Kidney/Urinary: nephrotic Flashcards

1
Q

What is the protein content of nephrotic syndrome

A

proteinuria greater than 3.5 g/day

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2
Q

what does proteinuria cause in nephrotic syndrome

A
  1. hypoalbuminemia
  2. hypogammaglobulinemia
  3. hypercoagulable state
  4. hyperlipidemia and hypercholesterolemia
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3
Q

hypoalbuminemia causes

A

pitting edema

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4
Q

hypogammaglobulinemia causes

A

increased risk of infection

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5
Q

hypercoagulable state is caused by

A

loss of antithrombin III

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6
Q

hyperlipidemia and hypercholesterolemia may cause

A

fatty casts in urine

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7
Q

What is a common cause of nephrotic syndrome in children

A

minimal change disease (MCD)

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8
Q

What is the cause of minimal change disease

A

idiopathic

may be associated with Hodgkin Lymphoma

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9
Q

What is the H&E stain for minimal change disease

A

normal glomeruli

- lipids may be seen in proximal tubule cells

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10
Q

What does minimal change disease look like in EM

A

effacement of foot processes

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11
Q

what is the selective proteinuria in minimal change disease

A

loss of albumin

no loss of immunoglobin

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12
Q

what can used to treat minimal change disease? Why can this be used

A

steroids

- mediated by cytokines from T cells

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13
Q

Focal segmental glomerulosclerosis (FSGS) is the most common cause of nephrotic syndrome in what cultlures

A

Hispanics

African Americans

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14
Q

what causes Focal Segmental Glomerulosclerosis (FSGS)

A

idiopathic

may be associated with HIV, heroin use, sickle cell disease

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15
Q

H&E stain for Focal Segmental Glomerulosclerosis (FSGS)

A

focal and segmental sclerosis

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16
Q

Focal Segmental Glomerulosclerosis on EM

A

effacement of foot processes

17
Q

Focal Segmental Glomerulosclerosis in Immunofluorescence

A

no immune complex deposits

negative IF

18
Q

Focal Segmental Glomerulosclerosis can progress to what

A

chronic renal failure

19
Q

What is a common cause of nephrotic syndrome in Caucasian adults

A

membranous nephropathy

20
Q

what causes membranous nephropathy

A

idiopathic

may be associated with hepatitis B or C, solid tumors, SLE, drugs ( NSAIDS, penicillamine)

21
Q

H&E form membranous nephropathy

A

thick glomerular basement membrane

22
Q

Immunofluorescence for membranous nephropathy

A

immune complex deposition

- subepithelial deposits with ‘spike and dome’ appearance

23
Q

Membranous nephropathy responds poorly to what medication and progresses to what

A
  • steroids

- chronic renal failures

24
Q

what does Membranoproliferative glomerulonephritis look like on H&E

A

thick glomerular basement membrane

‘tram-track’ appearance

25
Membranoproliferative glomerulonephritis on IF
granular due to immune complex deposition
26
what are the 2 types of membranoproliferative glomerulonephritis
Type I - subendothelial | Type II - dense deposit disease - intramembranous
27
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
28
what medication does not work well with membranoproliferative glomerulonephritis
steroids | chronic renal failure
29
for Lupus (SLE) what is the most common cause of death
renal failure
30
what is the most common disorder with in kidneys for SLE
Diffuse proliferative glomerulonephritis
31
Type I membranoproliferative glomerulonephritis is associated with what
HBV HCV ( hepatitis B and C)
32
how does diabetes mellitus impact the kidneys
high serum glucose - nonenzymatic glycosylation of vascular basement membrane - hyaline arteriolosclerosis
33
what is the first change in the kidney in diabetes mellitus
nonenzymatic glycosylation
34
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
35
characterize nephrotic syndrome
sclerosis of mesangium with formation of Kimmesteil-Wilson nodules
36
what organ is commonly involved in systemic amyloidosis
kidney
37
in systemic amyloidosis how do the kidneys get damaged
amyliod deposit sin mesangium, resulting in nephrotic syndrome
38
what does systemic amyloidosis look like with Congo red staining
apple-green birefringence under polarized light