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REGUB > L7: Pathology 4 > Flashcards

L7: Pathology 4 Flashcards

1
Q

Proteinuria is protein that is present in the urine. What specific protein is this normally in relation to?

A

albumin

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2
Q

What numerical value is considered proteinuria?

A

greater or equal to 3.5g/24 hours

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3
Q

What is nephrotic syndrome? (characteristics)

A
  • loss of protein in urine
  • no glomerular inflammation (affects visceral epithelial cells)
  • no increase in BP
  • no haematuria
  • hypoalbuminaemia, oedema, hypercholesterolaemia, hypercoagulable state (thrombophilia)
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4
Q

What are the main effects of nephrotic syndrome? [5]

A
  • proteinuria
  • hypoalbuminaemia
  • oedema
  • hypercholesterolaemia
  • thrombophilia (hypercoagulable state)
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5
Q

List the 5 main causes of Nephrotic Syndrome

A
  1. Minimal Change Disease
  2. Focal and Segmental Glomerulosclerosis
  3. Membranous Glomerulonephritis
  4. Amyloidosis
  5. Diabetes Mellitus
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6
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal Change Disease

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7
Q

What is minimal change disease? (characteristics) What can it cause?

A
  • can cause nephrotic syndrome
  • all ages (esp. children)
  • self limiting // responds well to steroids
  • results from direct injury to foot processes (flattening of foot processes)
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8
Q

What is the underlying pathology/mechanism of minimal change disease?

A

Nephrotic syndrome as a result of direct injury to foot processes (flattening of foot processes)

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9
Q

What can focal and segmental glomerulosclerosis cause? What are the 2 types?

A

can cause Nephrotic Syndrome

  1. Steroid Responsive
  2. Steroid Unresponsive
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10
Q

What is steroid RESPONSIVE FSGS? (characteristics)

A
  • circulating factor thought to cause foot process injury
  • if weaned off steroids, can get it again
  • recurs in transplants
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11
Q

What is steroid UNRESPONSIVE FSGS? (characteristics)

A
  • abnormality/absence of foot process protein (e.g. Nephrin)

- does not recur in transplants

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12
Q

In steroid-unresponsive FSGS, there is usually an abnormality in the foot processes - what abnormality is usually present?

A

abnormality in Nephrin (forming podocyte slit diaphragm)

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13
Q

What is membranous glomerulonephritis? (characteristics) What is targeted?

A
  • causes nephrotic syndrome
  • immune complex deposition disease
  • antigen/target: Phospholipase A2 Receptor (in foot processes)
  • sub-epithelial deposits (“spikes”)
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14
Q

What are some histological findings of membranous glomerulonephritis?

A
  • sub-epithelial deposits
  • spikes
  • thickened basement membranes
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15
Q

Membranous glomerulonephritis is an immune complex deposition disease - what is the antigen targeted?

A

Phospholipase A2 Receptor (abundant in foot processes)

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16
Q

Amyloidoisis can lead to nephrotic syndrome. What are some characteristics of this type of amyloidosis?

A
  • fibrils deposited in mesangium, capillary loops, arterioles + interstitium
  • all types of amyloid may affect kidney (except alzheimer’s)
17
Q

What is the most common type of amyloid seen in the kidney?

A

multiple myeloma/plasma cell dyscrasia

18
Q

How does diabetic nephropathy cause nephrotic syndrome?

A

through glycosylation of lipo-proteins in the mesangium and basement membranes

– this has secondary effects on the epithelial cells

– effects due to mesangial expansion + BM thickening

19
Q

What is a characteristic histological finding of diabetic nephropathy? (hint: micro-aneurysm)

A

Kimmelstein Wilson micro-aneurysm

- seen in nephrotic syndrome caused by diabetes

20
Q

What is nephritic syndrome? (characteristics)

A
  • affects endothelial cells
  • glomerular inflammation
  • haematuria
  • proteinuria
  • often hypertension
  • acute renal failure
21
Q

What is membranoproliferative glomerulonephritis (in relation to the acute nephritic syndrome)?

A
  • immune complex deposition disease
  • chronic disease (chronic endothelial cell injury)
  • chronic inflammation of mesangium and basement membrane
22
Q

What are 3 causes of membranoproliferative glomerulonephritis?

A
  1. C3 Glomerulonephritis
  2. Cryoglobulinaemia
  3. Severe SLE
23
Q

What is cryoglobulinaemia? What kidney condition can it cause?

A
  • in cold temps, immune complexes form that can cause inflammation and block blood vessels
  • can cause membranoproliferative glomerulonephritis

REGUB (22 decks)

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