Lecture 21.b - Nephrotic Syndrome

Question 1

Normal protein clearance is between ____ and ____ mg/day.

Answer 1

130 and 150mg/day

Question 2

5 criteria for Nephrotic syndrome classification:

1. Proteinuria > _____g/24hrs
2. Serum Albumin < ____g/dL
3. ______
4. Hyper_____
5. Lipiduria

But remember these patients can have NORMAL kidney function!

Answer 2

1. Proteinuria > 3.5g/24hrs
2. Serum Albumin < 3.5g/dL
3. Edema
4. Hyperlipidemia
5. Lipiduria

Question 3

Nephrotic syndrome patients are in a hyper______ state bc of loss of anticoags and increased production pro-coags.

Answer 3

Hypercagulable

Question 4

All Nephrotic Syndrome patients will be treated with ____ or ____ (standard for patients with Proteinuria), AND ____ (remember these patients will have hyper_____, so cholesterol will be high.)

Answer 4

ACE inhibitors or ARBs

Statins

Hyperlipidemia

Question 5

______ mutation, common among African Americans, is an important risk factor for Focal Segmental Glomerulosclerosis.

Answer 5

APO-L1

Question 6

Membranous Nephropathy, the second most common cause of non-diabetic Nephrotic syndrome, can be both Primary or Secondary. Primary is caused mostly by antibodies to ______ receptors (PLA2R) –> affecting podocytes.

Look for _____ (thick or thin?) GBM.

Answer 6

Phospholipase-A2 Receptor (PLA2R)

Thickened GBM

Question 7

Which class of Lupus causes Secondary Membranous Nephropathy Nephrotic Syndrome?

Answer 7

Class V

Question 8

Minimal Change Disease is much more common in ____ (children or adults?) Light microscopy will show normal glomerular structure, but what will EM show?

Answer 8

Children –> peak age between 6-8

EM will show podocyte effacement, despite normal light microscopy imaging.

Question 9

Minimal Change Disease in adults –> look for use of _____, or malignancy (especially ______ _____).

Answer 9

NSAIDs

Hodgkin’s Lymphoma

Question 10

Amyloidosis is a type of Glomerular Deposition Disease that causes Nephrotic Syndrome. Look for it to be identified by positive ____ ____ stain that shows ____ green birefringence.

Answer 10

Congo red stain

Apple Green

Question 11

Diabetic nephropathy –> look for ____ (thick or thin?) GBM and Kimmelsteil-Wilson lesions (nodular lesions in the glomerulus).

On gross imaging, will the kidneys appear large or small?

Answer 11

Thick

Large