Nephrotic and nephritic syndromes Flashcards
Characteristics of nephrotic syndrome
>3.5g proteinuria hypoalbuminemia edema hyperlipidema lipiduria
Characteristics of nephritic syndrome
Decreased renal function hypertenaion RBC and RBC casts Edema Proteinuria <3.5g/day
Periorbital edema
nephrotic syndrome.
Maltese crosses on urinalysis
lipiduria characteristic of nephrotic syndrome . “Refractile bodies”
Associated with a hyper coagulable state because of increased coagulation factors, increased platelet aggregation, and decreased ATIII
nephrotic syndrome
Increased risk for bacterial infections
nephrotic syndrome-loss of immunoglobulins and complement components
Normal renal function with 4+ protein on urinalysis and hyaline casts
Minimal change disease (nephrotic syndrome)
Peak incidence 2-6 years old, preference for males
Minimal change disease, nephrotic syndrome
History of allergy
Hodgkins lymphoma
NSAIDs
Minimal Change Disease (a nephrotic syndrome)
Normal light microscopy
negative IF
EM showing foot process fusion
minimal change disease (a nephrotic syndrome
Podocytes strangely expressing CD 80
Minimal change disease (a nephrotic syndrome)
Common in young adults (2-40) and African Americans
FSGS
suPAR
FSGS
Nephrotic syndrome that presents with proteinuria and hypertension. Urinary sediment often has RBCs
FSGS
Nephrotic syndrome associated with heroin usage
FSGS
Nephrotic syndrome associated with HIV
FSGS
nephrotic syndrome that can be idiopathic or related to minimal change disease
FSGS
Collapsing focal and segmental glomerulosclerosis
tubular dilation microcysts
reticuloendothelial inclusions
HIV nephropathy related to FSGS
APO lipoprotein L1 is the pathological factor
FSGS
Antibodies to phospholipase A2 on the podocyte
Membranous nephopathy
Related to gold and mercury drugs
Membranous nephopathy
Solid malignancies/carcinoma (breast, lung, GI tract, renal)
Membranous nephopathy
Immune deposits in the capillary
Membranous nephopathy
The following tests:
- CBC
- CXR, mammogram, stool test for occult blood, -sigmoidoscopy
Should be performed if this disease is suspected
Membranous nephopathy
Chronic HBsAG carriers
responds to interferon
Membranous nephopathy
HCV
Type I MPGN
Low C3
Low c4
Cryos
elevated LFTs
HCV-associated MPGN type 1
Low C3
Low C4
MPGN type I
Low C3
Normla C4
MPGN type II
HG/Pb
Membranous nephropathy
amyloidosis
plasma cell myeloma
lymphoma
Minimal change disease
Pulmonary renal syndrome (pulmonary hemorrhage)
Goodpasture’s
ANCA vasculitis
14-21 days after a GAS infection
post-infectious glomerulonephritis
14-21 days after staphylococcus endocarditis
post-infectious glomerulonephritis
infected vascular prostheses
abscesses or empyema
ventricolatrial shunts
Post-infectious glomerulonephritis
Antibody to strep antigens resulting in circulating immune complexes
post-infectious glomerulonephritis
Light microscopy shows proliferative and exudative GN with infiltration of neutrophils and monocytes
post-infectious glomerulonephritis
IF shows granular deposits of IgG and C3 in sub endothelial, mesangial and subepithelieal locations
post-infectious glomerulonephritis
EM shows “sub epithelial humps”
post-infectious glomerulonephritis
elevated ASO titer
post-infectious glomerulonephritis
IgA immune deposits in mesangium
IgA nephropathy
Light microscopy: increase in mesangial cell number and matrix
IgA nephropathy
EM: mesangial immune deposits
IgA nephropathy
asymptomatic hematuria/microhematuria
nonnephrotic hematuria
nml renal function
IgA nephropathy
Occurs immediately with the onset of viral illness
IgA nephropathy
Skin biopsy shows IgA
Henoch-Schonlein purpura
pupura on arms and legs
Henoch-Schonlein purpura, systemic IgA nephropathy
Histological pattern of proliferation (lobular) and thickening of the GBM
MPGN
Hep C
Cryos
RF low complement
MPGN
Iron deficient anemia
Goodpasture’s or ANCA associated vasculitis
ANCA
pauci0immune small vessel vasculitis
IF demonstrates “full house” C3, IgG, IgM, IgA, and C1qCryoglobulinemic glomerulonephritis
Lupus nephritis
Palpable purpura, arthralgias, generalized weakness
cryoglobulinemia
Skin lesions (palpable purpura), arthritis, GI involvement (colic and bleeding), GN Kid
HSP
focal proliferative necrotizing glomerulonephritis, often with crescents
HSP
SLE is associated most commonly with which type of Glomerulonephopathy?
membranous
Triad of nephritis, deafness, ocular lesions
Alport’s Disease
Basket weave pattern on electron microscopy
Alport’s disease
tubuloreticular body in endothelium
SLE nephritis
Hyaline arteriolar disease
DM
-Medial and intimal thickening
– Hyaline deposition
HTN in renal disease
fibrinoid necrosis and hyperplastic arteriolitis
malignant hypertension manifested in the kidney
- Pericarditis,pleuritis
- Nausea,vomiting, ulcers
- Neurologic: itching, seizures, lethargy, coma • Depressed immune response (infections)
- Platelet dysfunction (bleeding disorders)
- Amenorrhea
uremia
Eosins on a UA
AIN (a type of renal/intrinsic AKI)
BUN/Cr>20
pre renal azotemia
specific gravity > 1.010
pre renal azotemia
specific gravity =1.010 but the kidney is injured
ATN
FENa <1
pre renal azotemia (or rhabdomyolysis or radiocontrast-not prerenal)
FENa >2%
Either intrinsic renal AKI or port renal AKI
isosomotic urine in AKI
Intrinsic renal
High Uosm in AKI (>500)
pre renal azotemia
Pigmented, coarsely granular casts on UA
ATN
Renal tubular epithelial cells (RTEs) on a UA
ATN
AKI: cardiac dysfunction, edema, rales, S3 gallop
pre renal azotemia
Evidence of fever or rash after ampicillin
AIN
AKI: intravascular volume depletion (decreased weight, flat neck veins, postural changes in BP/pulse
Pre renal azotemia
anuria or swings in urine flow rate
post renal obstruction
“Starry sky appearance”
post-infectiousl glomerulonephritis