?
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The kidney thinks the body is volume expanded and is thus getting rid of excess sodium.
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What does low urine sodium (<10mEq/L) indicate?
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The kidney thinks the body is volume depleted and is thus reabsorbing sodium.
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What does a urine osmolarity of < 100 indicate?
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ADH is absent and the urine is dilute
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What is the daily osmolar load from dietary protein/salt?
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500-750 mOsm
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How do you clinically evaluate hyponatremia?
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Check plasma osmolarity, Uosm for presence/absence of ADH, urinary sodium for kidneys perception of volume status, and the H&P for the patients volume status
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What is the most common cause of hyponatremia with Uosm < 100?
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Primary polydipsia
Exceptions: Beer potomania, Tea & Toast Syndrome (which both cause hyponatremia and low Uosm without excessive fluid intake) |
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How is hyponatremia with Uosm > 100 evaluated?
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ADH is present, but one must determine if this is appropriate with respect to volume status, so look at urinary sodium
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In a patient with Uosm > 100, urinary sodium < 10, and is volume depleted, why does hyponatremia develop?
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Kidney is reabsorbing sodium and water to expand the vascular space, and non-osmotic stimuli to ADH secretion overwhelm the desire to keep Posm in the right range.
Brain/heart perfusion is more important than perfect Posm |
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In a patient with Uosm > 100, urinary sodium <10, and is volume expanded, why does hyponatremia develop?
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Kidney is receiving signals indicated poor perfusion despite volume excess (CHF, cirrhosis, nephrosis) and is holding on to sodium.
Non-osmotic stimuli to ADH secretion causes free water reabsorption. |
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In a patient with Uosm > 100, urinary sodium > 10, and is volume depleted, why does hyponatremia develop?
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Kidney is receiving wrong signal sand is wasting salt.
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What does high urine sodium (>10mEq/L) indicate?
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The kidney thinks the body is volume expanded and is thus getting rid of excess sodium.
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What does low urine sodium (<10mEq/L) indicate?
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The kidney thinks the body is volume depleted and is thus reabsorbing sodium.
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What does a urine osmolarity of < 100 indicate?
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ADH is absent and the urine is dilute
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What is the daily osmolar load from dietary protein/salt?
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500-750 mOsm
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How do you clinically evaluate hyponatremia?
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Check plasma osmolarity, Uosm for presence/absence of ADH, urinary sodium for kidneys perception of volume status, and the H&P for the patients volume status
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In a patient with Uosm > 100, urinary sodium > 10, and is volume expanded, why does hyponatremia develop?
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Brain or kidney is confused
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What are the causes of hyponatremia with Uosm > 100, UNa+ < 10, and volume depletion?
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GI losses (nausea/vomiting/diarrhea)
Skin losses (burns) Diuretics (late) |
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What are the causes of hyponatremia with Uosm > 100, UNa+ < 10, and volume expansion?
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CHF, cirrhosis/liver failure, nephrotic syndrome
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What is the desired rate of correction of hyponatremia?
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0.5 mEq/L/hr
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What does hypernatremia with Uosm < 300 indicate?
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Diabetes insipidus
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What can be administered to counteract the effects of high plasma potassium on threshold membrane potentials?
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Calcium
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Name three causes of hypokalemia.
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Metabolic acidosis
Hyperinsulinemia Increased catecholamines/beta agonists |
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How do you clinically evaluate hypokalemia?
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Determine GI vs. renal and acid-base status
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How do you determine if hypokalemia is due to renal or GI losses?
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Low urinary K = GI losses
High urinary K = renal losses |
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What does hypokalemia with low urinary K+ and alkalosis indicate?
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Vomitting (upper GI losses)
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What does hypokalemia with low urinary K+ and acidosis indicate?
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Lower GI losses: laxatives/villous adenomas
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What does hypokalemia with high urinary K+ and alkalosis indicate?
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Need to check BP, renin, and aldosterone
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What does hypokalemia with high urinary K+ and acidosis indicate?
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Ketoacidosis
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What are the possible causes of hypokalemia due to renal losses in a patient with hypertension and high plasma renin?
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diuretics, renovascular disease, reninoma, Cushings syndrome
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What are the possible causes of hypokalemia due to renal losses in a patient with hypertension and low plasma renin?
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Check aldosterone levels
High = adrenal adenoma or hyperplasia Low = exogenous mineralcorticoid |
