-
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
-
-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