Podcast
Questions and Answers
Which of the following is a function of the kidney?
Which of the following is a function of the kidney?
- Producing red blood cells
- Storing metabolic wastes
- Synthesizing vitamin D
- Regulating blood volume (correct)
The kidneys are described as:
The kidneys are described as:
- Anterior peritoneal
- Retroperitoneal (correct)
- Intraperitoneal
- Infraperitoneal
Which ribs partially protect the kidneys?
Which ribs partially protect the kidneys?
- 11th and 12th (correct)
- 9th and 10th
- 1st and 2nd
- 5th and 6th
What is the renal capsule primarily composed of?
What is the renal capsule primarily composed of?
What is the functional unit of the kidney?
What is the functional unit of the kidney?
What percentage of cardiac output do the kidneys receive?
What percentage of cardiac output do the kidneys receive?
Which part of the kidney receives the most blood flow?
Which part of the kidney receives the most blood flow?
What are the three layers of the glomerular filtration barrier?
What are the three layers of the glomerular filtration barrier?
What type of cells characterize the glomerular structure?
What type of cells characterize the glomerular structure?
What is the main job performed by the kidneys?
What is the main job performed by the kidneys?
Approximately what percentage of filtered sodium is reabsorbed by the kidneys?
Approximately what percentage of filtered sodium is reabsorbed by the kidneys?
Where does the largest amount of sodium reabsorption occur within the nephron?
Where does the largest amount of sodium reabsorption occur within the nephron?
What is the function of the Na+-K+ pump in tubular cells?
What is the function of the Na+-K+ pump in tubular cells?
In the collecting duct, which hormone regulates sodium reabsorption?
In the collecting duct, which hormone regulates sodium reabsorption?
Which of the following is regulated through aquaporin formation in the collecting duct?
Which of the following is regulated through aquaporin formation in the collecting duct?
What percentage of filtered sodium is normally found in the urine?
What percentage of filtered sodium is normally found in the urine?
What does the clearance of a substance refer to in the context of kidney function?
What does the clearance of a substance refer to in the context of kidney function?
Why is creatinine clearance a reliable indicator of kidney function?
Why is creatinine clearance a reliable indicator of kidney function?
The clearance of which substance is used to calculate the fractional excretion of sodium?
The clearance of which substance is used to calculate the fractional excretion of sodium?
The glomerular filtration rate is typically measured in what units?
The glomerular filtration rate is typically measured in what units?
According to the content, what is a normal GFR value?
According to the content, what is a normal GFR value?
Which body parameter can affect creatinine production?
Which body parameter can affect creatinine production?
Which of the following best defines the Mean Arterial Pressure?
Which of the following best defines the Mean Arterial Pressure?
What happens to diastolic blood pressure from adolescence to adulthood?
What happens to diastolic blood pressure from adolescence to adulthood?
What is the primary role of the kidneys in blood pressure regulation?
What is the primary role of the kidneys in blood pressure regulation?
What is the immediate response to maintain perfusion in organs during acute hemorrhaging?
What is the immediate response to maintain perfusion in organs during acute hemorrhaging?
What is the most significant action of angiotensin II in maintaining blood pressure?
What is the most significant action of angiotensin II in maintaining blood pressure?
Where are the primary sites of renin, and angiotensinogen production, respectively?
Where are the primary sites of renin, and angiotensinogen production, respectively?
The 'dipping' condition during sleep refers to:
The 'dipping' condition during sleep refers to:
What is a key initial step in evaluating a patient with confirmed hypertension?
What is a key initial step in evaluating a patient with confirmed hypertension?
In what form does calcium primarily exert its biological activity in the body?
In what form does calcium primarily exert its biological activity in the body?
Which of the following best describes the distribution of calcium within the body?
Which of the following best describes the distribution of calcium within the body?
Approximately how much calcium does the average person consume daily through their diet?
Approximately how much calcium does the average person consume daily through their diet?
Which vitamin is essential for the intestinal absorption of calcium?
Which vitamin is essential for the intestinal absorption of calcium?
