SEVEN HUNDREDS QUESTIONS AND ANSWERS IN NEPHROLOGY, DIALYSIS AND TRANSPLANTATION

“Preface” EXCEPT the Holley Koraan, no book is ever perfect. This book is not for studying, but rather to revise what you have already studied.

 

"بسم الله الرحمن الرحيم”

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“ سُبْحَانَكَ لاَ عِلْمَ لَنَا إِلاَّ مَا عَلَّمْتَنَا إِنَّكَ أَنتَ الْعَلِيمُ الْحَكِيمُ” 

  

SEVEN HUNDREDS QUESTIONS AND ANSWERS IN NEPHROLOGY, DIALYSIS AND TRANSPLANTATION 

“Preface”

EXCEPT the Holley Koran, no book is ever perfect.  This book is not for studying, but rather to revise what you have already studied. It is suitable for final revision, oral examinations, interviews and daily practice. Some questions were repeated, but in another form of answering, to view all the opinions. Some histo-pathologic slides and radiographic pictures were supplied. The language of this book is non-official, there are many abbreviations, they were used just to save your time and go directly to target information, so first of all and before starting reading, revise the list of abbreviations twice or more, so that you would not interrupt your reading. I would like to thank all my colleagues who helped me so much, as well as the respectable cast of revisers and the printing technicians who have a major impact in the appearance of this book in the current presentation.

 

  

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”List of abbreviations”.

