Nephrotic and Nephritic syndromes

Question 1

Nephrotic syndrome

Answer 1

>3.5g Proteinuria Hyperlipidemia Fatty casts Thromboembolism (ATIII loss) ^ Risk of infection FSGS, Membranous Nephropathy, Minimal change Dz, Amyloidosis, Membranoprolferative GN, Diabetic Glomerulonephropathy

Question 2

Membranous Nephropathy

Answer 2

Nephrotic LM- diffuse capillary and GBM thickening IF- granular immune deposition EM- Spike and Dome w/SUBEPITHELIAL deposits *Most common 1ary caucasian nephrosis *Anti-phospholipid A2 receptor *HBV, HCV, SLE, TUMOR

Question 3

Minimal Change Dz

Answer 3

Nephrotic LM-Normal EM- Foot process effacement *Kids *infection, immunization etc. *Hodgkins TX: CORTICOSTEROIDS

Question 4

Focal Segmental Glomerulosclerosis

Answer 4

Nephrotic LM- Segmental sclerosis and hyalinosis LM EM- Foot process effacement- Like minimal change AA/Hispanic HIV, SS Dz, Heroin abuse, Obesity, IFN treat, CKD- congenital or removal

Question 5

Membranoproliferative glomerulonephritis

Answer 5

Type I - SubENDOthelial immune complex deposits with granular IF- TRAM TRACK appearance HBV, HCV, Lupis, Subacute bacterial endocarditis Type II -Intramembranous DENSE DEPOSITS. LOW C3

Question 6

Diabetic Glomerulonephropathy

Answer 6

Mesangial expansion with GBM thickening. Eosinophilic nodular glomerulosclerosis “Kimmelstein wilson lesions” Glycosylation of GBM –> Permeability Glycosylation of efferent arterioles—> mesangial expansion

Question 7

Nephritic syndromes

Answer 7

Inflammatory process Hematuria, RBC casts, Azotemia, Oliguria, HTN, and

Question 8

Acute post strep GN

Answer 8

Hypercellular glomeruli with “lumpy bumpy” immune complexes along BM and mesangium SubEPITHELIAL humps on EM cola colored urine, HTN, decreased complement levels

Question 9

RPCGN

Answer 9

Goodpasture Wegener’s GPA Microscopic polyangiitis Crescent moon shaped fibrin, protein, and leukocyte infiltration

Question 10

Diffuse Proliferative GN

Answer 10

SLE/MPGN “Wire looping” of capillaries SubENDOthelial and intramembranous IgG with C3 deposition NEPHROTIC OR NEPHRITIC MOST COMMON CAUSE OF DEATH IN SLE

Question 11

IgA nephropathy

Answer 11

Mesangial proliferation with Mesangial Immune Complexes Henoch- schonnlein purpura URI/ gastroenteritis preceeding Hematuria, RBC casts, arthritis, rash

Question 12

Alport syndrome

Answer 12

IV collagen problem BM thinning Glomerulonephritis, deafness, eye problems “Cant pee, cant see, cant hear high C”