Kidney/Urinary: nephrotic

Question 1

What is the protein content of nephrotic syndrome

Answer 1

proteinuria greater than 3.5 g/day

Question 2

what does proteinuria cause in nephrotic syndrome

Answer 2

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

Question 3

hypoalbuminemia causes

Answer 3

pitting edema

Question 4

hypogammaglobulinemia causes

Answer 4

increased risk of infection

Question 5

hypercoagulable state is caused by

Answer 5

loss of antithrombin III

Question 6

hyperlipidemia and hypercholesterolemia may cause

Answer 6

fatty casts in urine

Question 7

What is a common cause of nephrotic syndrome in children

Answer 7

minimal change disease (MCD)

Question 8

What is the cause of minimal change disease

Answer 8

idiopathic

may be associated with Hodgkin Lymphoma

Question 9

What is the H&E stain for minimal change disease

Answer 9

normal glomeruli

- lipids may be seen in proximal tubule cells

Question 10

What does minimal change disease look like in EM

Answer 10

effacement of foot processes

Question 11

what is the selective proteinuria in minimal change disease

Answer 11

loss of albumin

no loss of immunoglobin

Question 12

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

Answer 12

steroids

- mediated by cytokines from T cells

Question 13

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

Answer 13

Hispanics

African Americans

Question 14

what causes Focal Segmental Glomerulosclerosis (FSGS)

Answer 14

idiopathic

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

Question 15

H&E stain for Focal Segmental Glomerulosclerosis (FSGS)

Answer 15

focal and segmental sclerosis

Question 16

Focal Segmental Glomerulosclerosis on EM

Answer 16

effacement of foot processes

Question 17

Focal Segmental Glomerulosclerosis in Immunofluorescence

Answer 17

no immune complex deposits

negative IF

Question 18

Focal Segmental Glomerulosclerosis can progress to what

Answer 18

chronic renal failure

Question 19

What is a common cause of nephrotic syndrome in Caucasian adults

Answer 19

membranous nephropathy

Question 20

what causes membranous nephropathy

Answer 20

idiopathic

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

Question 21

H&E form membranous nephropathy

Answer 21

thick glomerular basement membrane

Question 22

Immunofluorescence for membranous nephropathy

Answer 22

immune complex deposition

- subepithelial deposits with ‘spike and dome’ appearance

Question 23

Membranous nephropathy responds poorly to what medication and progresses to what

Answer 23

• steroids

- chronic renal failures

Question 24

what does Membranoproliferative glomerulonephritis look like on H&E

Answer 24

thick glomerular basement membrane

‘tram-track’ appearance

Question 25

Membranoproliferative glomerulonephritis on IF

Answer 25

granular due to immune complex deposition

Question 26

what are the 2 types of membranoproliferative glomerulonephritis

Answer 26

Type I - subendothelial | Type II - dense deposit disease - intramembranous

Question 27

Type II Membranoproliferative glomerulonephritis is associated with what?

Answer 27

C3 nephritic factor ( autoantibody that stabilizes C3 convertase) - leading to overactivation of complement, inflammation, and low levels of circulating C3

Question 28

what medication does not work well with membranoproliferative glomerulonephritis

Answer 28

steroids | chronic renal failure

Question 29

for Lupus (SLE) what is the most common cause of death

Answer 29

renal failure

Question 30

what is the most common disorder with in kidneys for SLE

Answer 30

Diffuse proliferative glomerulonephritis

Question 31

Type I membranoproliferative glomerulonephritis is associated with what

Answer 31

HBV HCV ( hepatitis B and C)

Question 32

how does diabetes mellitus impact the kidneys

Answer 32

high serum glucose - nonenzymatic glycosylation of vascular basement membrane - hyaline arteriolosclerosis

Question 33

what is the first change in the kidney in diabetes mellitus

Answer 33

nonenzymatic glycosylation

Question 34

what arteriole is impacted the most in diabetes mellitus? what does this lead to? which then will lead to what?

Answer 34

glomerular efferent arteriole - high glomerular filtration pressure - nephrotic syndrome

Question 35

characterize nephrotic syndrome

Answer 35

sclerosis of mesangium with formation of Kimmesteil-Wilson nodules

Question 36

what organ is commonly involved in systemic amyloidosis

Answer 36

kidney

Question 37

in systemic amyloidosis how do the kidneys get damaged

Answer 37

amyliod deposit sin mesangium, resulting in nephrotic syndrome

Question 38

what does systemic amyloidosis look like with Congo red staining

Answer 38

apple-green birefringence under polarized light