Kidney/Urinary: nephrotic Flashcards
What is the protein content of nephrotic syndrome
proteinuria greater than 3.5 g/day
what does proteinuria cause in nephrotic syndrome
- hypoalbuminemia
- hypogammaglobulinemia
- hypercoagulable state
- hyperlipidemia and hypercholesterolemia
hypoalbuminemia causes
pitting edema
hypogammaglobulinemia causes
increased risk of infection
hypercoagulable state is caused by
loss of antithrombin III
hyperlipidemia and hypercholesterolemia may cause
fatty casts in urine
What is a common cause of nephrotic syndrome in children
minimal change disease (MCD)
What is the cause of minimal change disease
idiopathic
may be associated with Hodgkin Lymphoma
What is the H&E stain for minimal change disease
normal glomeruli
- lipids may be seen in proximal tubule cells
What does minimal change disease look like in EM
effacement of foot processes
what is the selective proteinuria in minimal change disease
loss of albumin
no loss of immunoglobin
what can used to treat minimal change disease? Why can this be used
steroids
- mediated by cytokines from T cells
Focal segmental glomerulosclerosis (FSGS) is the most common cause of nephrotic syndrome in what cultlures
Hispanics
African Americans
what causes Focal Segmental Glomerulosclerosis (FSGS)
idiopathic
may be associated with HIV, heroin use, sickle cell disease
H&E stain for Focal Segmental Glomerulosclerosis (FSGS)
focal and segmental sclerosis
Focal Segmental Glomerulosclerosis on EM
effacement of foot processes
Focal Segmental Glomerulosclerosis in Immunofluorescence
no immune complex deposits
negative IF
Focal Segmental Glomerulosclerosis can progress to what
chronic renal failure
What is a common cause of nephrotic syndrome in Caucasian adults
membranous nephropathy
what causes membranous nephropathy
idiopathic
may be associated with hepatitis B or C, solid tumors, SLE, drugs ( NSAIDS, penicillamine)
H&E form membranous nephropathy
thick glomerular basement membrane
Immunofluorescence for membranous nephropathy
immune complex deposition
- subepithelial deposits with ‘spike and dome’ appearance
Membranous nephropathy responds poorly to what medication and progresses to what
- steroids
- chronic renal failures
what does Membranoproliferative glomerulonephritis look like on H&E
thick glomerular basement membrane
‘tram-track’ appearance
Membranoproliferative glomerulonephritis on IF
granular due to immune complex deposition
what are the 2 types of membranoproliferative glomerulonephritis
Type I - subendothelial
Type II - dense deposit disease - intramembranous
Type II Membranoproliferative glomerulonephritis is associated with what?
C3 nephritic factor ( autoantibody that stabilizes C3 convertase)
- leading to overactivation of complement, inflammation, and low levels of circulating C3
what medication does not work well with membranoproliferative glomerulonephritis
steroids
chronic renal failure
for Lupus (SLE) what is the most common cause of death
renal failure
what is the most common disorder with in kidneys for SLE
Diffuse proliferative glomerulonephritis
Type I membranoproliferative glomerulonephritis is associated with what
HBV
HCV
( hepatitis B and C)
how does diabetes mellitus impact the kidneys
high serum glucose
- nonenzymatic glycosylation of vascular basement membrane
- hyaline arteriolosclerosis
what is the first change in the kidney in diabetes mellitus
nonenzymatic glycosylation
what arteriole is impacted the most in diabetes mellitus? what does this lead to? which then will lead to what?
glomerular efferent arteriole
- high glomerular filtration pressure
- nephrotic syndrome
characterize nephrotic syndrome
sclerosis of mesangium with formation of Kimmesteil-Wilson nodules
what organ is commonly involved in systemic amyloidosis
kidney
in systemic amyloidosis how do the kidneys get damaged
amyliod deposit sin mesangium, resulting in nephrotic syndrome
what does systemic amyloidosis look like with Congo red staining
apple-green birefringence under polarized light