What percentage of ingested calcium is typically absorbed by the body?
What percentage of ingested calcium is typically absorbed by the body?
Through which organ is the absorbed calcium primarily eliminated from the body?
Through which organ is the absorbed calcium primarily eliminated from the body?
Along which structure does reabsorption occur following filtration in the kidneys?
Along which structure does reabsorption occur following filtration in the kidneys?
What separates the apical and basolateral membranes of cells to facilitate paracellular reabsorption?
What separates the apical and basolateral membranes of cells to facilitate paracellular reabsorption?
Which channels are present in tight junctions that are specific for calcium and magnesium?
Which channels are present in tight junctions that are specific for calcium and magnesium?
Which segment dedicated to calcium transport does not also utilize sodium transport?
Which segment dedicated to calcium transport does not also utilize sodium transport?
What form of calcium can be filtered by the nephron?
What form of calcium can be filtered by the nephron?
What is the kidney's goal for calcium that has been filtered?
What is the kidney's goal for calcium that has been filtered?
What is the most active circulating form of vitamin D?
What is the most active circulating form of vitamin D?
What kind of action is it when Vitamin D regulates reabsorption through the expression of various proteins?
What kind of action is it when Vitamin D regulates reabsorption through the expression of various proteins?
When there is an increase in calcium levels in tubular cells, the calcium-sensing receptor activity in the ascending limb of the loop of Henle is to:
When there is an increase in calcium levels in tubular cells, the calcium-sensing receptor activity in the ascending limb of the loop of Henle is to:
What is the most common cause of hypercalcemia?
What is the most common cause of hypercalcemia?
What is the most probable cause of hypocalcemia in the general population?
What is the most probable cause of hypocalcemia in the general population?
Which hormone has a crucial role in maintaining phosphate balance?
Which hormone has a crucial role in maintaining phosphate balance?
What is the most common cause of hyperphosphatemia?
What is the most common cause of hyperphosphatemia?
What triggers a chain reaction that leads to vasodilation, decreased renin and decreased sodium reabsorption?
What triggers a chain reaction that leads to vasodilation, decreased renin and decreased sodium reabsorption?
Nephrotic syndrome is primarily characterized by an alteration in the glomerular filter's:
Nephrotic syndrome is primarily characterized by an alteration in the glomerular filter's:
Which clinical condition is commonly associated with the rapid development of edema in nephrotic syndrome?
Which clinical condition is commonly associated with the rapid development of edema in nephrotic syndrome?
What does 'anasarca' refer to in the context of kidney disease?
What does 'anasarca' refer to in the context of kidney disease?
Which of the following is typically unable to pass through the glomerular membrane in a healthy individual?
Which of the following is typically unable to pass through the glomerular membrane in a healthy individual?
What is the primary reason albumin is typically unable to pass through the glomerular membrane?
What is the primary reason albumin is typically unable to pass through the glomerular membrane?
What is the initial event in nephrotic syndrome that leads to edema formation?
What is the initial event in nephrotic syndrome that leads to edema formation?
In nephrotic syndrome, what causes the liver to increase lipoprotein synthesis?
In nephrotic syndrome, what causes the liver to increase lipoprotein synthesis?
What is a key factor that contributes to hypercoagulability in nephrotic syndrome?
What is a key factor that contributes to hypercoagulability in nephrotic syndrome?
In a patient with suspected nephrotic syndrome, what is the 'magic number' for the protein-to-creatinine ratio in a random urine sample that indicates significant proteinuria?
In a patient with suspected nephrotic syndrome, what is the 'magic number' for the protein-to-creatinine ratio in a random urine sample that indicates significant proteinuria?
In nephrotic syndrome, which type of proteinuria is commonly observed?
In nephrotic syndrome, which type of proteinuria is commonly observed?
What is typically expected in the urinary microscopy of a patient with nephrotic syndrome?
What is typically expected in the urinary microscopy of a patient with nephrotic syndrome?
What is the primary target in the treatment of nephrotic syndrome?
What is the primary target in the treatment of nephrotic syndrome?
