DIT review - Renal 2 Flashcards
Describe the general characteristics of nephritic syndrome
- Proteinuria < 3.5 g/day
- Hematuria and RBC casts
- Azotemia – increased serum BUN and Creatine
- Hypertension – salt retention with periorbital edema
- Oliguria
What are the different types of nephritis syndrome
Post-strep glomerulonephritis
IgA nephropathy (Berger disease)
Alport Syndrome
Rapidly Progressive Glomerulonephritis
What type of strep infection precedes PSGN
Skin or pharynx
Where will you see immune complex deposits in PSGN + what other things will be seen on biopsy
- Hypercellular glomeruli
- Neutrophils
- EM: Immune deposits – subepithelial humps
- IF: “starry sky” granular appearance (“lumpy bumpy”)
What labs will you find in PSGN?
- Decreased C3 levels (complement is activated and used up)
- Anti-streptolysin O titer to prove that there was a previous Strep infection
What disease is associated with IgA nephropathy
- Associated with Henoch-Schonlein purpura
- Palpable purpura on butt and legs
- Arthralgias
- Abdominal pain
- Renal disease
Where will you see deposits in IgA nephropathy + what else will you see on biopsy?
- IgA immune complex deposited in mesangium
- Proliferation of mesangial cells
Describe the presentation of IgA nephropathy
- Presents as hematuria with RBC casts following a mucosal infection
What is the cause of Alport syndrome
- Due to defect in Type IV collagen (basement membrane)
- Leads to splitting of the basement membrane longitudinally
Presentation of Alport syndrome
- Presents as isolated hematuria, sensory hearing loss, and ocular disturbances
- “Can’t see, can’t pee, can’t hear high C”
What is the characteristic finding in rapidly progressive glomerulonephritis
- Characterized by crescents in Bowman space
- Crescents comprised of fibrin and macrophages
What are the subtypes of RPGN?
Goodpasture
Granulomatosis with polyangiitis (Wegener)
Microscopic polyangiitis
Diffuse proliferative glomerulonephritis
Finding in Goodpasture (presentation, IF)
- Type II HSR – antibodies against glomerular basement membrane
- Linear IF pattern
- Affects kidneys and the lungs (alveolar basement membrane)
- Presents as hematuria + hemoptysis
How do you differentiate Wegener’s from Microscopic polyangiitis
Wegener’s - cANCA
Microscopic polyangiitis - pANCA
Both have negative IF
What disease is associated with Diffuse proliferative glomerulonephritis
Lupus - most common type of renal disease in SLE
Describe the biopsy of diffuse proliferative glomerulonephritis
- Anti-dsDNA seen subendothelially and within mesangium
- Granular IF
- Light microscopy – deposits make basement membrane look thick – “wire looping” of capillaries
- THINK: wire lupus
- Often presents as nephrotic + nephritic syndrome
What are the general characteristics of nephrotic syndrome
- Proteinuria > 3.5 g/day
- Hypoalbuminemia – protein lost in urine
- Edema – decreased oncotic pressure due to hypoalbuminemia
- Increased risk of infection – loss of immunoglobulin in urine
- Increased risk of thrombosis – loss of antithrombin III
- Hyperlipidemia – liver tries to make more lipoproteins in order to make up for decreased oncotic pressure
What are the types of nephrotic syndrome?
Foot process effacement: Minimal change disease, focal segmental glomerulosclerosis
Immune deposition: Membranous nephropathy, Membranoproliferative glomerulonephritis
Other: Diabetes, Amyloidosis
Describe biopsy of Minimal change disease (H&E, EM, IF)
- H&E – normal
- EM – foot process effacement
- IF – negative
What is the most common cause of nephrotic syndrome in children and adults
Children - minimal change disease
Adults - Focal segmental glomerulosclerosis
What is a trigger for minimal change disease
Infections or immunizations
What populations are associated with focal segmental glomerulosclerosis
- Most common cause of nephrotic syndrome in African Americans and Latinos
- More prevalent in HIV patients
Describe the biopsy of focal segmental glomerulosclerosis
- H&E – focal (affects some glomeruli), segmental (affects part of glomerulus)
- EM – foot process effacement
- IF – negative
What kidney diseases are associated with Lupus
Diffuse proliferative glomerulonephritis (nephritic)
Membranous nephropathy (nephrotic)
