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First Aid for the USMLE Step 2 CK (10th Ed.)
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Glomerular Disease

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First Aid for the USMLE Step 2 CK (10th Ed.) | Medicine (MD/DO) School Study Aid

Glomerular Disease
21 Picmonics to Learn | 46 mins
Nephritic Syndrome
Inflammatory
Hematuria
RBC casts
Increased Nitrogen in blood
Oliguria
Hypertension
Proteinuria < 3.5 grams per day
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2 mins
Post Streptococcal Glomerulonephritis
Pathophysiology
Nephritic
Children
Signs and Symptoms
Edema
Cola Colored Urine
Follows Group A Streptococcal pharyngitis or Skin Infection
Diagnosis
Neutrophils
Immunofluorescence (IF) Granular
Lumpy Bumpy Appearance on Immunofluorescence (IF)
Subepithelial Immune Complex Humps
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2 mins
Berger's Disease (IgA Nephropathy)
Nephritic
IgA Nephropathy
Immune Complex Deposit in Mesangium
Increased Synthesis of IgA
Most Common Cause of Nephritic Syndrome
Overlapping Features with Henoch–Schönlein Purpura
Presents with Pharyngitis, URI or Acute Gastroenteritis
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1 min
Henoch-Schonlein Purpura
Most Common Childhood Vasculitis
Follows Pharyngeal or Respiratory Infection
Palpable Purpura on Legs and Buttocks
Arthralgia
Intestinal Hemorrhage
Black Stool (Melena)
Associated with IgA Nephropathy
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2 mins
Granulomatosis with Polyangiitis (GPA) Characteristics
Pathophysiology
Small Vessel Vasculitis
Necrotizing
Lungs and Upper Airway
Crescentic Glomerulonephritis
DIAGNOSTICS
c-ANCA
X-ray
Multiple Nodules in Lungs
Treatment
Cyclophosphamide
Corticosteroids
Rituximab
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3 mins
Granulomatosis with Polyangiitis (GPA) Symptoms
Upper Respiratory Tract
Saddle Nose
Perforation of Nasal Septum
Chronic Sinusitis
Otitis Media
Mastoiditis
Lower Respiratory Tract
Cough
Dyspnea
Hemoptysis
Kidney
Rapidly Progressive Glomerulonephritis
Hematuria
RBC Casts
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2 mins
Microscopic Polyangiitis
Pathophysiology
Necrotizing Small Vessel Vasculitis
Signs and Symptoms
Lungs, Kidneys, and Skin Commonly Affected
Palpable Purpura
Rapidly Progressive Cresentic Glomerulonephritis
Diagnosis
Lesions are Same Age
Non-granulomatous
Minimal Nasopharyngeal Involvement
P-ANCA
Treatment
Corticosteroids
Cyclophosphamide
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2 mins
Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss Syndrome)
Pathophysiology
Granulomatous Vasculitis
Signs and Symptoms
Sinusitis
Skin Lesions
Peripheral Neuropathy
Asthma
GI Disease
Heart Disease
Kidney Failure
Diagnosis
Eosinophilia
p-ANCA
Treatment
Corticosteroids
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4 mins
Anti-glomerular Basement Membrane Antibodies
Glomerulonephritis
Goodpasture's Disease
Linear immunofluorescence
Hemoptysis
Hematuria
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1 min
Rapidly Progressive Glomerulonephritis
Pathogenesis
Nephritic Syndrome
Crescent Shape
Crescents Consist of Fibrin and C3b
With Parietal Cells, Monocytes, and Macrophages
IMMUNOFLUORESCENCE
Linear Immunofluorescence
Negative Immunofluorescence
Granular Immunofluorescence
Etiology
Goodpasture Syndrome
Granulomatosis with Polyangiitis (Formerly Wegener's)
Microscopic Polyangiitis
Prognosis
Poor Prognosis
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3 mins
Alport Syndrome
Pathophysiology
Nephritic
X-linked
Mutation in Type IV Collagen
Diagnosis
Split Basement Membrane
Basket Weave Appearance
