Internal Med 9 Flashcards
What are the general principles 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 nephritic syndrome
- PSGN
- IgA nephropathy
- Alport syndrome
- Rapidly progressive (crescentic) glomerulonephritis
What will you see in biopsy in PSGN
♣ Hypercellular glomeruli
♣ Neutrophils
♣ EM: Immune deposits – subepithelial humps
♣ IF: “starry sky” granular appearance (“lumpy bumpy”)
What lab value might indicate PSGN
♣ Decreased C3 levels (complement is activated and used up)
Describe Henoch Schonlein purpura and what renal disease it is associated with
♣ Palpable purpura on butt and legs
♣ Arthralgias
♣ Abdominal pain
♣ Renal disease - IgA nephropathy
What will you see on biopsy in IgA nephropathy
♣ IgA immune complex deposited in mesangium
♣ Proliferation of mesangial cells
Describe Alport syndrome
o Due to defect in Type IV collagen (basement membrane)
- Leads to splitting of the basement membrane longitudinally
o Presents as isolated hematuria, sensory hearing loss, and ocular disturbances
♣ “Can’t see, can’t pee, can’t hear high C”
What are the 4 causes of rapidly progressive (crescentic) glomerulonephritis
- Goodpastures
- Granulomatosis with polyangiitis (Wegener’s)
- Microscopic polyangiitis
- Diffuse proliferative glomerulonephritis
Describe Goodpasture’s syndrome
• Type II HSR – antibodies against glomerular basement membrane
o Deposits comprised of IgG and C3
• Linear IF pattern
• Affects kidneys and the lungs (alveolar basement membrane)
• Presents as hematuria + hemoptysis
Describe Granulomatosis with polyangiitis
Wegener’s
• Affects kidney, lungs, and upper airway
• c-ANCA
• Negative IF
What is the most common kidney disease in lupus
Diffuse proliferative glomerulonephritis
Describe DPGN
• Anti-dsDNA seen subendothelially and within mesangium
• Granular IF
• Light microscopy – deposits make basement membrane look thick – “wire looping” of capillaries
o THINK: wire lupus
• Often presents as nephrotic + nephritic syndrome
Describe general principles 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 subtypes of nephrotic syndrome
Foot process effacement
- Minimal change disease
- focal segmental glomerulosclerosis
Thickening of basement membrane:
- membranous nephropathy
- membranoproliferative glomerulonephritis
Other
- Diabetic nephropathy
- Amyloidosis
Describe minimal change disease
♣ H&E – normal
♣ EM – foot process effacement
♣ IF – negative
o Most common cause of nephrotic syndrome in children
o Triggered by infections or immunizations
o Treatment – steroids
Describe FSGS
♣ H&E – focal (affects some glomeruli), segmental (affects part of glomerulus)
♣ EM – foot process effacement
♣ IF – negative
o Poor response to steroids
Describe membranous nephropathy
o This is the nephrotic presentation of SLE
o Biopsy:
♣ H&E – thickening of basement membrane
♣ EM – “spike and dome” appearance with subepithelial deposits (IgG and C3)
♣ IF – granular
Describe membranoproliferative glomerulonephritis
• H&E – thick basement membrane with “tram track” appearance
o Due to mesangium proliferating between the basement membrane
o THINK: membranoproliferative = membrane proliferating = 2 membranes
• EM – subendothelial deposits
• IF – granular
Common causes of membranoproliferative glomerulonephritis
♣ Hepatitis B
♣ Hepatitis C
♣ Lupus
♣ Subacute bacterial endocarditis
Biopsy of diabetic nephropathy
o Non-enzymatic glycosylation of basement membrane
o Will show sclerosing of the mesangium with Kimmelstien-Wilson nodules (round acellular nodules)
Describe kidney biopsy of amyloidosis
o Deposits within the mesangium
o Characterized by apple-green birefringence on Congo red staining
What chromosome is involved in CML
o t(9;22) – Philedalphia chromosome
♣ THINK: Carry Mai, Lord, because she is able
• Mai’s birthday is 9/22
• BCR-ABL (because she is able)
What will you see in platelets and RBCs in acute leukemia
o Often associated with pancytopenia
♣ Blasts “crowd out” normal hematopoiesis
Presentation of acute leukemias
- Anemia = low RBC
- Infection/fever = no good WBC
- Bleeding = low platelets
