Renal: Proteinuria And Hematuria

Front 1

Three components of the glomerular filtration barrier

Back 1

1) fenestrated capillary endothelium
2) Glomerular basement membrane
3) Glomerular epithelial cell (podocyte)

Front 2

Glomerular epithelial cell is also known as?

Back 2

podocyte

Front 3

Fenestrae of capp. endothleium is ____1__ to proteins

Back 3

1) Permeable

Front 4

1) What is the basis of size-selection in the glomerulus?
2) What is the key protein here?
3) How big is the pore formed?

Back 4

1) Slit diaphragm between podocytes (glomerular epithelium)
2) nephrin (180 kD)
3) 40 x 140 Angstroms

Front 5

The glomerular basement membrane contains what type of collagen?

Back 5

Type IV (4= floor)

Front 6

1) What is mutated in congenital nephrotic syndrome of the Finnish type?
2) population that this is seen in
3) major finding in urine?

Back 6

1) nephrin
2) neonates (dont live long)
3) massive amounts of protein in the urine

Front 7

What is the most restrictive barrier to filtration?

Back 7

Nephrin Slit diaphragm

Front 8

Hereditary nephritis (alports) is a mutation in?

Back 8

Type IV collagen

Front 9

1) What is the most important factor in determining if a given protein will be filtered?
2) The ___2___ can avdly reabsorb protein

Back 9

1) molecular size/weight
2) PCT

Front 10

The Glomerlular basemment membrane is restrictive to proteins of size.....

Back 10

1) > 200 kDa

Front 11

Does charge play any role in selectivity in the glomerulus?

Back 11

NOPE

Front 12

Size restriction becomes important for proteins greather than ___ kD

Back 12

25

Front 13

how do we experimentally demonstrate that increasing the size of paticles causes them to be filtered less?

Back 13

Administer dextran beads of increasing radius

Front 14

Diabetic nephropathy and nephrotic syndrome are modeled how in our sit diaphragm picture?

Back 14

Large pores in the filtration barrier.

Front 15

1) What is the albumin receptor which drives specific reabsorption called?
2-3) Two fates of reabsorbed albumin
NOTE- there is also a high capacity, non specific reabspoption system for albumin

Back 15

1) megalin
2) transcellular trafficking to the venous system
3) breakdown to AA for reuse

Front 16

Name a few freely filtered proteins that are almost completely reabsorbed.

Back 16

lysozyme
Beta 2 microglobulin
insulin

Front 17

1) normal 24 hour urine protein =
2) What protein makes up 50% of tubular protein?
3) What 3 other proteins are present in significant amounts

Back 17

1) 40-80 mg (150=upper limit of WNL)
2) Tamm-horsfall
3) albumin, IgG, light chain

Front 18

Main component of urinary casts?

Back 18

Tamm-Horsfall

Front 19

4 classifications of proteinuria... give examples.
1) non-pathologic (2)
2) Glomerular (2)
3) Tubular
4) Over-production

Back 19

1) heavy excercise, postural proteinuria
2) glomerulonephrtis, diabetic nephropathy
3) Intersitital nephritis
4) Multiple myeloma

Front 20

Two most common causes of proteinuria in the US

Back 20

DM and HTN

Front 21

Two lab tests we can use to accurately quanititate the degree of porteinuria

Back 21

24-hr urine
protein/ Creatinine ratio

Front 22

1) Pitting Edema is the most common sign of what kidney disease?
2) Where is it seen first?
3) Where is it see in more severe cases?

Back 22

1)Nephrotic syndrome
2) pre-tibial
3) peri-orbital, genitals, hands

Front 23

What is the gross appearance of urine with protein in it?

Back 23

Foamy

Front 24

RBC casts on the UM suggests?

Back 24

Glomerulonephritis

Front 25

1) Why do we consider the dipstick a "semi-quantitative" measure of urine protein?
2) What is the lower limit of detection?

Back 25

1) It does not acount for urine concentration. A person who drinks alot of water might get a negative, while someone who drinks les might be positive.
2) 20 mg/dL

Front 26

Name the two quantitiative methods measuring urine protein
1) classical
2) Convenient

Back 26

1) 24-hr urine
2) Urine protein/creatinine ratio

Front 27

The upper limit of normal of the urine protein/creatinine ratio is

Back 27

200 mg/mL

Front 28

How do we CHARACTERIZE urine protein

Back 28

SPEP
(Urine protein electrophoresis)

Front 29

Define selective vs. non-selective proteinuria

Back 29

selective has a prference of just albumin in the urine.
Non-selective proteinuria has proportionally raised albumin, Ig, and other plasma proteins

Front 30

non-selective proteinuria urine elctrophoresis should differ in what ay from serum electrophoresis?

