Nephritic and Nephrotic Syndromes

Question 1

Membranous nephropathy

Answer 1

Nephrotic
LM: diffuse capillary and GBM thickening
EM: spike and dome appearance with subepithelial deposits
IF: granular
Associated with: SLE, drugs, infections, solid tumors

Question 2

Minimal Change Disease

Answer 2

Nephrotic, selective loss of albumin, not globulins
LM: normal
EM: foot process effacement
Associated with: recent infection, immune stimulus. In children.
Responds to corticosteroids.

Question 3

Amyloidosis

Answer 3

Nephrotic
LM: congo red stain shows apple-green birefringence under polarized light.
Associated with: chronic conditions like multiple myeloma, TB, RA

Question 4

Membranoproliferative glomerulonephrosis

Answer 4

Nephrotic or nephritic
Type I: subendothelial IC deposits with granular IF, tram-track appearance from GBM splitting because mesangial ingrowth; associated with HBV, HCV
Type II: intramembranous IC deposits “dense deposits”; associated with C3 nephritic factor.

Question 5

Diabetic glomerulonephropathy

Answer 5

Nephrotic
Nonenzymatic glycosylation (NEG) of GBM, increases permeability and thickens them.
LM- mesangial expansion, GBM thickening, eosinophilic nodular glomerulosclerosis (Kimmelstiel-Wilson lesion)

Question 6

Acute poststreptococcal glomerulonephritis

Answer 6

Nephritic
LM- glomeruli enlarged and hypercellular, neutrophils, “lumpy-bumpy” appearance
EM- subepithelial immune complex (IC) humps
IF- granular eppearance due to IgG, IgM, and C3 deposition along GBM and mesangium

Question 7

Rapidly progressive (crescentic) glomerulonephritis

Answer 7

Nephritic
LM and IF– crescent moon shape. Crescents consist of fibrin and plasma proteins like C3b with glomerular parietal cells, monocytes, and macrophages
Associated with: poor prognosis with days to weeks before renal faiure
Causes: Goodpasture’s syndrome, Granulomatosis with polyangiitis, and microscopic polyangiitis

Question 8

Goodpasture’s syndrome

Answer 8

Nephritic
RPGN
type II hypersensitivity; antibodies to GBM and alveolar basement membrane, linear IF

Question 9

Granulomatosis and polyangiitis

Answer 9

Nephritic
RPGN
c-ANCA (PR3 anca)

Question 10

Microscopic polyangiitis

Answer 10

Nephritic
RPGN
p-ANCA (MPO anca)

Question 11

Diffuse proliferative glomerulonephritis

Answer 11

Nephritic or Nephrotic
LM- wire looping of capillaries
EM- subendothelial and sometimes intramembranous IgG- based ICs often with C3 deposition
IF- granular
Associated with: SLE or MPGN. Most common cause of death in SLE

Question 12

Berger’s disease

Answer 12

Nephritic
IgA nephropathy, related to Henoch-Schonlein purpura
LM- mesangial proliferation
EM- mesangial IC deposits
IF- IgA-based IC deposits in mesangium
Associated with: URI or acute gastroenteritis

Question 13

Alport syndrome

Answer 13

Nephritic
Mutation in type IV collagen, split basement membrane
X-linked
Associated with: glomerulonephritis, deafness, and sometimes eye problems.

Question 14

Focal Segmental Glomerulosclerosis

Answer 14

Nephrotic
LM: segmental sclerosis and hyalinosis
EM: effacement of foot processes
Associated with: HIV, heroin, obesity, interferon treatment, chronic kidney disease (congenital absence or surgical removal)

Question 15

Nephritic syndrome

Answer 15

Inflammatory process
Hematuria, RBC casts in urine
Associated with azotemia, oliguria, hypertension (due to salt retention) and proteinuria less than 3.5g/day

Question 16

Nephrotic syndrome

Answer 16

Massive proteinuria (more than 3.5 g/day, frothy urine), hyperlipidemia, fatty casts, edema.
Associated risk of thromboembolism because you're losing ATIII in urine making you hypercoagulable.  Also increased risk of infection (loss of immunoglobulins)