Which of the following is a key characteristic of minimal change disease?
Which of the following is a key characteristic of minimal change disease?
What is the underlying cause of minimal change disease?
What is the underlying cause of minimal change disease?
What is a common symptom in patients with minimal change disease?
What is a common symptom in patients with minimal change disease?
How does minimal change disease appear in renal biopsy under optical microscopy?
How does minimal change disease appear in renal biopsy under optical microscopy?
What happens to creatinine levels in a patient with nephrotic syndrome?
What happens to creatinine levels in a patient with nephrotic syndrome?
What is the primary characteristic in nephritic syndrome?
What is the primary characteristic in nephritic syndrome?
If red blood cells originate from the kidney what may be found in urine?
If red blood cells originate from the kidney what may be found in urine?
In post infectious glomerulonephritis, what is the typical timeframe between the infection and the development of glomerulonephritis?
In post infectious glomerulonephritis, what is the typical timeframe between the infection and the development of glomerulonephritis?
Nephritic syndrome is primarily characterized by what condition in the kidney?
Nephritic syndrome is primarily characterized by what condition in the kidney?
What type of red blood cells are typically found in the urine of individuals with nephritic syndrome?
What type of red blood cells are typically found in the urine of individuals with nephritic syndrome?
Acute post infectious glomerulonephritis involves the deposition of what?
Acute post infectious glomerulonephritis involves the deposition of what?
What is a typical urine presentation in a patient with nephritic syndrome?
What is a typical urine presentation in a patient with nephritic syndrome?
What additional symptom is often present alongside haematuria (blood in urine) in individuals with nephritic syndrome?
What additional symptom is often present alongside haematuria (blood in urine) in individuals with nephritic syndrome?
What is always considered a pathological indicator when detected in urine?
What is always considered a pathological indicator when detected in urine?
The presence of blood in the urine is also know as what?
The presence of blood in the urine is also know as what?
What does 'urinary sediment' refer to when evaluating kidney conditions?
What does 'urinary sediment' refer to when evaluating kidney conditions?
What main characteristics define nephritic syndrome?
What main characteristics define nephritic syndrome?
What can hyperfiltration lead to over time in the kidneys?
What can hyperfiltration lead to over time in the kidneys?
What is the most common glomerular disease in young adults?
What is the most common glomerular disease in young adults?
Episodes of gross haematuria in IgA nephropathy are typically associated with what?
Episodes of gross haematuria in IgA nephropathy are typically associated with what?
IgA nephropathy is histologically named what?
IgA nephropathy is histologically named what?
In IgA nephropathy, what is the primary issue?
In IgA nephropathy, what is the primary issue?
What condition affecting the respiratory or gastrointestinal tract is associated with IgA nephropathy?
What condition affecting the respiratory or gastrointestinal tract is associated with IgA nephropathy?
In terms of immunostaining, what is a characteristic finding in IgA nephropathy?
In terms of immunostaining, what is a characteristic finding in IgA nephropathy?
Which of the following is a common clinical presentation in IgA nephropathy?
Which of the following is a common clinical presentation in IgA nephropathy?
A renal biopsy in IgA nephropathy is characterized by?
A renal biopsy in IgA nephropathy is characterized by?
Cases of IgA nephropathy have been linked to what other disease?
Cases of IgA nephropathy have been linked to what other disease?
In the setting of IgA nephropathy affecting the glomerulus, what process leads to fibrosis and atrophy of the tubular cells?
In the setting of IgA nephropathy affecting the glomerulus, what process leads to fibrosis and atrophy of the tubular cells?
What is the single most common cause of chronic kidney disease (CKD) worldwide?
What is the single most common cause of chronic kidney disease (CKD) worldwide?
Approximately what percentage of diabetic patients are affected by diabetic nephropathy?
Approximately what percentage of diabetic patients are affected by diabetic nephropathy?
A patient with a GFR of 52 ml/minute would be classified as what stage of chronic kidney disease (CKD)?
A patient with a GFR of 52 ml/minute would be classified as what stage of chronic kidney disease (CKD)?