Signs and Symptoms
Ocular Disorders
Deafness
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2 mins
Nephrotic Syndrome
Signs and Symptoms
Massive Proteinuria > 3.5g per Day
Edema
Increased risk of infection
Thromboembolism
Hyperlipidemia
Fatty casts
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1 min
Minimal Change Disease
Pathophysiology
Nephrotic
Most Common in Children
May be Triggered by Recent Infection or Immune Stimulus
Diagnosis
On Electron Microscopy (EM) See Foot Process (Podocyte) Effacement
On Light Microscopy (LM) See Normal Glomeruli
Loss of Negative Charge
Selective Loss of Albumin
Treatment
Responds to Corticosteroids
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2 mins
Focal Segmental Glomerulosclerosis
Most Common Cause of Nephrotic Syndrome in Hispanic People and African Americans
Associated with Sickle Cell Disease and HIV
Associated Interferon Therapy and Heroin Abuse
Histopathology
LM Segmental Sclerosis and Hyalinosis
EM Focal Damage of Visceral Epithelial Cells
IF Negative
Signs & Symptoms
Microscopic Hematuria
Nonselective Proteinuria
Considerations
Poor Prognosis
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2 mins
Membranous Glomerulonephritis
Characteristics
Nephrotic
Diagnosis
LM Thickening of Capillary and Glomerular Basement Membrane (GBM)
EM Spike and Dome Appearance with Subepithelial Deposits
IF Granular
Primary
Phospholipase A2 Receptor Autoantibodies
Secondary
NSAIDS
Gold
Solid Tumors
Hepatitis B Virus (HBV)
Lupus
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3 mins
Diabetic Glomerulonephropathy
Pathophysiology
Nonenzymatic Glycosylation of Glomerular Basement Membrane
Nonenzymatic Glycosylation of Arterioles
Hyperfiltration
Increased GFR
Histological Findings
Hyaline Arteriolosclerosis
Mesangial Expansion
Type IV Collagen Deposition
Kimmelstiel Wilson Lesions
Presentation
Nephrotic
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2 mins
Systemic Lupus Erythematosus (SLE) Mechanism, Treatment and Complications
Mechanism and Characteristics
Systemic Autoimmune Disease
9:1 female to male ratio
Treatment
Glucocorticoids
NSAIDS
Hydroxychloroquine
Cyclophosphamide
Complications
Lupus nephritis
Libman-Sacks Endocarditis
Secondary Antiphospholipid Antibody Syndrome
Other
Drug-induced lupus
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2 mins
Systemic Lupus Erythematosus (SLE) Diagnosis and Clinical Features
IM DAMN SHARP acronym
Immunoglobulins
Malar rash
Discoid rash
Antinuclear antibody
Mucositis
Neurologic disorders
Serositis
Hematologic disorders
Arthritis
Renal disorders
Photosensitivity
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2 mins
Membranoproliferative Glomerulonephritis
Nephritic-Nephrotic Syndrome
Type I
Subendothelial Immune Complexes
Hepatitis C Virus
Granular IF
Tram Tracks Caused by Splitting of the GBM
Ingrowth of Mesangium
Type II
Dense Deposit Disease
C3 Nephritic Factor
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2 mins
Amyloidosis
Etiologies
Primary
Multiple Myeloma
Secondary
Tuberculosis (TB)
Rheumatoid Arthritis
Pathology
Congo Red Stain
Apple Green Birefringence
Complications
Nephrotic Syndrome
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2 mins
Mixed (Type II/III) Cryoglobulinemia
Characteristics
Rheumatoid Factor
Monoclonal or Polyclonal
Immune Complex Deposition in Cold Temperatures
Associations
Hepatitis C
Autoimmune Diseases
Clinical Features
Meltzer's Triad
Palpable Purpura
Arthralgias
General Malaise
Vasculitis
Glomerulonephritis
Diagnosis
Decreased Complement Proteins
Management
Treat Underlying Disorder
Immunosuppressants
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3 mins

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