• Quick facts:
  • MCC of proteinuria: Diabetes
  • FSGS is most common in African Americans
  • Obesity can induce FSGS - hyperfiltration which leads to damage of vasculature
  • On a Biopsy - the degree of tubulointerstitial fibrosis correlates best with GFR
  
  

  Posted 02/09/17 09:45:07 AM by Adam Faye

• Thin Basement Membrane Disease:
  • Heterozygous mutation in collagen of basement membrane
  • Leakage of RBCs, Protein
  • Initially thought to be benign but when you follow these individuals into their 60s - they develop renal failure
  
  

  Posted 02/09/17 09:46:22 AM by Adam Faye

• IgA Nephropathy:
  • Most common cause of primary GN in the developed world
  • Male predominance, peak incidence 20s—30s
  • Slow progression to ESRD seen in roughly half of diagnosed patients
  • Predictors of progression at diagnosis include impaired GFR, 24 hour urine protein consistently >1g/day, hypertension 
  Common clinical presentations:
  • Gross hematuria, often after URI or athletic activity (40-50%)
  • Persistent asymptomatic hematuria +/- mild to moderate proteinuria (20-30%)
  • Nephrotic syndrome, rapidly progressive GN (10%) 
  
  Treatment
  Nonimmunosuppressive therapy
  • ACEI/ARB, BP control
  • Statin for CV risk
  If not well controlled with BP control add Immunosuppressive therapy:
  • Indications: progressively declining GFR, persistent proteinuria >1g/day, worsening disease on serial biopsy
  • Corticosteroids
  • +/- cyclophosphamide, azothiaprine 
  
  

  Posted 02/09/17 09:50:50 AM by Adam Faye

• Intensive Supportive Care + Immunosuppression in IgA nephropathy:
  -Multicenter open label RCT of 309 patients. Six month run in with supportive care. Patients with proteinuria >0.75g/day (n=162) randomized to supportive care vs supportive care vs immunosuppression.
  -Significant difference in proportion achieving clinical remission (5% vs 17%, p=0.01) but no significant difference in proportion of patients with decrease in GFR >15 (28% vs 26%).
  -More adverse events in immunosuppression group  
  
  

  Posted 02/09/17 09:54:52 AM by Adam Faye

Created by Christopher Kelly

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