a.	Acid.
a.	Artery.
a.a.	Amino acid.
A.C.R.	Acute cellular rejection.
Aceta.	Acetaminophen.
A.H.R.	Acute humeral rejection.
A.I.N.	Acute Interstitial Nephritis.
A.K.I.	Acute kidney injury.
Alb.	Albumin/Albuminemia
A.L.I.	Acute Lung Injury.
AlloAg.	Alloantigen.
A.M.I.	Acute Myocardial Infarction.
A.M.R.	Acute antibody mediated rejection.
A.N.	Autonomic Neuropathy.
A.N.A	Antinuclear Antibody.
A.N.P.	Atrial Natruretic Peptide.
A.P.A.	Antiphospholipid antibody.
A.P.D.	Automated Peritoneal Dialysis.
A.P.O.	Acute Pulmonary Odema.
Abd.	Abdominal
Abn.	Abnormal.
ABOI.	ABO, blood group Incimbatibility.
Ac.	Acute
Ac. P.D.	Acute Peritoneal Dialysis.
Acc.	According.
Accum.	Accumulation.
ACEI.	Angiotensin Converting Enzyme Inhibitor
Aceta.	Acetaminophin.
Acq.	Acqured.
ADH.	Antidiuretic Hormone.
Adj.	Adjust/ Adjustment.
Adv.	Advantage.
Affer.	Afferent.
ag.	Agent.
Ag.	Antigen.
AGEP.	Advanced Glycation End Products.
Agnst.	Against.
AHG	Antihuman Glogulin.
Aldo.	Aldosterone.
Alkz.	Alkalanization.
Allo.	Allopurinol.
AlloAg.	Alloantigen.
Allog.	Allograft.
ALS	Antilymphocytic Serum.
Alth.	Although.
Angio.I.	Angiotensin I.
Angio.II.	Angiotensin II.
Anti-DNA.	Anti-double strand A.B.
APKD.	Adult Polycystic Kidney Disease.
ADPKD.	Autosomal Dominant Polycyctic Kidney Disease.
aPL.	antiphospholipid A.B.
APO	Acute Pumonery odema.
Appr.	Approaching.
Approx.	Approximatly.
ARBs.	Angiotensin Receptor Blockers.
ARDS.	Adult Respiratory Distress Syndrome.
ARDS/NETW	ARDS Network Group.
a.Sm.tic.	Asymptomatic.
Ass.	Associated.
Assess.	Assessment.
ATG.	Antithymocyte Glogulin.
ATGAM	Antithymocyte Gamaglobulin.
Athrsc.	Atherosclerosis.
Auto.dom.	Autosomal dominant.
Aza.	Azathioprine
B.A.L.	Bronchoalveoler lavage.
BAL.	Bioartficial Liver.
B.B.	Beta Blockers.
B.M.	Basement membrane
B.M.I.	Body mass index.
B. Mr.	Bone marrow.
BNP.	Brain Natriuretic peptide.
B.P.H.	Benign prostatic hyperplasia.
B.S.A.	Body surface area.
B.T.	Bleeding time.
B.V.	Blood Vessels.
BAL.	Broncho- alveolar Lavage.
Betw.	Between.
BIA.	Bioimpedance analysis
Bil. RAS.	Bilateral Renal Artery stenosis.
Bioch.	Biochemistry.
Bld. TX.	Blood Transfusion.
Bldy.	Bloody.
BMD.	Bone Mieralization Density.
C.	Complement.
CAG.	Chronic Allograft Glomerulopathy.
C.A.P.D.	Continuous Ambulatory Peritoneal Dialysis.
C.C.B.	Calcium channel blockers.
C.C.P.D.	Continuous Cycler Peritoneal Dialysis.
C.G.N.	Crescentic Glomerulonephritis.
C.I.	Contraindication.
C.K.	Creatine Kinase.
C.K.D.	Chronic Kidney disease.
CLL.	Chronic lymphocytic leukemia.
C.M.V.	Cytomegalovirus.
C.N.I.s (CALI).	Calcineurin inhibitors.
C.O.	Cardiac Output.
C.P.	Clinical Picture.
C.steroids.	Corticosteroids
C/O.	Complaint.
CAH	Chronic active hepatitis.
CALI.	Calcineurin Inhibitors.
CAN.	Chronic allograft Nephropathy.
Ca/PO4 Pr.	Ca/PO4 Product.
CCPD.	continuous cycler peritoneal dialysis.
Cd.	Could.
CDC.	Complement Dependent Cytotoxicity.
Ch.	Chronic.
Ch. P.N.	Chronic Pyelonephritis.
Ch.ch.	Characteristic/characterize.
CHD.	Coronary heart disease
CHr.	Reticulocyte HB concentration.
Chr.	Chromosome.
Chrono.	Chronotropic.
Cmax.
CMP.	Cardiomyopathy.
Cn.	Can.
ºC.	Temperature.
Combin.	Combination.
Comp.	Compared./Comparison.
Complc.	Complication.
Conc.	Concentration/concentrated.
Conf.	Confusion
Cong.	Congenital.
Conven.	Conventional.
cp.	Capsule.
Cph.	Cyclophosphamide.
Cpll.	Capillary.
