ASCP Flashcards
Lab features of Nephrotic Syndrome (4)
> 3.5 g protein>day
hyperlipidemia
edema
hypoalbuminia (
Name the two immune complex negative Dz associated with Nephrotic Syndrome
Minimal Change
FSGS
Name the two immune complex positive Dz associated with Nephrotic Syndrome
membranous GN
IgA GN
What is prognosis of minimal change
great; steroid responsive
secondary causes minimal change
NSAIDS
lymphproliferative Dzs
Em feature of minimal change
foot process effacement
Clinical Course of FSGS
steroid resistant; progressive in 30-50%
Are most cases primary or secondary for FSGS
primary
mutations in what class of proteins is associated with secondary FSGS
slit diaphragm/podocyte foot
process proteins: nephrin, podocin,
CD2AP, α-actinin
What viruses associated with secondary FSGS
HIV, parvovirus B-19
What are Biopsy findings in FSGS (LM, IF, and EM)
Biopsy findings:
LM - segmental glomerulosclerosis
IF - no immune deposits are present (IgM and C3 deposition
occurs in sclerosing lesions– non-specific binding)
EM - foot process loss +/- segmental
sclerosis
what happens to the foot processes in FSGS
FSGS - non sclerotic areas show
podocyte foot process effacement
what are the 5 variants of FSGS
FSGS, nos-- Most common FSGS, perihilar--Reduced renal mass FSGS, cellular---Early, severe onset FSGS, tip lesion-More benign form FSGS collapsing-- Rapidly progressive
what are 3 secondary causes of the collapsing variant of FSGS
HIV nephropathy
Parvovirus B-19
Pamidronate
• Other causes
What is HIV nephropathy/collapsing glomerulopathy
= A combination of glomerular, tubular, and
interstitial abnormalities, with an ultrastructural
finding that predicts HIV seropositivity:
includes:
Collapsing FSGS
Dilated tubular casts – filled with protein casts that can look like amyloid
Prominent interstitial inflammation, fibrosis
Endothelial reticulotubular inclusions on EM
Clinical - rapid progression to renal failure
