05.13 - Nephrotic Syndrome 1 (Nichols, Showkat) - PP + Handout Flashcards
Other than Post-infectious GN, Subepithelial humps are seen in
SLE
What tx do you use in both Primary and Secondary Nephrotic
Supportive measures to control HTN
Granular casts can result from
Aggregates of plasma proteins or breakdown of cellular casts
Why do patients with nephrotic syndrome have subcutaneous lipid deposits (Xanthelasma)
Increased hepatic synthesis of cholesterol, TG’s and Lipoproteins
Estimated glomerular pore radius for spherical molecules
42 angstroms
Most common cause of ESRD requiring dialysis
Diabetic Nephropathy
3 diseases: Subendothelial space or Mesangial Immune Complex formation and complement activaiton with inflammation
Post-Infectious GN, IgA Nephropathy, Lupus Nephritis
Normal rate of protein excretion
40-80 normal; 150 upper limit of normal
3.5 mg/day 24 hour urine corresponds with what spot urine protein/creatinine ratio
3.5
Spike and Dome is buzzword for
Membranous Nephropathy
Buzzword for Alport Syndrome
Basketweave
Buzzword for MPGN
Tram Tracks
Most important prognostic predictor of nephrotic syndrome
Degree of Proteinuria
Nephrotic patients have __ filtration SA, and ___ change in large pores
Loss of filtration surface, increased number of large pores
Main site of charge hindrance
Anionic charged lamina rara interna, Fenestrate capillary endothelium
Subepithelial deposits tend to cause a ___ picture, wherease Subendothelial and Mesangial deposits tend to cause a ____ picture
Nephrotic, Nephritic
Buzzword for Post-Infectious GN
Subepithelial Humps
Fatty casts are indicative of
Lipiduria of nephrotic syndrome
If there is generalized edema, evaluate for
Proteinuria
Tram Tracks is buzzworf for
MPGN
Subepithelial humps is buzzword for
Post-Infectious GN
Foot process effacement is buzzword for
Minimal Change Disease
Most common cause of rapidly progressive GN
Autoimmune Vasculitis
Basketweave is buzzword for
Alport Syndrome
Earliest clinical manifestation of Diabetic Nephropathy
Microabluminuria
BP in Nephrotic vs Nephritic
Elevated in Nephritic
If ___ are present, Fatty casts can have ___ pattern under polarized light
Cholesterol or cholesterol esters, Maltese cross
A 24-hour collection of urine will have less than __
150 mg of protein
Podocyte injury occurs in what 2 diseases
Minimal Change, Focal Segmental Glomerulosclerosis
Tubular disease is associated with proteinuria of ___ proteins
LMW
Nephrotic patients have __ excretion of SMW dextrans, and ___ excretion of LMW dextrans
Lower, higher
Subepithelial space immune complex formation and complement activation, without inflammation
Membranous Nephropathy
4 features of Nephrotic Syndrome
Edema, Proteinuria, Hypoalbuminemia, Hyperlipidemia
Creatinine in Nephrotic vs Nephritic
Elevated in Nephritic, Normal or mild elevation in Nephrotic
Granular casts almost always indicate
significant renal disease
2 absolute contraindications to renal bx
Bleeding Diathesis, Uncontrolled HTN
4 features of chronic GN
HTN, Renal Insufficiency, Proteinuria, Shrunken Smooth Kidneys on US
Does the dipstick detect microalbuminuria
No, Microalbuminuria is 300 mg/day
Nephrotic Syndrome mechanisms without glomerular inflammation include glomerular capillary wall deposition in ___, ___, and ___
Diabetic Nephropathy, Amyloidosis, and Light Chain Deposition disease
Casts that can be seen in Nephrotic Syndrome
Hyaline, Granular, Fatty, (WBC)
Muddy brown casts are a type of ___ almost always seen in ____
Granular Cast, Acute Tubular Necrosis
A spot urine protein/creatinine ratio of less than ___ corresponds with 24 hour urine protein of 150
0.15
Microalbuminuria is defined as
30-300 mg/day
WBC casts are indicative of
Inflammation
Nephrotic Syndrome mechanisms without glomerular inflammation include subepithelial immune complex formation and complement activation in
Membranous Nephropathy
Macromolecules > ___ nm are completely restricted
4 nm
Uncharged macromolecules < ___ nm filter freely
1.8
Onion skin in spleen =
Lupus
Urinary sediment in Nephrotic Syndrome
Inactive - without dysmorphic RBCs or RBC casts
How are proteins reabsorbed in PT
Endocytosis by endothelial cells –> Hydrolyzed in lysosomes into AAs –> Re-enter circulation
Proportion of filtered proteins that are reabsorbed
Almost all
Main site of size hindrance for larger molecules
Lamina Densa and Slit diaphragm
Buzzword for Membranous Nephropathy
Spike and Dome
Nephrotic Syndrome mechanisms without glomerular inflammation include podocyte injury in ___ and ___
Minimal Change Disease and Focal Segmental Glomerulosclerosis
Loss of more than ___ of protein per day in urine is defined as Nephrotic
3.5 mg
Buzzword for Lupus Nephritis
Wire Loops
Threshold for protein dipstick
300-500 mg/day
2 causes of xanthelasma
Hyperlipidemia in nephrotic syndrome; Amyloidosis
Upper limit of normal for spot urine protein/creatinine ratio
0.15
Subepithelial deposits tend to cause a ___ picture, as seen most characteristically with
Nephrotic, Membranous Nephropathy
Primary Nephrotic syndrome management includes disease modifying tx w/
Corticosteroids and Immunosuppression
Major causes of Membranous Nephropathy
Idiopathic or due to Systemic Disorders: SLE, Hep B, Drugs (Gold, penicillamine)
Onion-skin is buzzword for
HTN nephropathy; Scleroderma