CPP.	Cerebral Perfusion Pressure.
Crossm.	Cross  matching.
CRRT.	Continuous Renal Replacement therapy.
Csp.	Cyclosporine.
CTA.	Computed Tomographic
Cth.	Catheter.
CVA.	Cerebrovascular Accidents.
C.V.Cth.	Central Venous Catheter.
CVP.	Central venous pressure.
CVS.	Cardiovasculer System accidents.
CVVHD.	Continuous venovenous Hemodialysis.
CVVHDF.	Continuous venovenous Hemodiafiltration.
CVVHF.	Continuous venovenous Hemofiltration
cx.	Complex.
D.D.	Differential Diagnosis.
D.M.I.	Type I. D.M.
D.M.II.	Diabetes Mellitus type II.
D.W.	Dry Weight.
D.X.	Dialysis.
DAPD.	Day time dwel Automated Peritoneal Dialysis.
Dc Np.	Diabetic Nephropathy.
Dc Np. I.	Diabetic Nephropathy in type I. D.M.
Dc Np. II.	Diabetic Nephropathy in type II. D.M.
Dc. Rnp.	Diabetic Retinopathy.
Dcr.	Decreased.
DDA.	Deceaced Donor Allograft.
Def.	Deficiency.
Depo.	Darbepoietin a.
deps.	Deposition/Deposits.
Dev.	Development.
DEXA.	Dual Energy X-ray Absorptiometry.
Dg.x.	Diagnosis.
Dge.	Damage.
DGF.	Delayed graft function.
DHP.	Dihydropyridine.
DIC.	Disseminated Intravascular Coagulopathy
Diff.	Different.
Dis.	Disease
Disadv.	Disadvantage.
Diso.	Disorder.
Dopa.	Dopamine.
Drr.	Diarrhea.
DPGN.	Diffuse Proliferative Glomerulonephritis.
DSA.	Donor sensitive Antibodies.
Dsz.	Desensitization.
DTH.	Delayed type hypersensitivity response.
Dur.	During.
Dysf.	Dysfunction.
Dzr.	Dialyzers.
Dzt.	Dialysate.
E.K.R.	Equal Renal Clearance.
E/M.	Electron microscopy.
Ed.	Edema.
Effer.	Efferent.
Enz.	Enzyme.
Epo.	Erythropoietin.
ESA	Erythrocytosis Stimulating Agents.
Eval.	Evaluation.
Evid.	Evidence.
Evrol.	Everolimus.
Exch.	Exchange.
Excr.	Excretion/excreted.
F.	Factor
F.A.	Fatty acids.
F.F.P.	Fresh Frozen Plasma.
F.H.F.	Fulminant Hepatic Failure
F.S.G.S.	Focal segmental glomerulosclerosis.
FENa.	Fractional Sodium excretion.
Foll.	Following/followed
Fr.	From.
G.	Glomeruler.
g.	Gram.
G. sclerosis.	Glomerulosclerosis.
GBM	Glomerular Basement membrane.
G.I.	Gastro-intestinal.
G.L.	Guide Lines.
Gluc.	Glucose.
Glcoid.	Glucocorticoid.
Gp.	Glomerulopathy.
G.N.	Glomerulonephritis.
G.P.S.	Goodpasture's syndrome.
GAG.	Glucose Aminoglicans.
Gen.	Generation
GERD	Gastroeosphogeal Reflux Disease.
GFR.	Glomerular filtration rate.
H.A.V.	Hepatitis A. Virus.
H.D./HDX.	Hemodialysis.
H.F.	Heart failure.
HG.	Hypoglycemia.
Hist.	Histological.
Histp.	Histopathological.
H.I.V.A.N.	H.I.V.-associated Nephropathy.
H.P.F.	High Power Field.
H.R.S.	Hepatorenal Syndrome
H.S.P.	Henoch-Schönlein purpura.
HSM.	Hepatosplenomegally.
H.T.	Hypertension.
HB.uria.	Hemoglobulinuria.
Hct.	Hematocrit.
HDF.	Hemodiafiltration.
HF.	Hemofiltration.
Hge.	Hemorrhage.
HiiG    ****	High dose IV. IG.
HIT.	Heparin-induced thrombocytopenia.
Hpt.	Hypotension.
Hyperpara.	Hyperparathyroidism.
Hyperchlst.	Hypercholesterolemia.
Hv.	Have/Having.
HypoC.	Hypocomplementemia.
HZD.	Hydrochlorothiazide.
I.A.B.P.	Intraaortic Baloon Pumping.
IAP.	Intraabdominal pressure.
I.C.T./ I.C.P.	Intracranial tension/pressure.
I.F.	Immunofluorescence study.
Ig.	Immuoglobulin.
IgAN/Ig A Np	Ig. A Nephropathy.
I.H.D.	Ischemic Heart Disease.
I.H.DX.	Intermittent Hemodialysis.
I.J.	Internal jugular.
I.N.	Interstitial Nephritis.
I.P.	Immunoperoxidase.
I.P.D.	Intermittent Peritoneal Dialysis.
I.V.C.	Inferior vena cava.
I.V.P.	Intravenous Pyelography.
Im/m.	Immunosuppressive therapy/Immunologic.
Incid.	Incidence.
