Term
NEPHRITIC
Rapidly Progressing GN |
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Definition
RPG - Crescent cells
TX - Aggresive reduction of HTN and fluid overload. Salt/H2O restriction |
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Term
NEPHRITIC
Post Infectious GN |
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Definition
Most often dt GABS - 1-3 weeks post inf
Pharyngitis also post SA, Hep, CMV, malaria, toxo
Oliguria, low comp, high ASO, cola urine, RBC casts, prot <3.5, EM subepi "humps"
Tx - supportive and ATB
Prog-good for kids, others not so much. |
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Term
NEPHRITIC
IgA Nephropathy - Berger's |
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Definition
Most common GN - Berger's Dz
Children, Young adults, males
Hematuria, maybe gross. Assoc w/ URI, GI symptoms, flu-like,
cola or red urine
Protein > than 1 is unfavorable prognostic - consider ACEI or ARB, steroids
HTN
40-50% will have prog renal insuff, complement normal, biopsy for mesangial IgA deposits |
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Term
NEPHRITIC
Henoch Shoenlein Purpura |
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Definition
Male children
Looks like IgA but presents with Palpable Purpura on lower extremities, Arthralgia, Abdominal symp...nausea, melena
Prognosis good |
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Term
NEPHRITIC
Pauci Immune ANCA Associated GN |
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Definition
Seen w/ Wegener's, microscopic angitis, and Churg Strauss
80% assoc w/ ANCA
S/S fever, mal, wt loss, hemat and proteinuria
Weg - upper and lower resp tract nodular lesions that can bleed
Churg Strauss has eosinophilia & asthma
C-ANCA Wegener's P-ANCA specific for antimyeloperoxidase Ab
Pathologically sm vessels and glom will lack immune deposits
Steroids |
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Term
NEPHRITIC
Anti GBM GN
w/ pulmonary hemorrhage = Goodpastures |
|
Definition
6:1 males.
Preceded by URI, hemoptysis, edema, HTN, resp failure
Sputum hemosiderin-laden macrophages
CXR pulm infiltrates dt hemorr
Dx conf w/ presence of anti-GBM Ab |
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Term
NEPHRITIC
Cryoglobulin Associated GN |
|
Definition
Assoc, w/ cold precip Ig
Dz w/ precip of cryoglobs in glom capp
Assoc w/ hep b/c or other viral, bact, fungal inf
Skin lesions, arthralgias, fever, hepatosplenomegaly
Rheum Fact inc'd in presence of cryoglobs
Biopsy - look for crescents
Tx - underlying inf, steroids, plasma x-change, interferon, cytotoxics |
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Term
NEPHROTIC
Minimal Change Disease |
|
Definition
70-90% Kids under 10 - usually 2-3 yr M>>>F Idiopathic
NSAIDs and lymphoma assoc in adults
S/S - rapid onset edema, protein loss, adults HTN and renal insufficiency, incr'd susceptibility to infection
No lesions via light microscopy - EM shows problems W/ podocytes
Cortisone - kids good, adults not as good |
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Term
NEPHROTIC
Membranous Nephropathy |
|
Definition
Most common cause of primary nephropathy in adults
Immune mediated - in secondary dz - Hep B, endocard, syphilis, thyroid, ca
Heavy proteinuria, hypoalb, hyperlip, edema, many to ESRD over 3-10 years
Dz affects capillaries rather than BM
EM - dense immune deposits - X-plant |
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Term
NEPHROTIC
Membranoproliferative Glomerulonephropathy |
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Definition
Proliferation of cells in the mesangeal area
Can present as nephrosis or nephitic
Biopsy...