Back 30

NONE, they should look about the same because there is little filtration

Front 31

Selective proteinuria show what on urine electrophoresis?

Back 31

increased albumin

Front 32

Differentiating feature of selective ad non-selective proteinuria on urine electrophoresis?

Back 32

increase in other proteins besides albumin on non-selective.

Front 33

multiple myeloma shows what in a serum and urine protein electropheresis?

Back 33

gamma spike!

Front 34

proteinuria >3.5 g/ 24 hr
Hypoalbuminemia
Hyperlipidemia
Edema
In a child........ Dx?

Back 34

Nephrotic syndrome

Front 35

24 hours urine protein
1) Nephrotic Syndrome
2) Nephritic Syndrome

Back 35

1) > 3.5 g
2) < 3.5 g

Front 36

Which syndrome, nephritic or nephrotic has low (<3.5 g/dL) plasma albumin?

Back 36

nephrotic

Front 37

Edema is found in:
1) Nephrotic Syndrome?
2) Nephritic Syndrome?

Back 37

1) yes
2) yes

Front 38

Which syndrome, nephritic or nephrotic has increased lipids?

Back 38

Nephrotic

Front 39

Are RBC casts seen in
1) nephrotic syndrome?
2) nephritic syndrome?

Back 39

1) no
2) yes

Front 40

Are Oliguria/ARFseen in
1) nephrotic syndrome?
2) nephritic syndrome?

Back 40

1) no
2) yes

Front 41

Is Hematuria seen in
1) nephrotic syndrome?
2) nephritic syndrome?

Back 41

1) yes or no
2) yes

Front 42

Is HTN seen in:
1) nephrotic syndrome?
2) nephritic syndrome?

Back 42

1) yes or no
2) yes

Front 43

Edema, hematuria, RBC casts, HTN, and oliguria ar classically present in...

Back 43

nephritic syndreom

Front 44

We see urine protein >3.5 g/24 h, BUT we dont see edema, hyperipidemia, orlow plasma albumin. What is the Dx?

Back 44

Nephrotic range proteinuria

Front 45

We see high urine protein but it is less than 3.5 g/day and has no accompanying features. Dx?

Back 45

Non- Nephrotic range proteinuria

Front 46

proteinuria in the upright position, but not supine. Urine protein < 1g/day.
1) Dx?
2) Prognosis?

Back 46

1) Postural porteinuria
2) excellent

Front 47

1) One of the two main mechanisms of salt and water retention in glomerular disease is Over-Fill edema....explain
2) Is this aldosterone dependant?

Back 47

1) Primary NaCl retnetion by the kidney CCD. Increased expression of ENaC and Na/K ATPase. Resistancne to ANP. Salt retention causes HTN, which auses increased hydrostatic pressure and overflow of fluid into the body tissues.
2) NOT aldo dependant

Front 48

1) One of the two main mechanisms of salt and water retention in glomerular disease is Under-Fill edema....explain
2) population?

Back 48

1) Sever hypoalbuminemia lows plasma fluid to leak into interstitium causing edema. This drop in absolute IVV causes RAAS activation and consequent avidity of the kidney for NaCl and water.
2) kids

Front 49

1) Which is the predominant cause of edema in proteinuric states, over or under fill?
2) Who is resistant to iduretic therapy, over or under fill?
3) Which one presnts with HTN?

Back 49

1) Over-fill
2) Underfill
3) Over-fill

Front 50

Plasma renin activity:
1) overfill edema
2) underfill edema

Back 50

1) normal/low
2) High

Front 51

Plasma Aldosterone activity:
1) overfill edema
2) underfill edema

Back 51

1) low/normal
2) High

Front 52

Urine Sodium
1) overfill edema
2) underfill edema

Back 52

1) low
2) low

Front 53

Plasma Albumin
1) overfill edema
2) underfill edema

Back 53

1) 1.7-3.5 g/dL
2) < 1.7 g/dL

Front 54

GFR
1) overfill edema
2) underfill edema

Back 54

1) low
2) normal/low

Front 55

Hypoalbuminemia edema, hyperlipidemia, hypercoagulable state, and immune dysfunction are systemic onsequences of .....

