12.3 Nephrotic Syndrome Flashcards
What is the hallmark of nephrotic syndrome?
Proteinuria
What is the main protein loss in nephrotic syndrome?
Albumin
Why is there a hypercoaguable state in nephrotic syndrome?
Preferential loss of AT III as well as the slowed production of coagulation factors.
Why does hyperlipidemia occur with nephrotic syndrome?
Increased liver production of lipids and cholesterol to counteract the thinning of blood proteins.
Who is generally affected by Minimal Change Disease?
Children
What condition is associated with MCD?
Hodgkin’s Lymphoma
What happens to the foot processes in MCD?
The are effaced (fused together)
What is the H&E finding in MCD?
Normal findings
What proteins are lost in MCD?
Albumin
What is the main treatment for MCD that has good response?
Steroids - they know out the effect of the cytokines
Who is generally affected with Focal Segmental Glomerular Sclerosis (FSGS)?
African Americans
Hispanics
What are some of the associations with FSGS?
HIV
Heroin Use
Sickle Cell Disease
What will be seen on FSGS microscopy?
- Focal and Segmental Glomerular Sclerosis (only some are affected)
- Effacement of the foot processes
Does FSGS respond to steroids?
NO
Who is primarily affected by membranous nephropathy?
Caucasian adults
What can membranous neuropathy be associated with?
SLE
Solid tumors
Hepatitis B/C
Drugs - NSAIDs and pencillamine
What is found on microscopy of membranous nephropathy?
- Thick glomerular basement membrane
- “Spike and dome” appearance
- Immune complex deposition with granular IF
What does “membranous” indicate?
Immune complex deposition - shows with granular IF
What are the microscopy findings with membranoproliferazive glomerulonephritis (MPGN)?
- Thick capillary membranes with “tram track” appearance
- Immune complex deposition with granular IF
What is Type I MPGN?
Sub endothelial immune complex deposits - associated with hepatitis B/C
- More often with the formation of “tram tracks”
What is Type II MPGN?
Deposition of immune complex in the basement membrane - associated with C3 nephritic factor mutation that stabilizes C3 convertase
What is a unique feature of MPGN?
It can create nephrotic, nephritic or both syndromes
Where is the deposition in membranous nephropthy?
Sub epithelial deposition
What is the pathogenesis of diabetic nephropathy?
Non-enzymatic glycosylation of vascular basement membrane due to high glucose levels which leads to hyaline arteriolosclerosis - preferentially in the efferent arteriole that results in increased glomerular pressure
How does diabetes lead to nephrotic syndrome?
Hyperfiltration will result from NEG which leads to microalbuminuria, eventually causing nephrotic syndrome
How does systemic amyloidosis cause nephrotic syndrome?
Amyloid most commonly deposits in the kidney in the mesangium which leads to nephrotic syndrome
What are the lab findings for amyloid?
Apple-green birefringence under polarized light.