Incl.	Include.
Incr.	Increased.
Infc.	Infection.
IFN-g.	interferon –gamma
Inflmm.	Inflammation.
Inj.	Injury.
I.HDX.	Intermittent H.DX.
I.ry	Primary.
JVP.	Jugular venous pressure.
Kid.	Kidney.
Kru.	Residual kidney function.
L.L.	Lower Limb.
Lev.	Level.
L.F.T.	Liver function tests.
L.M.	Light microscopy.
L.N.	Lupus Nephritis.
L.V.	Left ventricle.
L.V.D.	Left ventricular dilatation.
L.V.H.	Left ventricular hypertrophy.
LA.	Lupus Anticoagulant.
LDA.	Living Donor Allograft.
LDH.	Lactate dehydrogenase.
Les.	Lesion
LMWH	Low molecular weight heparin.
Lodiv.	Low dose IV. IG.
Lt.	Left.
LVED volume.	Left Ventricle End Diastolic Volume
m.	Month.
M. Cryg.	Mixed Cryoglobulinemia
M.C.	Minimal change.
MesPGN	Mesangial proliferation glomerulonephritis.
M.I.	Myocardial infarction.
M.H.C.	Major histocompatibility complex.
m. m.	Mucous membranes.
M.M.	Multiple myeloma.
M.N.	Memranous Nephropathy.
M.O.D.F./MODS	Multiple Organ Dysfunction Syndrome.
M.P.	Microscopic Polyangiitis.
M.P.N.	Membranoproliferative Nephropathy.
m.w.	Molecular Weight.
MAHA.	Microangiopathic Hemolytic anemia.
Maint.	Maintenance.
MBD	Mineralization Bone Disease.
MCD.	Minimal change disease.
Mch.	Mechanism.
Mch. v.	Mechanical ventilation.
Metb.	Metabolism.
MHC.	Major histocompatibility complex.
Microalb.	Microalbuminuria.
Mj.	Major.
MPd./Mprd	Methylprednislone.
MRA.	Magnetic resonance angiography.
MMF.	Mycophenolate Mofetil.
Mnf.	Manifestation.
Mod.	Moderate.
Morb./mortal.	Morbidity & mortality
MPO.	Myeloperoxidase.
Msc.	Muscle.
msng.	Mesangial.
Mthx.	Methotrexate.
N.	Normal.
n. & v.	Nausea & vomiting.
nasophx.	Nasopharynx./Nasophyngeal.
n./c.	Nomenclature.
N.F. k.B.	Nuclear factor k.B.
N.G.N.	Necrotizing Glomerulonephritis.
N.O.	Nitric Oxide.
N.O.S.	Nitric oxide synthetase.
N.P.D.	Nocturnal Peritoneal Dialysis
N.R.P.	Nephrotic Range Proteinuria.
N.S.	Nephrotic Syndrome.
N.S.	Normal Saline.
NHDX	Nocturnal hemodialysis.
NIH.	National Institute of Health.
NIPD.	Nocturnal Intermittent Peritoneal Dialysis.
Nodosa.	No dose adjustment.
Non Dc.	Non diabetic.
Non-sp.	Non-specific.
Nor.	Noradrenaline.
nPNA.	normalized Protein equivalent of Nitrogen Appearance.
nPNA.	Protein equivalent of nitrogen appearance (normalized to ideal body weight).
O.F.C.	Ostiitis fibrosa Cystica.
Ob.	Obstruction/Obstructive.
ºC	Temperature.
Occ.	Occur.
Occs.	Occasionally.
OGTT.	Oral Glucose Tolerance Test.
P.A.F	Platelet aggregation factor.
P.C.	Pneumocystis Carnii.
PCR.	Polymerase chain reaction.
P.D.	Peritoneal Dialysis.
P.D.G.F.	Platelet-derived Growth Factor.
P.E.	Pulmonary Embolism.
P.G.	Prostaglandins.
P.H.	Pulmonary Hypertension.
P. H.	Past History.
PHR.	Percent hypochromic RBCs.
P.J.	Pneumocystis Jerovecii (Carnii).
P.M.	Peritoneal Membrane.
P.M.N.	Polymorphnuclear Leukocytes.
P.N.	Peripheral Neuritis.
P.R.	Peripheral resistance.
PTE.	Post-transplantation Erythrocytosis.
P.T.L.D.	Post-transplantation lymphoproliferative disorder.
P.V.D.	Peripheral vascular disease.
PAF.	Platelet activation factor.
PAN	Polyarteritis Nodosa
Partc.	Particuler/particularly.
Path.	Pathology.
PCR.	Protein Catabolic Ratio.
Pec.	Parathyroidectomy.
PECAM.
PCWP.	Pulmonary capillary wedge pressure.
PEP.   Xxx	Paired                 ??????????
PET.	Peritoneal Equilibration Test.
Pl.	Plasma.
Pl.	Pleural.
Plt.	Platelet.
PN.	Pyelonephritis.
Pn.	Pneumonia.