How long after a diabetes diagnosis does diabetic nephropathy typically develop?
How long after a diabetes diagnosis does diabetic nephropathy typically develop?
Which type of diabetes is mainly an autoimmune disease?
Which type of diabetes is mainly an autoimmune disease?
Which type of diabetes typically has a sudden onset?
Which type of diabetes typically has a sudden onset?
In which type of diabetes is there an absolute deficiency of endogenous insulin?
In which type of diabetes is there an absolute deficiency of endogenous insulin?
Which type of diabetes is the most common form?
Which type of diabetes is the most common form?
The kidneys can be affected by which type of long-term complications from diabetes?
The kidneys can be affected by which type of long-term complications from diabetes?
What kidney condition is a result of atherosclerosis leading to renal artery stenosis?
What kidney condition is a result of atherosclerosis leading to renal artery stenosis?
What is the first condition that leads to kidney damage due to diabetes?
What is the first condition that leads to kidney damage due to diabetes?
Glycemic control's role in kidney damage involves:
Glycemic control's role in kidney damage involves:
Besides glycemic control, what medications are crucial for preventing kidney damage in diabetes?
Besides glycemic control, what medications are crucial for preventing kidney damage in diabetes?
Hyperglycemia increases glomerular filtration rate by:
Hyperglycemia increases glomerular filtration rate by:
In diabetic nephropathy, what is the type of damage incurred by the kidney?
In diabetic nephropathy, what is the type of damage incurred by the kidney?
Hyperfiltration in the glomerular district eventually results in:
Hyperfiltration in the glomerular district eventually results in:
In diabetic nephropathy what damage leads to nephrotic syndrome?
In diabetic nephropathy what damage leads to nephrotic syndrome?
Following hyperfiltration, what is the first sign of kidney damage detectable in diabetic nephropathy?
Following hyperfiltration, what is the first sign of kidney damage detectable in diabetic nephropathy?
What does nephrotic syndrome mean in terms of protein excretion?
What does nephrotic syndrome mean in terms of protein excretion?
Why is there an increase in GFR (glomerular filtration rate) in the first phase of hyperfiltration?
Why is there an increase in GFR (glomerular filtration rate) in the first phase of hyperfiltration?
In lupus nephritis, kidney damage primarily results from what?
In lupus nephritis, kidney damage primarily results from what?
What is a key immunological characteristic observed in patients with lupus nephritis?
What is a key immunological characteristic observed in patients with lupus nephritis?
What is a specific cause of post-renal acute kidney failure in multiple myeloma?
What is a specific cause of post-renal acute kidney failure in multiple myeloma?
What is the role of sex hormones, particularly estrogens, in lupus nephritis?
What is the role of sex hormones, particularly estrogens, in lupus nephritis?
In the context of lupus nephritis, what does the term 'full house' typically refer to?
In the context of lupus nephritis, what does the term 'full house' typically refer to?
What is the primary cause of kidney damage in myeloma kidney?
What is the primary cause of kidney damage in myeloma kidney?
Which of the following is characteristic of Class 5 lupus nephritis?
Which of the following is characteristic of Class 5 lupus nephritis?
What clinical finding is often associated with Class 1 lupus nephritis?
What clinical finding is often associated with Class 1 lupus nephritis?
What does the term 'mesangial' refer to in the context of glomerular diseases?
What does the term 'mesangial' refer to in the context of glomerular diseases?
Which of the following is most essential in diagnosing lupus nephritis?
Which of the following is most essential in diagnosing lupus nephritis?
What term describes altered red blood cells in urine, indicative of glomerular hematuria?
What term describes altered red blood cells in urine, indicative of glomerular hematuria?
What is the primary initial effect of myeloma on bone that leads to hypercalcemia?
What is the primary initial effect of myeloma on bone that leads to hypercalcemia?
What is the purpose of antiproteinuric therapy in patients with Class 5 lupus nephritis?
What is the purpose of antiproteinuric therapy in patients with Class 5 lupus nephritis?
