Fang 2 Flashcards
1
Q
NephrITIC vs nephrOTIC syndrome
A
- Nephrtic syndorme
- HTN
- HEMATURIA
- RBC cast
- NephrOTIC syndrome
- PROTEINURIA > 3.5g/24hr
- generalized PITTING EDEMA (due to HYPOALBUMINEMIA
- hypercholesterolemia (due to hypoalbuminemia)
- FATTY CASTS
2
Q
NephrITIC syndrome
A
- Due to breaks in the glomerular capillary loop
- erythrocytes spill out into urinary space
3
Q
nephrotic syndrome
A
- due to glomerular capillary filtration defects
- epithelial cell foot process EFFACEMENT AND DETACHEMENT
- shortening and or thinning of podocytes
- epithelial cell foot process EFFACEMENT AND DETACHEMENT
4
Q
Chronic renal failure pathology
A
- Caused by untreated pathology leads to scarring/fibrosed kidney
- slow rise in creatinine over months to years
- GrOSS
- kidneys are small
- cortex is thinned
- increase pelvic fact
- MICRO
- glomerular sclerosis
- interstitial fibrosis
- tubular atrophy
5
Q
Causes of NEPHROTIC SYNDROME
A
- Priamry
- minimal change disease
- focal segmental glomerulosclerosis
- membranous nephropathy
- Secondary
- Diabetic nephropathy
- Amyloidosis, SLE, DRUGS, infections, malginancies etc
6
Q
Minimal chagne glomerulopathy
A
- most COMMON CAUSE of nephrotic syndrome in CHILDREN (2-6)
- normal glomeruli on LM and Iimmunofluorescence
-
EFFACEMENT OF FOOT PROCESSES ON ELECTRON MICROSCOPE
- DIFFUSE EPITHELIAL FOOT PROCESS EFFACEMENT
- lipid in tubular cells
- usually respond to steroids (cortisol)
7
Q
Focal segmental GlomeruloSclerosis (FSGS)
A
- Proteinuria is defining feature
- PROGRESSIVE GLOMERULAR SCARRING
- early in disease course: focal and segmental –> progress to diffuse and global
- Symtpoms
- HYPERTENSION
- common in African americans
- microscopic HEMATURIA
8
Q
Causes of FSGS
A
- 80% are IDIOPATHIC
- VIRUS associated
- HIV, CMV, EBV, etc
- DRUG-INDUCED associated
- HEROIN, anabolic steroids
9
Q
Pathology of FSGS
A
- LM = SEGMENTAL SCLEROSIS (hyalinosis)
- IF = mild IgM and CS or negative
- EM = diffuse epithelial cell injury (foot process effacement)
10
Q
Membranous glomerulopathy
A
- DEPOSITION OF Ag-Ab COMPLEXES
- LM = thickened capillary walls; SPIKES on silver stain
- IF = GRANULAR IgG and C3 along the GBM
- EM = subEPITHELIAL DEPOSITS
SEE POWERPOINT FOR PICS
11
Q
Membranoproliferative GLOMERULONEPHRITIS (MPGN)****
A
- nephrotic syndrome with a nephritic component (hematuria)
- steroids and immunosuppressive drugs are NOT effect
- MESENGIAL HYPERCELLULARITY + CAPILLARY wall remodeling (with the formation of double contours)
- TYPES
- Type I = subendothelial depositis
- Type 2 = intramembranous deposits
- predominant MESANGIAL INVOLVEMENT
12
Q
MPGN TYPE I
A
- LM = TRAM TRACKS (on silver stain)
- IF = granular CS (and often with IgG)
- EM = subendothelial and mesangial depositis (SubENDO vs SubEPI in membranous GN)
- mesangial interpositioning between endothelial cels and GBM
13
Q
MPGN TYPE 2
A
- LM = tram track (on silver stain
- IF = C3 ONLY (NO IgG)
-
EM = INTRAMEMBRANE DEPOSIT
- lamina densa - electron dense material
LOW SERUM C3!!!
14
Q
Acute nephrITIC syndrome
A
- caused by 2 conditions
- DIFFUSE PROLIFERATIVE glomerulonephritis
- ACUTE POST-STREP GN
- CRESCENTIC GLOMERULONEPHRITIS
- Goodpasture’s disease
- lupus nephritis
- ANCA-assocaited diseases
- DIFFUSE PROLIFERATIVE glomerulonephritis
15
Q
Acute glomerulonephritis
A
- Hematuria, azotemia, oliguria, HTN
-
IN CHILDREN after a latent period of 1-3 WEEKS following STREP INFECTION
- POST-INFECTIOUS
- LOW COMPLEMENT 3 LEVELS (vs MPGN)
- 95% of recovery
- LM = diffuse proliferative GN with NEUTROPHILS
- IF = scattered granular (starry sky) IgG, IgM, and CS along GBM and in mesenagium
- EM = SUBEPITHELIAL HUMPS
