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Glossary of IM Renal Glomerular Dz USMLE 2

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Dx:
Edema, lipiduria, foamy urine, hypoalbuminemia, hyperlipidemia, hypercoagulation, protein in urine
Nephrotic syndrome
Dx:
"Maltese crosses" in urine
cholesterol in urine

(Nephrotic syndrome)
Why does the nephrotic syndrome pt have edema?

hypercoaguability?
Edema - decrease ion serum proteins and oncotic pressure

Hypercoag - loss of Proteins C and S and antithrombin III
Dx:
child w/ epithelial foot process loss on EM

Tx?
Minimal Change Dz

Tx: steroids
Dx:
glomerular scarring involving limited number of glomeruli w/ IgG and complement deposition

Most common in what patients?
(5)
Focal Segmental Glomerulosclerosis

Common in (Halt MID Stream):
HIV;
Men (younger) w/ HTN
IV drug users;
DM;
Sickle cell
What can Focal Glomerulosclerosis lead to?
(2)

Tx?
HTN and Chronic Renal Dz

Tx: Cyclophosphamide
First line of Tx for all Nephrotic syndrome
Protein and NaCl restriction
Dx:
MCC of Nephrotic Syndrome in adults that is slow to progress and has little response to steroids

Etiology? (6)
Membranous Glomerulonephritis

Etiology (SHIT):
SLE / Syphilis;
HBV / HCV;
Idiopathic;
Tumor
Rule of thirds for Membranous GN
1/3 get CRF

1/3 have spontaneous remission

1/3 remain nephrotic w/o pregression
Tx for Membranous GN
(2)
Cyclophosphamide

Chlorambucil
Dx:
Abrupt onset hematuria w/ RBC casts, smoky-brown urine, proteinuria, hypertension, edema and azotemia (low GRF)
Acute Glomerulonephritis

(Nephritic syndrome)
Dx:
presents 2 weeks after pharyngitis or impetigo w/ dark urine and edema
Poststrep. GN
Deposition of what causes glomerular damage in poststrep GN?

Tx?
Deposition of IgG, C3 and C4 in a grandular pattern

Tx underlying infection
Dx:
hematuria immediately after an infection or exercise
IgA nephropathy

(Berger's Dz)
what (and where) is the immune complex deposition of IgA nephropathy?
Mesangeal deposition of IgA and C3
Dx:
immune deposits on BM cause it to look double-layered

what is it associated w/?
(2)
Membranoproliferative

("Tram-track" appearance)

Assoc w/:
Hepatitis C
Cryoglobinemia
How is type I membranoproliferative different then type II?
Type I:
slowly progressive

Type II:
low serum C3 due to Auto-Ab vs C3
Tx of Membranoproliferative for adults (2) and kids
Adults:
ASA
Dipyridimole

Kids:
Steroids
Dx:
Fulminant renal failure w/ proteinuria, hematuria and RBC casts and epithelial cell proliferation in glomeruli
(2 names)
Rapidly Progressive GN

(Cresentric GN)
(3) types of Rapidly Progressive GN
1. Pauci-Immune RPGN

2. Immune complex RPGN

3. Anti-glomerular BM Ab Dz
Serum marker for Pauci-Immune RPGN
ANCA positive

(Wegner's = c-ANCA)
(polyarteritis nodosa = p-ANCA)
Etiology of Immune Complex RPGN
(5)
SPLIT:
Syphilis;
Post-strep GN;
Lupus nephritis;
IgA nephritis;
Tumors
another name for Anti-GMB Ab disease

what cells cause problem?
Goodpasture's disease

Cytotoxic T-cells (CD-8)
Tx for all RPGN
(2)

what percent go on to end-stage renal disease?
Tx:
steroids
cyclophosphamide


80%
Renal involvement w/ Lupus type I - V

Which has "wire-loop" abnormality?
I: no renal involvement
II: Focal-Segmental
III: Focal-Proliferative
IV: Diffuse Proliferative (most severe - wire-loop)
V: Membranous
MCC of End-Stage Renal Dz

What is the early manifestation?

What do Bx show?
Diabetes

starts w/ microalbuminuria

Bx: Kimmelstiel-Wilson nodules
Dx:
palpable purpura on buttocks and legs of kids, abdominal pain, vomiting, hematuria and GI bleeding
Henoch-Schonlein purpura
Dx:
Tubule plugging w/ Bence-Jones proteins

what electrolyte disorder from Dx also leads to kidney trouble?
What causes pt to go into CRF?
Multiple myeloma

Hypercalcemia

E.Coli infection of kidney from abnormal Ab production

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