Type 1 thick - infectious
Type 2 dense - idiopathic
Treat symptoms
Immunosuppresion to stop proliferation |
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Term
NEPHROTIC
Focal Segmental Nephrotic Stenosis |
|
Definition
Idiopathic or second to heroin, obesity or HIV
Most common in AAs
Nephrotic & nephritic features
Persistent proteinuria and HTN - 80% hematuria
Most progress to ESRD in 6-8 years
Sclerotic lesions, immune complexes IgM and C3, and foot processes problems
Tx High dose corticosteroids |
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Term
NEPHROTIC
Systemic Disease |
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Definition
Amyloidosis - deposits in kidney
Diabetic nephropathy - leading cause of ESRD - Kimmelstein Wilson Nodules - sclerotic lesions
HIV associated nephropathy
SLE and Hep C Infection have both nephritic & nephrotic components |
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Term
|
Definition
Toxins and ischemia
Lead to edema, infiltration with PMN's and tubular necrosis |
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Term
TUBULOINTERSTITIAL
Chronic |
|
Definition
Lead to edema, infiltration with PMN's and tubular necrosis
Gout, heavy metals, obstructive (prostatitis), vesicoureteral
chronic analgesic use, multiple myeloma
S/S Polyuria dt tubular damage - dilute urine
Dehydration
Labs - hyperK, hyperCl, low proteinuria <2, waxy casts |
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Term
CYSTIC DISEASES OF THE KIDNEY
Simple - Solitary |
|
Definition
Common - 60-70%
Asymptomatic unless infected
Important to differentiate from ca, abscess, or polycystic kidney dz
USN, CT |
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Term
CYSTIC DISEASES OF THE KIDNEY
Autosomal Dominant Polycystic Kidney Disease |
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Definition
Most common hereditary dz of the kidney
50% will have ESRD by 60
Abdominal or flank pain, hematuria, proteinuria, hx of UTI and stones, HTN, family hx
Large kidneys that are often palpable
EPO ok |
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Term
CYSTIC DISEASES OF THE KIDNEY
Medullary Sponge Kidney |
|
Definition
Relatively common and B9
Auto dominant
Assoc w/ medullary cysts. Marked irregular enlarge of med and interpapillary collecting ducts
Hematuria, UTI's and stones, dec'd concentrating ability
IVP shows striations
No treatment...hydration |
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Term
ARF - ACUTE RENAL FAILURE
Prerenal |
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Definition
| Poor perfusion of the kidneys |
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Term
ARF - ACUTE RENAL FAILURE
Intrarenal - 50% |
|
Definition
Acute Tubular Necrosis - ischemia, prerenal azotemia shock, major trauma/crush, metabolic (ca, myeloma) nephrotoxins - chemo, aminoglycs, IV contrast, etc.
Acute Glomerulonephritis - SLE, acute GN
Acute Interstitial Nephritis - infection, drugs - PCN, NSAIDS, cipro, furosemide, analgesic, phenytoin
Vascular - vasculitis, malig HTN, HUS/TTP, preeclampsia, sickle cell |
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Term
ARF - ACUTE RENAL FAILURE
Postrenal |
|
Definition
Obstruction of the ureters, prostate, bladder, urethra
least common - reversible
pressure in kidneys leads to dec'd GFR
endometriosis, ca, fibrosis, intratubular - methotrex, acyclovir |
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Term
CKD/ESRD
Chronic Kidney Disease End-Stage Renal Disease |
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Definition
|
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Term
| NEPHRITIC SYNDROME OVERVIEW |
|
Definition
Hematuria, Proteinuria, HTN, Reduced GFR
Edema - not as bad as nephrotic
Hematuria - mishapen cells, casts
Moderate proteinuria
Biopsy necessary except bleeding d/o's or massive HTN |
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Term
| NEPHROTIC SYNDROME OVERVIEW |
|
Definition
Heavy Proteinuria - >3.5 Marked peripheral edema when alb is <3 dt sodium retention Dyspnea
Hypoalbuminemia, hyperlipidemia(fat casts in urine - Maltese Cross), edema, decreased clotting fact
Hypertriglyceridemia leads to pancreatitis
Serum protein <6 Inc'd Sed Rate Dec'd clearance of VLDL leads to hypertrig
Tx - reduce salt, start diuretics
Manage hypercoagulability - anticoag therapy |
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