2.8 Path: Proteinuria

Question 1

What is nephrotic syndrome?

Answer 1

Increase permeability of glomerulus–> >3.5g urine protein

Lipiduria, hyperlipidemia, hypercholesterolemia, albumuria, hypoalbumuria, low plasma volume–>Edema

Question 2

Minimal change disease

Answer 2

Most common nephrotic syndrome in kids
effacement of podocytes. Fusion of visceral epithelial foot process.
tx: Steroids with improvement.

Question 3

Minimal change disease IF

Answer 3

Nothing

Question 4

Minimal change disease EM:

Answer 4

Effacement of podocytes, loss of foot processes

Question 5

Membranous glomerulonephritis

Answer 5

Thickening of the BM due to deposition of immune complexes to subepithelial

Question 6

Membranous glomerulonephritis IF

Answer 6

Granular deposits

Question 7

Membranous glomerulonephritis EM

Answer 7

Spike and dome appearance, thickened BM due to deposits of IC

Question 8

Membranous glomerulonephritis Light micro

Answer 8

Thickened BM with spikes on silver stain

Question 9

Tx for Membranous glomerulonephritis

Answer 9

Steroids for rapidly progressive RF

Question 10

Chronic glomerulonephritis

Answer 10

Cause ESRD,

Gross: sym shrunken, finely granular because loss of tubules, thyroidization

Question 11

Focal Segmental Glomerulosclerosis

Answer 11

Glomerular enlargement due to overwork causes flattening of foot processes occurs at the endothelial

Question 12

Focal Segmental Glomerulosclerosis IF

Answer 12

none

Question 13

Focal Segmental Glomerulosclerosis EM

Answer 13

Loss or detachment of podocytes with flattening and fusion. Thickened BM

Adhisions to bowman’s capsule
Hypercellular mesangium

Question 14

secondary Causes of Focal Segmental Glomerulosclerosis

Answer 14

Sickle cell, congenital, obese, HIV, Drugs (Pamidronate)

Question 15

Diabetic Glomerulosclerosis

Answer 15

Thickened BM, increased mesangial matrix, Kimmelsteil wilson nodulars

Afferent and efferent arterioles show hylanization

Question 16

Renal amyloidosis

Answer 16

AL or AA amyloid
AL: light chains of immunoglobbulins from neoplastic B cells
AA: Derived from liver in serum response to infection, inflammation, or neoplasm

Path: Deposition of amyloid in mesangium and capillary walls of glomerulus resulting in large eosinophilic pale spheres with total obliteration in advanced causes

Question 17

Renal amyloidosis Staining

Answer 17

Light micro: Congo stain red or pink

Polarized micro: Apple green birefringence