Glomerular- Clinical

Question 1

Case: pt presents with abrupt onset of nephritic syndrome (pharoh), labs show ASO, granular IF pattern, and subepithelial humps. What is in this pt history?

Answer 1

Strep infection 1-4 weeks ago.

PSGN

Question 2

Case: pt presents with episodic macroscopic hematuria, especially after respiratory infections, has RBC casts in urine. What Ab is elevated in this pt?

Answer 2

IgA

IgA nephropathy/Bergers

Question 3

Case: pt presents with microscopic hematiura, RBC casts, purpura, and abdominal pain. What is the Dx?

Answer 3

Henock-Schnlein purpura

Question 4

Case: pt presents with asymptomatic hematuria and heavy proteinuria, tram tracks on H&E, labs show immune complexes in the subendothelium. What is most likely in this pt’s history?

Answer 4

HBV or HCV infection

Type I MPGN

Question 5

Case: pt presents with immune complex deposition in the GBM, nephritic and nephrotic syndromes, and tram tracks. What factor is present in this pt causing the Sx?

Answer 5

C3 nephritic factor

Question 6

What is the Tx for Type I MPGN?

Answer 6

Long term corticosteroids

temporary relief = dipyridamole + ASA

Question 7

True or False: the Tx of Type II MPGN is unknown.

Answer 7

True

Question 8

Case: pt presents with sudden deterioration of renal fxn witha ctive urinary sedements and a focal necrotizing cresentric glomerulonephritis. What is the Dx?

Answer 8

RPGN

Question 9

Case: pt presents with hemoptysis, nasal sores, and granulomatous inflammation of the glomeruli. What test can u do to confirm the Dx?

Answer 9

c-ANCA

Wegeners

Question 10

Case: pt presents with necrotizing inflammation of medium-sized vessels. You suspect polyarteritis nodosa. What will be the result of the ACNA test?

Answer 10

Nothing.

Question 11

Case: a young male presents with hemoptysis and hematuria but no other organ systems involved. What is the Ab directed against in the lungs and GBM?

Answer 11

Type IV Collagen

goodpasture disease

Question 12

Case: kid presents with abrupt onset of nephrotic syndrome, effacement of foot processes, and just proteinuria. What is the appropriate Tx?

Answer 12

Corticosteroids

minimal change disease

Question 13

What is the association of minimal change in adults?

Answer 13

Hodgkin lymphoma

Question 14

Case: adult presents with proteinuria and immune complexes that show spike and domes on H&E. What are instances of complete and partial remission?

Answer 14

25% complete
50% partial

(Membranous nephropathy)

Question 15

What is the cause of primary membranous nephropathy?

Answer 15

I DONT KNOW

Question 16

What are the causes of secondary membranous nephropathy?

Answer 16

SLE
HCV/HBV
Medications
Neoplasia

Question 17

What are the 2 causes that can cause membranous nephropathy?

Answer 17

NSAIDs and Penicillamine

Question 18

Though u cant use steroids for memrbanous nephropathy, what can u do to control the systemic Sx?

Answer 18

control edema, HTN, hyperlipidemia and proetinura via ACEi’s and ARB’s

Question 19

What is the most common cause of end stage renal disease in the US?

Answer 19

Diabetic Nephropathy

Question 20

What is the first manifestation of diabetic nephropathy?

Answer 20

Microalbuminuria

Question 21

These are nodules that are pathnomic for diabetic nephropathy.

Answer 21

Kimmelstiel-Wilson nodules

Question 22

What are the 2 drugs u can give to slow the rate of progression of diabetic nephropathy?

Answer 22

ACEi’s or ARBs

Question 23

What is the circumstances of diabetes where u need a renal biospy?

Answer 23

Atypical course with rapid neophrotic-range proteinuria

Question 24

Immune deposits in the glomerular capillary subendothelium show what systemic disease?

Answer 24

SLE

[remember this is the same location for Type I MPGN (nephrotic) and for DPGN (nephritic)]