Postop.	Postoperative.
Pph.	Plasmapheresis.
PPT.	Precipitate.
Pr.	Peritoneal.
PRA.	Panel Reactive Antibodies.
Predn./ pred.	Prednisone.
Pres.	Presence.
Prev.	Previous.
Prolif.	Proliferative.
Prot.	Proteinuria.
Prox.	Prophylaxis.
PSGN.	Post Streptococcal G.N.
Ptn.(s)	Patient.(s)
PTRA	Percutanous Transluminal Renal Angiography.
Pulm.	Pulmonary.
Q.b.	Blood pump speed.
Q.d.	Dialysate input rate.
R.	Renal
R. I.	Renal insufficiency.
RES.	Reticuloendothelial system.
Reg.	Regimen.
R.A.S.	Renal Artery Stenosis.
R.B.F.	Renal blood Flow.
R.N.	Reflux Nephropathy.
R.R.	Respiratory Rate.
R.T.x.	Renal transplantation.
R.V.T.	Renal vein thrombosis.
RAAS.	Renin angiotensin aldosterone system
Rapa	Rapamycin.
Rbdlsis	Rabdomyolysis.
RBGN	Rapidly progressive glomerulonephritis.
Rcrr.	Recurrence.
Recip.	Recipient.
Recmm.	Recommendation/recommend.
reg.	Regimen.
Rel.	Related.
Rep.	Report/reported.
Req.	Requirement/require .
Resp.	Respiratory.
Respo.	Response.
Retics.	Reticulocytic count./Reticulocyte.
Rhabdo.	Rhabdomyolysis.
Rhoid.	Rhomatoid arthritis.
Rj.	Rejection.
Rt.	Right.
2ndry./IIry.	Secondary.
S.A.	Surface area.
S.E.	Side Effects
S.F.	Substitution fluid.
S.L.E.	Systemic Lupus erythematosis.
S.N.S.	Sympathetic nervous systems.
S.O.B.	Shortness of breath.
Sol.	Solution.
SOT.	Solid Organ Transplantation.
SCUF.	Slow continuous ultrafiltration.
Scv.	Subclavian.
SGF.	Slow graft function.
Shd.	Should.
SHPT	Secondery hyperparathyroidism.
Signif.	Significance.
SIRS.	Systemic Inflammatory Response Syndrome.
Siros.	Sirolimus.
SLEDD.	Slow Low Efficiency Daily Dialysis.
Sm.	Symptom.
Sm.tically.	Symptomatically.
Sn.	Sign.
SNGFR.	Single Nephron GFR
Sp. Gr.	Specific Gravity.
Ssc.	Small solute clearance.
Ssz.	Sensitization.
St.	Stain.
Std.	Standard.
Sugg.	Suggest/Suggestion.
Suppl.	Supplement.
Susp.	Suspected, Suspicious.
Synd.	Syndrome.
Synth.	Synthesis.
Syst.	System.
T.E.	Thromboembolism.
T.I.N. T/I. dis.	Tubulo-interstitial Nephritis. Tubulo-interstitial dis.
T.L.Rs.	Toll like receptors.
T.M.A.	Thrombotic microangiopathy
T.N.F.	Tumor Necrosis Factor.
TT.L.R.s.	Toll receptors.
T.P.D.	Tidal Peritoneal Dialysis.
T.P.N.	Total Parenteral Nutrition.
T.X.A2	Thromboxan A2
Tx.	Transplantation.
TX.	Transfusion.
TALLH.	Thick ascending limb of loop of Henle.
Tcrol.	Tacrolimus.
TG.	Thymoglobulin.
TGFB.	Transforming Growth Factor B.
Thpy.	Therapy.
thr.	Through
Tmb/SX.	Trimethobrim/Sulfamethoxazol.
TPR.	Total phosphate reabsorption.
TrG.	Triglycerides/ Triglyceridemia..
TSAT.	Transferrin Saturation.
TTP-HUS.	Thrombotic thrombocytopenic pupura/Hemolytic Uremic syndrome.
ttt.	Treatment.
Tub.	Tubular
U.B.	Urinary Bladder.
U.F.	Ultrafiltration.
U.F. Co.	Ultrafiltration coefficient.
U.O.	Urine Output.
U.S.	United States.
U.T.I.	Urinary tract infection.
UAE.	Urinary albumen excretion.
Un.ttted.	Untreated.
Ur.	Urinary.
Urar./ URAR.	urine albumin-to-creatinine ratio .
us.	Usually.
v.	Vein.
v.	Very.
V. acc.	Vascular access.
V. sp.	Very specific.
V.A.M.	Vascular cell adhesion molecule.
V.C.	Vasoconstriction.
V.D.	Vasodilatation.
V.R.	Venous Return.
V.U.R.	Vesicoureteric Reflux.
Vcc.	Vaccine/vaccination.
-ve.	Negative
Vol.	Volume.
Vsc.	Vasculer.
VTE	Venous thromboembolism.
w./wkly.	Week/weekly.
W.G.	Wegener’s granulomatosis.
Whm.	Whom.
Wt.	Weight
XOI.	Xanthine oxidase inhibitor.
Xt.	Xenotransplantation/Xenotransplant.

