12.3 - Nephrotic syndrome Flashcards
why does nephrotic syndrome result in a hypercoagulable state?
loss of antithrombin III
how does nephrotic syndrome lead to fatty casts?
due to hyperlipidemia and hypercholesterolemia
minimal change disease is associated with what type of cancer?
hodgkin lymphoma
what is seen on EM in minimal change disease?
effacement of foot processes
what is the IF finding in minimal change disease?
normal
is minimal change disease responsive to steroids?
yes - excellent response
which type of nephrotic syndrome is associated with HIV, heroin, and sickle cell disease?
FSGS
what are the H&E findings in FSGS?
focal and segmental sclerosis
what is seen on EM in FSGS?
effacement of foot processes
what are the IF findings in FSGS?
normal
is FSGS responsive to steroids?
no
which type of nephrotic syndrome is associated with hep B, hep C, solid tumors, SLE, drugs?
membranous
thick glomberular BM on H&E (no tram tracks) - diagnosis?
membranous nephropathy
what are the EM findings in membranous nephropathy?
subepithelial deposits with “spike and dome” appearance
subepithelial deposits with “spike and dome” appearance on EM - diagnosis?
membranous nephropathy
is membranous nephropathy responsive to steroids?
no
thick glomberular BM on H&E with tram tracks - diagnosis?
membranoproliferative glomerulonephritis
what is the IF appearance of membranous nephropathy?
granular
what is the IF appearance of membranoproliferative glomerulonephritis?
granular
where are the deposits in type I membranoproliferative glomerulonephritis? what diseases is it associated with?
- subendothelial
- associated with HBV, HCV
where are the deposits in type II membranoproliferative glomerulonephritis?
intramembranous
which type of membranoproliferative glomerulonephritis is associated with C3 nephritic factor? what does it do?
- type II
- autoantibody that stabilizes C3 convertase, leading to overactivation of complement, inflammation, low levels of circulating C3
low levels of C3 and intramembranous deposits - diagnosis?
type II membranoproliferative glomerulonephritis
what is the end result of the nonenzymatic glycosylation of the vascular BM seen in DM?
hyaline arteriolosclerosis
which glomerular arteriole is affected more by nonenzymatic glycosylation? what is the result?
- efferent
- high GFR and hyperfiltration injury leading to microalbuminemia
what is the cause of the high GFR and hyperfiltration injury leading to microalbuminemia seen in DM?
selective nonenzymatic glycosylation of the efferent arteriole
what drug can slow the progression of hyperfiltration induced damage in DM? why?
- ACE inhibitors
- via prevention of efferent vasoconstriction from angiotensin II
what is the organ most involved in systemic amyloidosis? where does the deposition occur? what is the end result?
- kidneys
- mesangium
- nephrotic syndrome
