10.28: Renal III Flashcards
What is MCD?
- Minimal change disease
- Present with generalized and periorbital edema
- Common in 2 - 6 yo: 95% of their nephROTIC synd.
What is FSGS?
Focal and Segmental Glomerulosclerosis
What is assumed diagnosis in child with nephrotic syndrome?
- MCD
- If course is normal and uncomplicated no biopsy is necessary
- ***If it is determined that it is resistant steroids, biopsy performed
Is biopsy necessary in adults / kids for nephrotic syndrome?
Adults: Yes
Child: No, assumed MCD
Pathogenesis of MGD?
- Reversible injury of unknown origin to podocytes of epithelial cells of basement membrane
- No more more slit membranes allowing albumin leak
What type of immune complex is involved in MCD?
- No IC involvement
- No inflammation
What does MCD disease usually occur after?
- NSAIDs
2, Viral infection - Hodgkins
What is podocyte effacement?
- Injury to epithelial cells of basement membrane
- Causes the feet to fuse losing slit membrane
- Allows proteins to pass through: nephrotic syndrome
Prognosis of MCD?
- Recurrent episodes of nephrotic syndrome
- Stops at puberty
- Treat with steroids to reverse podocyte injury
Treatment for membranous nephrotic syndrome?
- Very hard to treat
- MCD is treated easily with steroids
General presentation of MCD?
- Child
- Proteinuria: foamy urine
- ***Can be less than 3g in child
- Periorbital and generalized edema
- Lipiduria
What is effacement of podocytes characteristics of?
MCD
Differential diagnosis of 7-8 yo with nephrotic syndrome??
- 75% chance MCD
2. FSGS
Selective vs. nonselective proteinuria?
Selective: only albumin
Non selective: proteins other than albumin as well
**Usually indicative of greater degree of renal injury
FSGS presentation?
- Nephrotic syndrome
- Higher incidence of hematuria
- Proteinuria is often non selective
DIfference in injury between FSGS and MCD?
MCD: Reversible injury to podocytes w. steroid treatment
FSGS: Injury is irreversible
Progression of FSGS?
- Initially only glomeruli in juxtmed. involved
- Eventually all will be involved: global sclerosis leading to tubular atrophy and interstitial fibrosis
- Will progress to renal failure
Treatment of FSGS?
- Initially responds to steroids
- Becomes dependant, then resistant
Creatinine levels in FSGS?
Rising serum creatinine
Possible etiologies of FSGS?
- Idiopathic
- HIV
- Parvovirus B19
- Heroin
- Sickle cell disease
- Obesity
- Low birthweight
- Bodybuilding steroids
- HTN
- Mutation in proteins for slit diaphragms
What occurs in HIV associated FSGS?
- Collapse of tuft and proliferation of visceral epithelium
- Rapid progression to failure with very poor prognosis
“Collapsing FSGS”
When is immune complex seen in nephrotic syndrome?
- Membranous nephropathy
- Autoimmune and resistant to steroids
Two disease associated with nephrotic syndrome w/ hematuria?
- MPGN: Membranoproliferative glomerulonephritis
2. DDD: “Dense Deposit Disease”
Etiology of MPGN?
Primary IC formation with complex activation, secondary to:
- Chronic immune disorders
- Hepatitis
- Endocarditis
- Chronic Bacterial infections
- Plasma cell monoclonal protein production