 

 

“ Symbole meanings”

 

ê	Decrease/minimize/diminish/ impair./ suppress.
é	Increase/ maximize/augment/ enhance.
Ø/]	Leading to/results in.
%  / A	Warning/take care.
N	Fatal/ Grave outcome.
(x)/Ö = S.E.	Side Effects/Adverse effects.
V/T	Avoid/ C.I.
ØØ	Results in/ leading to
+ve.	Positive.
-ve	Negative.
G	Attention/one.
É	With/in association.
—	Attention call.
Ï	Resistance/ blocked response .
Ð	Reversed resistance.
<	Waow.
¯¯¯	Enjoy this meaning.

 

 

(A)    Clincal Nephrology.

﴾﴾I. General Topics.  ﴿﴿

Q.1. Who is the most talent physician in medical practice?

A.  THe Nephrologist.             

Q.2. What are the benefits of early referral of renal patient to his specialist?

A.“Early Referral” has the following benefits:        < <

(1)                 Slowing progression rate of CKD.

(2)                 Patient counseling & education.

(3)                 Reduction of co-morbid load.

(4)                 Choice of dialysis modality.

(5)                 Vascular access creation.

(6)                 More compliance to treatment.

(7)                 Pre-emptive transplantation.

(8)                 Better outcome of early dialysis.

(9)                 HB.V. vaccination in pre-DX.Ø Good immune response.

(10)              Non-emergent initiation of DX.

(11)              Lower morbidity  & improved rehabilitation.

(12)              Less frequent  &  shorter hospital stays.    ã

(13)              Lower cost.  $

(14)              Improved survival.   üü

Q.3. How much beneficial is this family of drugs, ACEI/ARBs, to renal patients? What are the extra-renal benefits?    <<

A. ACEI/ARBs hv so many beneficial effects:

1)   Anti-hypertensve effect (Systemic).

2)   Reduction of intra.G. pressure (Renal).

3)   Anti-proteinuric effect.

4)   Renoprotective effect.

5)   Antisclerotic (antifibrotic) effect. (see below.  )

6)   Anticytokine effect. [Down regulating TGF-B  (transforming growth f. B.)].

7)   ACEI Øé KininØéL-arginineØ NOS ØN.O. (ACEI is a vital N.O. < generator). (see Q.425)

8)   ttt. of erythrocytosis (ACEI/ARBs). (see below.  )

9)   Uricosuric effect (only Losartan.). (see below. )

Extra renal benefits :

1.    L.V.H. regression.

2.    Delay in proliferation & progression of Dc Retinopathy.

3.    Incr. insulin sensitivity & better glycemic control.

4.     Better dyslipidemic control (in some trials).

Q.4. Define the general poor prognostic risk factors of renal dis. prog-ression?

(1) Old age.

(2) Male gender.

(3) Black race.

(4) High B.P. at presentation.

(5) High S. cr. At presentation.

(6) Life style:TwoAmj. F.:  I. Obesity.   II. Smoking:Ö Incr. rate of R. func. loss, H.T., glucose intolerance .. most prominant in Dc.s. (see also Q. 358.)

(7) Heavy proteinuria.

(8) “DD” gene polymorphism: “DD” genotype Ö progression of R. dis., e.g. {Ig A, Dc Np., APKD, R.T.x. & H.T. Nephrosclerosis}.

(9) Clustering<of risk f.:[H.T.- D.M.- Prot.- dylipidemia]hs the foll. impacts:

                       i.    High B.P. Ø aggravates proteinuria.  

                      ii.    ProteinuriaØ hs the pressor effect of sodium retention.

                     iii.    Proteinuria not only enhances susceptibility to H.T. R. dge, but also enhances lipid-associated R. structural dge.

(10)       Absence of gross hematuria. (Ig A. Np.).

(11)       Duration of preceding Sms.       

(12)       Biopsy finding:  (A) L.M.: 

1.            Crescent & adhesion formation.

2.            Glomeruler scarring.

3.            Tubular atrophy .

4.            Interstitial fibrosis. 

5.            Vsc. wall thickening.

                      (B) I.F.: Cpll. loop IgA deposits. (Ig A. Np).

                                    (C) E/M. (Ig A. Np):

                                                                                   I.        Mesangiolysis.

                                                                                 II.        G.B.M. abnormalities.

                                                                               III.        Cpll. wall electron-dense deposits.

Q5.What are the prognostic markers at presentation in IgA Np.?