Which renal syndrome is associated with glomeruli deposition of amyloid-related fragments of light chains?
Which renal syndrome is associated with glomeruli deposition of amyloid-related fragments of light chains?
What is the general definition of Lupus Nephritis?
What is the general definition of Lupus Nephritis?
Flashcards
What are the kidney's main roles?
What are the kidney's main roles?
Regulates blood volume, removes waste, regulates pH/blood pressure, regulates electrolytes, and handles hormonal regulation.
What is the renal capsule?
What is the renal capsule?
Connective/fibrous tissue that allows kidney expansion.
What is the Pararenal Fat (Adipose)?
What is the Pararenal Fat (Adipose)?
Adipose tissue layer around the kidney capsule that cushions and protects it.
What is the Renal Fascia?
What is the Renal Fascia?
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What is the renal cortex?
What is the renal cortex?
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What is the renal medulla?
What is the renal medulla?
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What is a nephron?
What is a nephron?
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What is the glomerulus?
What is the glomerulus?
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What can pass through the filtration barrier?
What can pass through the filtration barrier?
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Where is sodium reabsorbed?
Where is sodium reabsorbed?
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What kind of reabsorption happens in the proximal tubular cells?
What kind of reabsorption happens in the proximal tubular cells?
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What is the Na+-K+ pump?
What is the Na+-K+ pump?
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What does Na+-K+ ATPase do?
What does Na+-K+ ATPase do?
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What is cotransport?
What is cotransport?
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What are WNK kinases?
What are WNK kinases?
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Fractional Excretion of Sodium (FENa)
Fractional Excretion of Sodium (FENa)
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Clearance
Clearance
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Estimated Glomerular Filtration Rate (eGFR)
Estimated Glomerular Filtration Rate (eGFR)
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MDRD Formula
MDRD Formula
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Cockcroft-Gault equation
Cockcroft-Gault equation
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Fractional excretion of sodium formula
Fractional excretion of sodium formula
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Low fractional excretion of salt
Low fractional excretion of salt
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Potassium Modulation
Potassium Modulation
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ENaC vs. ROMK channel
ENaC vs. ROMK channel
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Systolic Pressure
Systolic Pressure
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Mean Arterial Pressure (MAP)
Mean Arterial Pressure (MAP)
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Pulse Pressure
Pulse Pressure
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Kidney's Role in BP Regulation
Kidney's Role in BP Regulation
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Long term control blood pressure
Long term control blood pressure
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White Coat Effect
White Coat Effect
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Alteration of calcium and phosphate metabolism
Alteration of calcium and phosphate metabolism
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Role of Calcium
Role of Calcium
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Calcium concentration gradient
Calcium concentration gradient
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Calcium Storage
Calcium Storage
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Calcium Absorption
Calcium Absorption
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Renal Calcium Handling
Renal Calcium Handling
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Calcium absorption cells
Calcium absorption cells
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Paracellular Calcium Transport
Paracellular Calcium Transport
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Calcium Reabsorption in Kidney
Calcium Reabsorption in Kidney
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Vitamin D forms
Vitamin D forms
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PTH effects on Calcium/Phosphate
PTH effects on Calcium/Phosphate
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Hyperparathyroidism
Hyperparathyroidism
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Chronic kidney disease with hypocalcemia
Chronic kidney disease with hypocalcemia
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Hypocalcemia Symptoms
Hypocalcemia Symptoms
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Causes of hypophosphatemia
Causes of hypophosphatemia
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Hyperphosphatemia cause
Hyperphosphatemia cause
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Hypertension to CKD transition
Hypertension to CKD transition
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Abnormal Albumin finding
Abnormal Albumin finding
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Pressure natriuresis curve
