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Nephrotic Flashcards

1
Q

5 primary renal nephrotic

A

Hereditary Nephrotic Syndromes

Minimal change disease

Focal Segmental Glomerulosclerosis

Membranous nephropathy

Membranoprolifeartive GN

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2
Q

3 systemic nephrotic

A

Diabetes

Amyloid and Light Chain

SLE (membranous)

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3
Q

3 Primary renal Nephritic

A

Post Infectious
IgA
Rapid Progressive GN

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4
Q

2 systemic Nephritic

A 
Vasculitis (ANCA)
Immune Complex (SLE / HSP)
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5
Q

Nephrotic Syndrome - is BV low?

A

No - edema without low BV because primary problem is with salt excretion

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6
Q

5 SIGNS NEPHROTIC

A 
Prtoeinuria
Hypoalbuminemia 
Lipiduria (oval fat bodies)
Hyperlipidemia 
Edema
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7
Q

Complications of nephrotic

A

Hypercoagulable
Infection
Decreased VitD

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8
Q

Management nephrotic

A

ACE-I helps proteinuria (even though drops GFR a tiny bit due to efferent constriction - the drop in proteinuria is worth it)

Low Salt

Diuretics

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9
Q

Most common children

A

MCD

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10
Q

Most common adults

A

Membranous and FSGS

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11
Q

Hereditary nephrotic

presentation

A

infant / child
edema
FtoT
polyhydraminos on ultrasound

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12
Q

Hereditary nephrotic

etiology

A

mutations in nephrin / podocin

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13
Q

Minimal change disease

presentation

A

2-8y/o
edema / ascites / weight gain
normal blood pressure

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14
Q

MCD

Labs

A

renal function normal or slightly depressed

urinalsyis - 4+ protein, hyaline casts, microscopic hematuria (Rare)

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15
Q

MCD associations

A

allergy/atopy
Hodgkins
NSAIDS

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16
Q

MCD Patho

A

circulating permeability factor
leads to podocyte injury
(foot process fusion - expression of CD80 in podocytes)

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17
Q

MCD treatment

A

steroids (prednisone)

short course cytoxan if relapse

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18
Q

MCD
LM
IF
EM

A

LM - normal
IF - negative
EM - foot process fusion

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19
Q

FSGS

Labs

A

renal function normal or slightly depressed

4+ protein, hyaline casts, microscopic hematuria

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20
Q

FSGS associations

A

usually idiopathic

HIV

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21
Q

FSGS pathophsyiology

A

ciruclating factor (unknown)
Viral factor in HIV
APOL1

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22
Q

FSGS treatment

A

steroids - does not respond well to treatment

Calcineurin inhibitors / MMF

23
Q

HIV nephropathy

presents as FSGS - additional characteristics?

A

collapsed glomerular tuft
cystic tubules
tubuloreticular inclusions (reticuloendothelial)

RESPONDS to antivirals

24
Q

Membranous nephropathy

associations

A

cancer / lupus / hepB/ Hg

25
membranous nephropathy | histology
biopsy shows BM thickening - normocellular - granular immune complex deposits that are subepithelial
26
Treatment MN?
Steroids and cytoxin (as is immune complex mediated)
27
GRANULAR DEPOSITS - SUBEPITHEIAL
Membranous
28
what test should you do on patients with membranous?
cancer screen
29
pathogeneis membranous?
Antibody to PLA2R on podocyte which is then shed and lodges in subepithelium -
30
mercury linked to?
membranous
31
HBV linked to?
membranous | deposits contain HBe antigen
32
Membranoproliferative GN | presentation
HTN | Mildly reduced renal function
33
MPGN Type I | associations
HCV (low C3 and C4 AND + RF) low grade infection idiopathic
34
MPGN pathology
GBM thickening hypercellularity granular immune complex deposits (SUBENDOTHELIAL)
35
MPGN treatment
treat HCV | Steroids
36
nephrotic that is HTN
MPGN
37
MPGN type 1 | complement?
low c3 and c4 | classic pathway
38
MPGN type 2 | complement disorder
low c3 normal c4 (because activates alternate) | usually childhood
39
nephrotic syndrome blood anomalies?
in addition to the loss of protein we see hypercholesteremia / hypokalemia / hyponatremai
40
what happens to the glomerulus in nephrotic syndrome?
epithelial cell detachment and BM degradation - loss of polyanion
41
Pathogenesis of Glomerular injury? MCD/FSGS
``` Non-inflammatory circulating factors/Ig's bind GEC membranes and or GBM without fixing complement --> loss of polyanion --> GEC detachment (MCD/FSGS) ```
42
Pathogenesis of Glomerular injury in membranous
Non-inflammatory complement fixing anti-GEC Ab's alternative complement pathway may involve oxidants/proteases
43
``` minimal change nephropathy clinical morph EM IF Tx/Prog ```
``` nephrotic syndrome no change EM - foot process effacment IF negative steroids/good ``` some circulating factor that we don't know - CD80 starts to show
44
FSGS cause treatment
unknown CF can also be due to HIV/Heroine/hyperfiltration in late stage renal disease steroids - relapse common
45
Membranous
``` circulating immunoglobulins attack podocyte PLA2R Subepithelial spikes / bm thickening stain c3/5 - granular BM Steroids ```
46
Membranous 85% idio | 15% other?
bugs drugs tumors rheum
47
MPGN morph path treat
GBM thickening - double countour chronic immune complex subendo deposition IF - Granular GBM STeroid / interferon
48
MPGN common cause
hepB sle cryoglobin
49
what % of amyloidosis cases have renal involvemnet and how does it present?
85% proteinuria - histology shows amorphous pink material in glomeruli and vessels - birefrigenence green - congo red EM - Spaghetti
50
most common cause of esrd
``` diabetes (38%) HTN/Vascular (25%) GN (19%) Interstitial nephritis (4%) PCKD (5%) Other (9%) ```
51
DM | kidney lesions
hyaline arteriolar disease glomerulosclerosis - diffuse or nodular expansion of mesangium BM thickening
52
Kinnelsteil Wilson nodules care characteristic of
glomerular disease in DM
53
Malignant HTN renal disease
vascular insult --> fibrinoid necrosis and hyperplastic arteriolitis - onion --> kidneys release renin exacerbating problem
54
HTN renal disease
finely granular surface scarring - scarred glomeruli | hyaline depot in vessels and medial / intimal thickening

Renal (6 decks)

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