A. Three situations:   B

I. Good prognosis: Recurrent macroscopic proteinuria.   üü

II. Poor prognosis:  

A.   Clinical:

i.             R.I.

ii.            H.T.

iii.           Gross obesity.

iv.           Increased age.

v.            Hyperuricemia.

vi.           Degree of proteinuria.

vii.          Duration of preceding Sm.s.

B.   Histopathological:

i.             Tub. atrophy.

ii.            Interstitial fibrosis.

iii.           Segmental glomerulosclerosis.

iv.           Mesangial hypercellularity.

v.            Endocapillary propliferation.

vi.           Capillary loop IgA deposits.

vii.          Crescents. (controversial).

III. No impact on prognosis:   ¿ ¿

i.             Gender.

ii.            Serum IgA level.

iii.           Intensity of IgA deposits.

-      N.B.: None of the clinical or histopathological adverse features, EXCEPT capillary loop IgA deposits, are specific to IgA Np.

Q6. What are the factors associated with worse renal survival in M.N.?

A. Worse renal survival in M.N. is ass. with:

(1) Old age.

(2) Male gender.

(3) High B.P.

(4) High s. Cr.

(5) HLA type: HLA B18/DR3/Bff.

(6)  Low s. albumin: < 1.5 g/dl.

(7) Urine proteins:

v    N.S.

v    Prot. > 8 g/6 m.

v    IgG > 250 mg/d.   <

v    B2 micrglobulin > 0.5 ug/min.   <

(8) Biopsy finding:

·                     G. focal sclerosis.

·                     Tubulointerstitial dis.

·                     E/M: stage III, IV.

Q.7. What is the prognostic factors affecting Dc Np.?

1)   Proteinuria incr. the risk of death 3.5 times comp. to non-diabetics.

2)   Cardiac ANP predicts CVS Morbidity & mortality in Dc Np. I.

3)   Homocysteine Ø incr. CVS risk in Dc Np. II.

4)   Incr. circululating N-terminal (Probrain) natriuretic peptideØ a new independ-ent risk f. of overall & CVS Morbidity/MR in Type I & II. D.M. é no Sm. of H.F.

5)   Reduction of R. function Øé CVS Risk.

6)   “Mannose-binding Lectin” & “Symmetric dimethyl arginine” a recent bio-markers for CVS in Dc Np.

“Putative promoters” for prognosis in Dc Np.:8

1)   Systemic H.T.

2)   G. H.T. (defective autoregulation é GFR.).

3)   Hyperlipidemia.

4)   Smoking.

5)   Magnitude of proteinuria (>3 g.Øworse prognosis.).

6)   Dietary protein intake.

7)   Glycemic control (Good impact of tight glycemic control in FDc Np.I. but notFin II.Ø delay of progressionüof DcNp.).

8)   ACE(I.D.)(insertion/deletion) polymorphism: D allele hs deleterious effect é dis. progression, So, Losartan, e.g. hs maximum benefit é ACE/ DD., comp. to I.D. gene.

Q.8. What are interesting pearls to keep in mind as regard etiology of nephrotic syndrome?

A. As regard etiology of nephrotic syndrome:

1)   Dc. Np. : Æ  The most common cause of N.S. in overall .

2)   M.N.  ÆThe most common cause of idiopathic N.S. in adults.

3)   FSGS  ÆThe most common cause of idiopathic N.S. in African Amricans.

4)   M.C.D. ÆThe most common cause of idiopathic N.S. in children.

5)   IgA Np.: Æ  The most common cause of G.N. worldwide.

Q.9. What renal diseases associated with a strong family history of the disease?

A. Renal diseases associated with a “strong family history” of the disease:

1)   Polycystic kidney dis..

2)   Alport syndrome.

3)   Hypertensive Nephrosclerosis.

4)   Diabetic Nephropathy.

5)   Fabry’s disease.

6)   Lupus Nephritis.

7)   FSGS. (rarely familial.).

Q.10. Explain, how can “Low complement” level help in diagnosis of many renal diseases?        

A. Hypocomplementemia (H.C.) is a relative common finding é diffuse G.N. incl.:

1)   Lupus nephritis.

2)   Postinfectious G.N..

3)   Memberanous G.N. due to lupus or to HBV.

4)   Membranoproliferative G.N..

5)   Mixed cryoglobulinemia.

6)   Serum sickness.

7)   Hereditary complement deficiencies.