Fundamentals of Glomerulonephritis Practice Questions with complete Solutions Rated A+

Fundamentals of Glomerulonephritis Practice Questions with complete Solutions Rated A+ What is glomerulonephritis? - Answers -renal dz in which an *immunologic mechanism* triggers inflammation and proliferation of glomerular tissue -can results in damage to the glomerular basement membrane, mesangium, or glomerular capillary What amount of protein is lost in microalbuminuira, macroalbuminuria, nephritic syndrome, and nephrotic syndrome - Answers -Microalbuminuria: 30-300 mg -macroalbuminuria >300 mg per day -nephritic: 1-3 gm/day -nephrotic: >3gm per day what are the 3 big findings in nephritic syndrome? - Answers 1. Hematuria (dark urine) 2. proteinuria (1-3 gm/day) 3. RBC casts -can also have Hypertension, reduced GFR, oliguria, AKI, edema and fluid overload what are the 4 big findings in nephrotic syndrome? - Answers 1. hypoalbuminemia 2. heavy proteinuria (>3gm) 3. edema 4. hyperlipidemia How does the immune system dysfunction damage the glomerulus? - Answers -damage is caused by the deposition of immune complexes and compliment in the tissue of glomerulus -also by invasion of polymorphonucular neutrophils -this causes reactive thickening of the GBM What are the 4 types of GN in reference to how much of the glomerulus is involved? - Answers -Focal: <50% of the glomeruli are involved -diffuse: all the glomeruli are involved -segmental: only part of the glomerular tuft is involved (<50% of tuft) -global: the entire glomerular tuft is involved What are the clinical findings of acute GN? - Answers -edema (scrotal, periorbital and facial) -general weakness, fever, abd pain, malaise -HTN -dark urine and possible oliguria -evidence and renal failure (high BUN and Cr) -U/A: proteinuria, RBC casts what is the initial lab work up for someone you suspect has acute GN? - Answers -CH50, C3, and C4 levels -anti-GM auto-antibodies -ANA -anti-dsDNA -ANCA (vasculitis) -HIV -Viral Hep panel -anti-phospholipase A2 receptor antibody Which results of the renal biopsy signal which etiology of GN? - Answers -minimal or no deposits: Pauci-immune GN, GPA, churg-strauss (type 3 RPGN) -linear deposits: anti-GBM GN (type 1 RPGN) -granular deposits: PSGN, IgA nephropathy, HSP, HIV, HBV, HCV associated GN, cryoglobinemia, SLE or other autoimmune disorder (RPGN type 2) what are the etiologies acute glomerular nephritis? - Answers -PSGN -IgA nephropathy (bergers dz) -Henoch-Schonlein -Anti-GBM GN -cryoglobulin associated GN What classically causes PSGN and when does is usually occur? - Answers -1-4 weeks after impetigo, cellulitis, pharyngitis or URI -classically caused by group A beta-hemolytic strep, but increasingly also caused by *staph* What are the 4 mechanisms in which PSGN occurs? - Answers 1. circulating immune *complexes* get deposited in GBM 2. step antigens get deposited in GBM and induced immune rxn 3. antibodies cross react with glomerular proteins 4. nephritogenic strain of strep causes auto-immune dysfunction What are the S/S and lab levels seen in PSGN? - Answers -oliguric -edematous -HTN -cocacola colored urine -RBC casts -proteinuria <3 gm -serum complement: low -streptozymite titers elevated: *unless blunted by previous abx tx* -renal biopsy *if pt does not improve within 1 wk* what is the tx for PSGN? - Answers *supportive* -abx -salt and fluid restriction -diuretics (if fluid overload) -anti-HTN What is the prognosis for PSGN? - Answers -very favorable in children