Pressure natriuresis curve
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Kidney Failure
Kidney Failure
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Glomerulonephritis
Glomerulonephritis
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Nephrotic Syndrome
Nephrotic Syndrome
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Nephritic Syndrome
Nephritic Syndrome
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Anasarca
Anasarca
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Frothy Urine
Frothy Urine
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Glomerular Filter Layers
Glomerular Filter Layers
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Nephrin and Podocin
Nephrin and Podocin
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Hypoalbuminemia
Hypoalbuminemia
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Lipiduria
Lipiduria
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Dyslipidemia
Dyslipidemia
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Hypercoagulability
Hypercoagulability
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Thrombosis
Thrombosis
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Non-Selective Proteinuria
Non-Selective Proteinuria
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Protein-to-Creatinine Ratio
Protein-to-Creatinine Ratio
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Podocytopathy
Podocytopathy
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Diffuse Glomerular Disease
Diffuse Glomerular Disease
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Focal Glomerular Disease
Focal Glomerular Disease
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Segmental Glomerular Disease
Segmental Glomerular Disease
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Global Glomerular Disease
Global Glomerular Disease
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Immunocomplex Glomerulonephritis
Immunocomplex Glomerulonephritis
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Nephritic Syndrome Cause
Nephritic Syndrome Cause
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Dysmorphic RBCs
Dysmorphic RBCs
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Nephritic Syndrome as Spectrum
Nephritic Syndrome as Spectrum
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Acute Post-Infectious Glomerulonephritis
Acute Post-Infectious Glomerulonephritis
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Clinical sign of Nephritic syndrome
Clinical sign of Nephritic syndrome
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RBCs in Urine
RBCs in Urine
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Urinary Sediment in Nephritic Syndrome
Urinary Sediment in Nephritic Syndrome
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Nephritic Syndrome Characteristics
Nephritic Syndrome Characteristics
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Hypoalbuminemia in Nephritic Syndrome
Hypoalbuminemia in Nephritic Syndrome
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IgA Nephropathy
IgA Nephropathy
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IgA Nephropathy & Mucosal Immunity
IgA Nephropathy & Mucosal Immunity
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IgA Nephropathy Pathogenesis
IgA Nephropathy Pathogenesis
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IgA Levels in Nephropathy
IgA Levels in Nephropathy
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IgA Nephropathy Pathology
IgA Nephropathy Pathology
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IgA Nephropathy Prognosis
IgA Nephropathy Prognosis
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Unfavorable Factors in IgA Nephropathy
Unfavorable Factors in IgA Nephropathy
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Reduced Glomerular Filtration: How?
Reduced Glomerular Filtration: How?
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Detect Glomerulonephritis
Detect Glomerulonephritis
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Diabetic Nephropathy
Diabetic Nephropathy
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Diabetic Nephropathy Diagnosis
Diabetic Nephropathy Diagnosis
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Hyperfiltration
Hyperfiltration
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Glucose-Sodium Cotransport
Glucose-Sodium Cotransport
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Proteinuria in Diabetic Nephropathy
Proteinuria in Diabetic Nephropathy
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Inflammatory Kidney Damage
Inflammatory Kidney Damage
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Kidney Hypertrophy
Kidney Hypertrophy
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Diabetic Nephropathy Treatment
Diabetic Nephropathy Treatment
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Stages of Diabetic Nephropathy
Stages of Diabetic Nephropathy
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Microalbuminuria
Microalbuminuria
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Proteinuria in Diabetic Nephropathy
Proteinuria in Diabetic Nephropathy
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Hypertension
Hypertension
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Evolution of DN
Evolution of DN
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Kidney biopsy
Kidney biopsy
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Vasculitis
Vasculitis
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Vessel size influence on patient impact
Vessel size influence on patient impact
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Wegener granulomatosis incidence
