Nephrotic/nephritic syndrome Flashcards
Key clinical features of Nephrotic Syndrome:
- Prominent edema 2. Proteinuria (>3.5 g/day) 3. INACTIVE urinary sediment 4. NON-inflammatory 5. Normal blood pressure 6. Hypoalbuminemia (
Key cells involved in Nephrotic syndrome vs Nephritic syndrome?
Nephrotic: Podocyte Nephritic: Endothelial Cell (mesangial cell)
Key clinical features of Nephritic Syndrome:
- Mild edema 2. Proteinuria and RBC in urine 3. Active Urinary sediment - Dysmorphic RBVc and RBC casts 4. Inflammatory 5. Hypertension
Mechanisms and examples of diseases that present with Nephrotic syndrome?
- Podocyte injury - Minimal change disease - Focal segmental glomerulosclerosis 2. Subepithelial space immune complex formation and complement activation - Membranous nephropathy 3. Glomerular capillary wall deposition disease - amyloidosis - Light change deposition disease - Diabetic nephropathy
Mechanisms and examples of diseases that present with Nephritic syndrome?
- Subendothelial space or mesangial immune complex formation and complement act. - Post-infectious glomerularnephritis - IgA nephropathy - Lupus nephritis 2. Abs directed at the GMB - Anti-GMB disease 3. Necrotizing injury and inflammation of the vascular and glomerular capillary wall (abs against cytoplasmic antigens - ANCAs) - Wegner’s
Factors that predispose to immune complex entrapment and formation:
- High Plasma flow rate 2. High intraglomerular pressure 3. High Glomerular hydraulic permeability
The spectrum of immune complex disease is dependent on what 2 factors>
- Nature of antigen involved 2. Site of immune complex deposition
What are the sites of immmune complex deposition (5)
- Subepithelial 2. Membranous 3. Subendothelial 4. Mesangial 5. Basement membrane
Subepithelial deposits of immune complex is associated with what glomerular syndrome?
Nephrotic = Subepithelial deposits
Disease with subepithelial deposits of immune complexes?
(Nephrotic syndrome) 1. Membranous nephropathy i.) primary cause = idopathic ii.) secondary causes - SLE - Diabetes mellitus (DM) - Hepatitis B - Drugs (gold, penicillamine) 2. Post-infectious glomerulonephritis (late stage)
Disease with subendothelial and mesangial deposits of immune complexes?
(Nephritic syndrome) 1. Focal or diffuse proliferative SLE 2. Post-infectious glomerulonephritis (early stage) 3. IgA nephropathy (prominently in mesangium)
Name 3 diseases associated with these clinical presentations: 1. Urine protein > 3.5 g/day 2. Hypoalbuminemia (
- Membranous Nephropathy 2.Minimal change disease 3. Focal segmental glomerulosclerosis (disease of nephrotic syndrome)
Name 2 diseases associated with these clinical presentations: 1. Renal failure over day/weeks 2. proteinuria (
- ANCA vasculitis 2. Lupus nephritis (rapidly progressive glomerularnephritis)
Name 2 diseases associated with these clinical presentations: 1. Hypertension 2. Renal Insufficiency 3. Proteinuria (often > 3g/day) 4. Shrunken smooth kidney
- Diabetic Nephropathy 2. Hypertensive nephropathy (Chronic glomerularnephritis diseases)
Name these two Urinary sediments. Which glomerular syndrome are these found in? Insert pic!
A = Oval Fat bodies B. Maltese Cross Nephrotic Syndrome
Syndrome associated with an abnormal glomerulus without inflammation?
Nephrotic syndrome
Syndrome associated with an abnormal glomerulus with inflammation?
Nephritic syndrome
Buzz word association game: Foot process effacement (on electron microscopy)
Minimal Change Disease
Buzz word association game: Spike and Dome (on electron microscopy)
Membranous Nephropathy
Buzz word association game: Subepithelial humps (on electron microscopy)
Post-infectious Glomerulonephritis
Buzz word association game: Tram tracks
Membranoproliferative Glomerulonephritis
Buzz word association game: Basket weave
Alports Syndrome
Buzz word association game: Wire Loops
Lupus Nephritis
Buzz word association game: Onion-Skin
- Hypertensive nephropathy or 2. Scleroderma
Function of the golmerular filtration barrier?
Prevents the filtration of from blood elements and proteins into the urinary space pf bowman’s capsule - selecticity based on: Charge, size and shape
Selectivity of golmerular filtration barrier for proteins:
i. HMW Proteins = completelely restricted - (radius > 40 Angstrom) ii. Intermediate MW proteins ~ 1mg/dL -ex: Albumin (Radius = 36 Angstrom) iii. LMW proteins = almost completely unrestricted (Radius
Type of Proteinuria (seen with any glomerulonephritis) in which albumin is the dominant protein in the urine?
Glomerular
Type of Proteinuria in which LMW proteins are seen?
Tubular -secondary to tubulointerstitial disease
Type of Proteinuria in which production and hence filtration exceeds the reabsorption capacity?
Overflow e.g. Multiple myeloma
What protein does the urine dipstick measure?
ALBUMIN! normal = absent abnormal = 1+, 2+, 3+
Normal range for proteinura?
40-80 mg/day in healthy individual -150mg/day is upper range of normal
Nephrotic range of proteinuria? (High yield) - 24-hour urine collection? - Spot urine protein creatinine ratio?
- 24-hour urine: > 3.5g - Spot urine protein creatinine ratio: >3.5
General management for primary nephrotic and nephritic syndromes? - prognosis based on?
Preserve Kidney Function - pronosis/predictor of kidney function: Proteinuria 1. Supportive Measures: - Control HTN (low salt diet, ACEI/ARBs) 2. Tx of the disease - Steroid - immunosuppresive drugs (cyclophosphamide)
