12.3 - Nephrotic syndrome

Question 1

why does nephrotic syndrome result in a hypercoagulable state?

Answer 1

loss of antithrombin III

Question 2

how does nephrotic syndrome lead to fatty casts?

Answer 2

due to hyperlipidemia and hypercholesterolemia

Question 3

minimal change disease is associated with what type of cancer?

Answer 3

hodgkin lymphoma

Question 4

what is seen on EM in minimal change disease?

Answer 4

effacement of foot processes

Question 5

what is the IF finding in minimal change disease?

Answer 5

normal

Question 6

is minimal change disease responsive to steroids?

Answer 6

yes - excellent response

Question 7

which type of nephrotic syndrome is associated with HIV, heroin, and sickle cell disease?

Answer 7

FSGS

Question 8

what are the H&E findings in FSGS?

Answer 8

focal and segmental sclerosis

Question 9

what is seen on EM in FSGS?

Answer 9

effacement of foot processes

Question 10

what are the IF findings in FSGS?

Answer 10

normal

Question 11

is FSGS responsive to steroids?

Answer 11

no

Question 12

which type of nephrotic syndrome is associated with hep B, hep C, solid tumors, SLE, drugs?

Answer 12

membranous

Question 13

thick glomberular BM on H&E (no tram tracks) - diagnosis?

Answer 13

membranous nephropathy

Question 14

what are the EM findings in membranous nephropathy?

Answer 14

subepithelial deposits with “spike and dome” appearance

Question 15

subepithelial deposits with “spike and dome” appearance on EM - diagnosis?

Answer 15

membranous nephropathy

Question 16

is membranous nephropathy responsive to steroids?

Answer 16

no

Question 17

thick glomberular BM on H&E with tram tracks - diagnosis?

Answer 17

membranoproliferative glomerulonephritis

Question 18

what is the IF appearance of membranous nephropathy?

Answer 18

granular

Question 19

what is the IF appearance of membranoproliferative glomerulonephritis?

Answer 19

granular

Question 20

where are the deposits in type I membranoproliferative glomerulonephritis? what diseases is it associated with?

Answer 20

• subendothelial

- associated with HBV, HCV

Question 21

where are the deposits in type II membranoproliferative glomerulonephritis?

Answer 21

intramembranous

Question 22

which type of membranoproliferative glomerulonephritis is associated with C3 nephritic factor? what does it do?

Answer 22

• type II
• autoantibody that stabilizes C3 convertase, leading to overactivation of complement, inflammation, low levels of circulating C3

Question 23

low levels of C3 and intramembranous deposits - diagnosis?

Answer 23

type II membranoproliferative glomerulonephritis

Question 24

what is the end result of the nonenzymatic glycosylation of the vascular BM seen in DM?

Answer 24

hyaline arteriolosclerosis

Question 25

which glomerular arteriole is affected more by nonenzymatic glycosylation? what is the result?

Answer 25

• efferent

- high GFR and hyperfiltration injury leading to microalbuminemia

Question 26

what is the cause of the high GFR and hyperfiltration injury leading to microalbuminemia seen in DM?

Answer 26

selective nonenzymatic glycosylation of the efferent arteriole

Question 27

what drug can slow the progression of hyperfiltration induced damage in DM? why?

Answer 27

• ACE inhibitors

- via prevention of efferent vasoconstriction from angiotensin II

Question 28

what is the organ most involved in systemic amyloidosis? where does the deposition occur? what is the end result?

Answer 28

• kidneys
• mesangium
• nephrotic syndrome