Wegener granulomatosis incidence
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Upper respiratory tract symptoms
Upper respiratory tract symptoms
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Lupus Nephritis
Lupus Nephritis
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Systemic Lupus
Systemic Lupus
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Etiology of Lupus Nephritis
Etiology of Lupus Nephritis
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Pathogenesis of Lupus
Pathogenesis of Lupus
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Nuclear Antigens
Nuclear Antigens
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Clinical Presentation of Lupus
Clinical Presentation of Lupus
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Lupus Nephritis Relapse
Lupus Nephritis Relapse
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Diagnosing Lupus
Diagnosing Lupus
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Classifying Lupus Nephritis
Classifying Lupus Nephritis
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ISN/RPS Classes
ISN/RPS Classes
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Lupus Lesions
Lupus Lesions
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Class 5 Lupus Nephritis
Class 5 Lupus Nephritis
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Myeloma Kidney
Myeloma Kidney
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Damage in Proximal Tubules
Damage in Proximal Tubules
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Distal Tubular Obstruction
Distal Tubular Obstruction
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Study Notes
Lupus Nephritis
- Lupus nephritis is a secondary glomerular disease related to lupus and can lead to different kinds of glomerular nephritis
- Systemic lupus is a chronic inflammatory autoimmune disease targeting endoantigens
Systemic Lupus vs. Other Glomerulonephritis
- Systemic lupus is different from glomerulonephritis linked to bacterial antigens, like post-infection glomerulonephritis
- Systemic lupus causes deposition of immunocomplexes in various districts, not just the kidneys
- Lupus, like vasculitis, is a systemic disease
Autoantibodies and Kidney Damage
- Kidney damage is mainly due to the deposition of immunocomplexes
Manifestations and Incidence
- Lupus is a systemic disease that can manifest by involving various organs, like the skin
- Typical in females, especially younger ones
- Incidence is 10 new cases/100,000 per year
Etiology
- The etiology of this disease is multifactorial
- There is a genetic predisposition
- Concordance in twins is an example of familiarity of the disease
- There is different susceptibility among different races
- Familiarity can be expressed as different autoimmune diseases in the same families
Environmental Factors
- Environmental factors can trigger the start and relapse of the disease
- Environmental factors include drug consumption or infections
Sexuality and Hormones
- Sexuality is a relevant etiological factor
- Production of different sex hormones, especially estrogens, plays a role in the etiology
Pathogenesis
- The pathogenesis involves impairment in immune tolerance and dysfunction in T and B lymphocytes, leading to autoantibody production
- Autoantibodies are directed to nuclear antigens
Immunological Stimuli
- Immunological stimuli, such as bacterial or viral infections, lead to B and T cell activation
- Impaired immune tolerance leads to the production of autoantibodies
Autoantibody Targets
- Patients typically have more than one kind of autoantibody, targeting cytoplasmic and nuclear antigens which makes the disease systemic
Clinical Presentation
- The fact that autoantibodies target nuclear antigens causes a systemic condition, resulting in variable symptoms among patients, with severities that range from mild to severe
Autoantibodies and Complications
- Autoantibodies can be related to clotting factors, the thyroid gland or other districts
- Inflammation is mainly due to the formation of immunocomplexes and complement activation
Polymorphic Clinic Presentation
- The disease presents with a polymorphic clinic presentation due to different kinds of antibodies
Generalized Symptoms
- Generalized symptoms include fever, weight loss, and generalized malaise
- Organ-dependent specific symptoms depend on the type of autoantibody formation
Organ Involvement
- Examples of organ involvement include skin, nose, or uterine mucosal alteration, anemia, joint and muscular pain, and lung or heart involvement, particularly endocarditis
Kidney Involvement
- Clinical presentations are diverse with the disease affecting the kidneys
- Kidney involvement is a critical condition that leads to chronic kidney disease
- Butterfly rash is a typical clinical presentation
Diagnostic Classification
- Detecting many antinuclear antibodies is the intial step, confirming the presence with more than one other factor
Scoring Diagnosis
- Considering the clinical presentation and blood test results to diagnose lupus.
Lupus Nephritis Classification
- Clinical and histological classification of lupus nephritis are crucial for deciding therapeutic approach and prognosis
Renal Biopsy
- A renal biopsy is important for classifying lupus nephritis according to the type of histological lesion.
- Classification helps relate glomerular damage based on localization and severity of damage
Inflammation and Autoimmunity
- It is an immunological disease that leads to inflammation
- Inflammation is not the only result of autoimmunity, starting from class 5 is membranous condition.