Back 55

Nephrotic syndrome

Front 56

1) Does the liver try to compesate for hypoalbuminemia in the nephrotic syndrome?
2) Does it make up for losses usually?
3) How will protein intake affect this condition?

Back 56

1) Yes, doubles albumin production from 5-8 to 10-16 g/day
2) no
3) exacerbate albumin loss (paradoxical) because liver response to protein load is to increase hydrostatic pressure.

Front 57

In the Nephrotic presentation of hyperlipidemia:
1) _DLlevel rises as a contributing factor?
2) _DLprotein level falls as a contributing factor
3) ______ enzyme loss in the urine contribultes to the fall of (2) because _____4____
5) what is the stimulis that causes the liver to make cholesterol?
6) __DL levels rise due to reduced peripheral uptake ad catabolism in tissues.

Back 57

1) LDL
2) HDL
3) LCAT
4) LCAT esterifies cholesterol to a form which can be carried by HDL
5) low oncotic pressure, because it is attenuated by administration of dextran or albumin.
6) VLDL

Front 58

1) Does treatment of the hyperlipidemia help slow the progress of Nephrotic syndrome?
2) With what do we treat it?

Back 58

1) Yes
2) Statins ( HMG CoA reductase inhibitors)

Front 59

1) How does the nephrotic syndrome change coagulability?
2) Most common manifestation
3)

Back 59

1) Hypercoagulable
2) DVT

Front 60

Name 4 things that may be involved in the hypercoagulable state of the nephrotic syndrome

Back 60

Antithrombin III loss in urine
Deficiency of protein S
Increased platelet aggregation
Increased hepatic fibrinogen synthesis (correlates with albumin production)

Front 61

These all may be causes of immune dysfunction in _______ syndrome:
1) reduced plasma IgG
2) impaired cell mediated immunity (blunted skin tests)
3) Immunosupresie agents used in the treatment of the kidney disease

Back 61

Nephrotic syndrome

Front 62

Hematuria is described as microscopic OR

Back 62

Gross (visible)

Front 63

1) Glomerular disease causing hematuria is common in:
2) Urinary tract tumor causing hematuria is common in:
3) _____ is a common cause of isolated microscopic hematuria in both kids and adults.

Back 63

1) kids
2) adults
3) Hypercalciuria.

Front 64

The DDx for hematuria contains diseases of boht the
1) upper and lower tract (4)
2) kidney (6)

Back 64

1) Infection, stones, neoplasia, trauma
2) Parenchymal disease, glomerular disease, interstitial disease, neoplasi, cystic disease, papillary necrosis

Front 65

Gross hematuria
flank pain
Respiratory infection

Dx?

Back 65

IgA nephropathy

Front 66

Grossly bloody urine with closts is caused by?

upper/lower tract or kidney abnormality?

Back 66

uper or lower tract abnormality

Front 67

What may cause intermittent hematuria?

Back 67

Kidney or bladder cancer

Thus dont rule out neoplasia upon subsequent negative UA.

Front 68

Tea or cola colored urine suggests?

Back 68

Glomerulonephritis

Front 69

WBC and bacteria suggest what

1) in a female
2) in a male

Back 69

1) UTI
2) prostatisits

Or another inflammatory process

Front 70

GLOMERULAR bleeding is shown by what in the UM?

Back 70

dysmorphic RBCs

Front 71

Intravenous pyelogram is ordered mostly to evaluate for two things..

Back 71

stones and tumors

Front 72

Prefered test for stones in pt. with renal dysfunction

Back 72

US, because no dye as in a pyelogram

Front 73

Best test to eval a renal mass detected on an IVP (pyelogram) or US.

Back 73

CT

Front 74

Abnormal imaging study suggest need for what other examination

Back 74

Endoscopy

(Cytoscopy= urethra)
(Endoureterscopy= upper tract)

Front 75

1) prevalence of UA abnormalities in school aged children
2) malignancy causing UA abnormality is unlkely below what age?

Back 75

1) 1-2 %
2) 40

Front 76

Routine UA is recommended for kids, adults, or both?

Back 76

Just kids

Front 77

1) Kidney biopsy id done on what guidance?
2) Main risk?
3) Only do this in what general situation

Back 77

1) US
2) bleeding
3) It can have significant clinical imapact

Front 78

5 indications for kidney biopsy

Back 78

1) Nephrotic syndrome
2) Nephritic syndrome
3) ARF of unknown etiology
4) CKD of uknown etiology
5) Possible hereditary disease.