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Clin Med - Kidney & Male GU
Kidney and Male GU
23
Medical
Graduate
03/22/2009

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Cards

Term
NEPHRITIC

Rapidly Progressing GN
Definition
RPG - Crescent cells

TX - Aggresive reduction of HTN and fluid overload. Salt/H2O restriction
Term
NEPHRITIC

Post Infectious GN
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.
Term
NEPHRITIC

IgA Nephropathy - Berger's
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
Term
NEPHRITIC

Henoch Shoenlein Purpura
Definition
Male children

Looks like IgA but presents with Palpable Purpura on lower extremities, Arthralgia, Abdominal symp...nausea, melena

Prognosis good
Term
NEPHRITIC

Pauci Immune ANCA Associated GN
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
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
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
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
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
Term
NEPHROTIC

Membranoproliferative Glomerulonephropathy
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
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
Term
NEPHROTIC

Systemic Disease
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
Term
TUBULOINTERSTITIAL

Acute
Definition
Toxins and ischemia

Lead to edema, infiltration with PMN's and tubular necrosis
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
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
Term
CYSTIC DISEASES OF THE KIDNEY

Autosomal Dominant Polycystic Kidney Disease
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
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
Term
ARF - ACUTE RENAL FAILURE

Prerenal
Definition
Poor perfusion of the kidneys
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
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
Term
CKD/ESRD

Chronic Kidney Disease End-Stage Renal Disease
Definition
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
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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