Nephritic Syndrome
- The first four classes are characterized by a nephritic syndrome caused by inflammation
Lupus Nephritis Classes
- Class 1 has minimal mesangial deposition of immunocomplexes
- Class 2 has proliferation in mesangial cells that becomes more complex
- Class 3 and 4 have active and chronic lesions (proliferative and fibrotic lesions)
Class 5 and 6
- Class 5: Characterized by glomerular damage due to deposition of immunocomplexes and membranous glomerulonephritis with a nephrotic syndrome presentation
- Class 6: Characterized by advanced sclerosis leading to end-stage renal disease due to accumulation of immunocomplexes in a different spot.
Fibrosis
- When fibrosis occurs, the patient starts to move towards the end stage of renal disease
Active vs. Chronic Lesions
- The main difference between classes 3 and 4 is the proportion of active and chronic lesions, which is important to define therapy
Importance of Immunosuppressive Therapy
- The more active the disease, the more the patient is treated with immunosuppressive therapy to reduce fibrosis
Hematuria and Proteinuria
- Both hematuria and proteinuria are observed
- Hematuria is a small amount with increase in blood pressure and creatinine
Filtration Barrier Alteration
- Alteration in filtration barrier caused by breakage of basal membrane prevents proper filtering, allowing red blood cells and proteins to pass through
Progression of Lupus Nephritis
- Observation of clinical history includes the evolution from class 1 to class 4 and also from class 5 to 3
- Professor notes the disease switches back and forth quickly, chaning the clincial picture of the patient
Pathogenesis and Accumulation of antibodies
- Accumulation can occur in subendothelial and subepithelial districts
- Subendothelial deposition is due to high avidity autoantibodies creating circulating immunocomplexes, whereas subepithelial accumulation is due to in-situ formation
- Autoantibodies target antigens present in the basal membrane, leading to in-situ formation of immunocomplexes
Inflammatory Response
- High-class lupus nephritis is caused by tumoral antigens in the mesangial region, leading to in-situ proliferation and mesangial proliferation
Complement activation
- Pathogenesis includes accumulation of immunocomplexes in the glomerular, interstitial, and vascular walls, with complement activation and inflammation
- Complement activation and inflammation lead to renal damage
- Demonstrated via immunostaining
Renal Biopsy
- Said that is very important to define the therapy and the prohgnosis for patients
Class 1 & 2
- In classes one and two, there is minimal mesangial lesions with only minimal deposition of immunocomplexes
- Results in a normal urinary with excellent renal prohgnosis
Class 2
- In mesangial proliferative lupus nephritis, mesangial expansion and proliferation occur
- Mild nephritc syndroms is present such as micro hematuria with low proteniuria
- Immunosuppression is not needed
Class 3 & 4
- Charecterized by the presense of active and lesions that can be mesangial
- Main difference betweeen can be focal such as micro hematuria without renal insificiency
Class 4 Progression
- Diffusion of the infection can lead to renal deffiencty
- Foclal Lesion - less than 50% diffused is more than 50
Class 5 & 6
- Both have a marked clincal picture with proteniuria
- This alteration is a pecilar parttern that follow as extention with the lesion
Class 6
- 6: is a bit of an outlier in terms of classification, and this is because renal impairment in glomerulonephritis is classified in a glomerulocentral way (basically focused mostly on the impairment of the structure of the glomerulus). With the class 6 presentation, we have the involvement of extraglomerular structures, such as the tubular interstitium and the vascular aspects.
Renal Biopsy
- As physicians, we do a renal biopsy when we have persistent proteinuria and glomerular hematuria. Keep in mind that glomerular hematuria is characterized by the presence of acanthocytes, which are altered red blood cells in the urine, that are a signal of a break in the basal membrane or a reduction in the glomerular filtration rate that is probably due to glomerular sclerosis.
Treatment
- Treatment mainly revolves around the pathological class activitiy
- It is very common to ask a patient to repeat the renal biopsy after some years in order to confirm class changes or decide on a new protocol of therapy. The treatment depends on the pathological class activity (so the activity and the chronicity indexes).
New protocol theraoy
- Is always used in the present
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