PANCE Blueprint Renal System - All Smarty PANCE Renal System Flashcard Lesson Sets Combined (Smarty PANCE) Exam Questions and Answers 100% Correct

PANCE Blueprint Renal System - All Smarty PANCE Renal System Flashcard Lesson Sets Combined (Smarty PANCE) Exam Questions and Answers 100% Correct What are the characteristics of glomerular disease? Proteinuria, hematuria (microscopic or gross), renal insufficiency, and HTN. Depending upon the cause, systemic symptoms may also be present. A 10 y/o is brought to the clinic with her mother for dark urine. The mother mentions that the child was complaining of sore throat and cough/cold symptoms two ago. The urine shows gross hematuria without nitrites or leukocytes. Postinfectious (Poststreptococcal) glomerulonephritis What is the typical clinical presentation of postinfectious GN? Presentation varies from asymptomatic with only microscopic findings on urinalysis to that of a nephritic syndrome: gross hematuria, HTN, edema, and acute renal failure. Symptoms appear 2–3 weeks after streptococcal pharyngitis or other bacterial infection What are the characteristic laboratory findings of postinfectious GN? Urine sediment reveals dysmorphic RBCs or RBC casts and proteinuria (occasionally nephrotic range); serum studies are remarkable for hypocomplementemia, positive ASO titer. What are the renal biopsy characteristics for LM, IF, EM? LM - Glomerular hypercellularity, with epithelial and endothelial cell proliferation, and an inflammatory glomerular infiltrate composed of neutrophils. Capillary lumens are usually obliterated. Crescents may be present. IF - Granular deposition of IgG and C3 in the glomerular tuft EM - Large, irregular, subepithelial "hump"-shaped deposits What is the appropriate management of postinfectious GN? No specific therapy other than the treatment of the underlying infection in most cases. A trial of steroids may be indicated if renal failure is severe. There is no evidence supporting aggressive immunosuppression. What is the prognosis of postinfectious GN? Self-limited, with Cr returning to baseline in 6 weeks in most cases; hematuria typically resolves within 6 months. 15% of patients with poststreptococcal GN have persistent proteinuria at 3 years, 2% at 7–10 years. Progression to ESRD is rare, as is recurrence. A 33-year-old man comes to the ED because of blood in his urine for 2 days. He has also been feeling unwell, with a sore throat, running nose, cough, and fever. Medical history includes three episodes of hematuria in the past that have spontaneously resolved. His temperature is 98.9°F; pulse is 82/min; respirations are 18/min, and blood pressure is 145/90 mm Hg. PE is normal. Urinalysis shows moderate numbers of erythrocytes, a few leukocytes, red cell casts, and a large amount of protein. No bacteria are cultured. A renal biopsy demonstrates large dark mesangial deposits. IgA nephropathy What is the typical clinical presentation of IgA nephropathy? Gross hematuria with or without proteinuria during viral upper respiratory tract infection or GI illness, persistent microscopic hematuria, and sometimes associated dull flank pain, with a 2:1 male predominance, often presenting in the second and third decades of life What are the most common conditions with which IgA nephropathy is associated? Liver disease (e.g., alcoholic cirrhosis), inflammatory bowel disease, celiac sprue, and HIV What are the characteristic laboratory findings of IgA nephropathy? Normal or decreased renal function, persistent microhematuria, and variable proteinuria; urine sediment reveals dysmorphic RBCs and RBC casts What are the renal biopsy characteristics of IgA nephropathy for LM, IF, EM? LM - Focal or diffuse mesangial proliferation with matrix expansion. Crescents may or may not be present. IF - Globular IgA deposition in the mesangium and capillary walls EM - Electron dense mesangial deposits What is the appropriate management of IgA nephropathy? Most patients will benefit from ACE-I or ARB to reduce proteinuria and BP, as well as a statin. Patients with nephrotic range proteinuria may also benefit from the addition of fish oil, while patients with more severe disease require immunosuppression What is the of IgA nephropathy of IgA nephropathy? Patients without proteinuria and who have preserved GFR have a low risk of progressing to ESRD. Of patients who develop proteinuria, 30% will progress slowly to ESRD within 30 years A 26-year-old man presents with hematuria, periorbital edema, and jaundice. He has a medical history of opioid use disorder with prior hospitalizations for a heroin overdose. He is on Suboxone but is non-adherent. His blood pressure is 162/102 mmHg. Physical examination is significant for scleral icterus, hepatomegaly, and palpable purpura. Serology shows decreased C3 and C4 levels and elevated anti- hepatitis C antibodies. Urinalysis demonstrates dysmorphic red blood cells and red blood cell casts Membranoproliferative glomerulonephritis (MPGN) What is the typical clinical presentation of MPGN? Variable decrease in renal function, HTN, anemia, hematuria, and proteinuria What are the most common causes of secondary MPGN? Hepatitis B/C, cryoglobulinemia, lupus, and HIV What are the characteristic laboratory findings of MPGN? Variable increase in BUN/serum creatinine, anemia, low serum C3 or C4, and presence of serum C3 nephritic factor (especially in type II). Urine sediment contains dysmorphic RBCs, WBCs, and RBC casts What are the renal biopsy characteristics of MPGN for LM, IF, EM? LM - Thickening and "tram-tracking" (splitting) of GBM. Mesangial proliferation and interposition. IF - Fine granular deposition of C3 and IgG deposition in the mesangium and along peripheral capillary walls. EM - Mesangial interposition and duplication of GBM. Immune complex deposits are present; the location (mesangial, subendothelial, or subepithelial) dictates the type of MPGN (I, II, or III)