Nephritic Syndrome
This is the most common form of primary GN around the world and involves IgA deposits in the glomerulus.
This is the classic flare seen in Berger syndrome.
****Berger causes nephritic syndrome, i just ran out of space in that column lol
Describe the urine output associated with ARF.
What is oliguria (decreased urine output/infrequent urination)?
This type of dialysis occurs 3x/week for 3-4hrs each session and is reserved for hospital settings.
What is hemodialysis?
If you see these nodules on a question, your answer will involve diabetes.
What are Kimmelstiel-Wilson nodules?
These are pathognomonic of diabetic nephropathy (meaning if you see these, they 100% have diabetic nephropathy).
*Mnemonic: NephRITIc = RIGA
Rapidly progressive GN (crescents)IgA nephrologist (Berger syndrome)
Goodpasture syndrome
Acute diffuse proliferative GN
This systemic disease can cause nephrotic syndrome.
What is diabetes?
This is the most common cause of primary ARF.
+100 points for every other cause you can name.
What is acute tubular necrosis?
- Ischemic
- Severe GN
- Severe infection
- Secondary to surgery, trauma, pregnancy
- Toxic agents (contrast, heavy metals, etc)
What are some fluid and electrolyte issues you might see in CRF? Name one.
(There are three listed in the slides)
1) Edema
2) Metabolic acidosis
3) Hyperkalemia
This is the mechanism of kidney injury in SLE.
What is immune complex deposition in renal structures.
This type of GN presents with crescents, and these are proliferations of the epithelium of the Bowman’s capsule of the glomerulus.
What is Rapidly Progressive GN (RPGN)?
What immunoglobulin is seen in cases of membranous GN?
What is IgG?
Impairment of blood flow to the kidney causing ARF is defined as this type of ARF.
What is pre-renal ARF?
Describe the 4 stages of CRF?
+200 points if you can name the associated GRF percentages associated with each one.
1) Diminished renal reserve (GFR = 50% of normal)
2) Renal insufficiency (GFR = 25-50% of normal)
3) Renal failure (GFR = <20% of normal)
4) End-stage renal disease (GFR = <5% of normal)
This antibody is associated with thromboembolic complications in SLE.
What is antiphospholipid antibody?
A patient presents with ARF with alveolar hemorrhage (causing hemoptysis). What syndrome are you thinking?
+100 if you can name what this would likely be if this patient also presents with systemic symptoms (fever, weight loss, fatigue).What is Goodpasture syndrome?
This is the most common cause of nephrotic syndrome in children and is described by fusion of podcytes with a mostly normal glomerulus.
What is minimal change disease (MCD)?
*Possibly a dysfunction of T-cell function. May follow a URTI or immunization.
In terms of treating ARF, this is the most important aspect of treatment.
*Hint: What is important to control? Answer may be more broad than you think.
Fluid and electrolyte balance and fixing acid-base imbalances.
What are some calcium and bone-related issues you might see in CRF? Name two.
(There are three listed in the slides)
1) Low calcium (hypocalcemia)
2) High phosphate (Calcium and phosphate always inversely related)
3) Secondary hyperparathyroidism (to increase PTH to increase calcium)
4) Renal osteodystrophy
Kidney abscesses and papillitis is common in patients with this systemic disease.
What is diabetes?
Briefly explain the pathogenesis of nephritic syndrome.
Inflammation of the glomeruli -> proliferation of cells -> hematuria and proteinuria, reduced GFR -> oliguria, elevated BUN and creatinine in blood.
In terms of lab testing that you’ll definitely do every day as an optometrist…what are the signs of nephrotic syndrome?
Mnemonic: NephROTic = You turn PALE when you ROT
PALE:Proteinuria
HypoAlbuminemiaHyperLipidemia
Edema
Papillary tip necrosis can cause kidney outflow obstruction, causing post-renal ARF. Name of the three causes for papillary tip necrosis.
+100 points for each additional cause you can name.
1) DM
2) analgesic abuse
3) Sickle cell
1) Low protein diet
2) ACE inhibitors
3) Organ transplant
4) Dialysis
This antibody in SLE can provide information about the degree of SLE and the level of nephritis.
What is anti-ds (double stranded) DNA antibody?