Nephrotic/nephritic syndrome

Question 1

Key clinical features of Nephrotic Syndrome:

Answer 1

1. Prominent edema 2. Proteinuria (>3.5 g/day) 3. INACTIVE urinary sediment 4. NON-inflammatory 5. Normal blood pressure 6. Hypoalbuminemia (

Question 2

Key cells involved in Nephrotic syndrome vs Nephritic syndrome?

Answer 2

Nephrotic: Podocyte Nephritic: Endothelial Cell (mesangial cell)

Question 3

Key clinical features of Nephritic Syndrome:

Answer 3

1. Mild edema 2. Proteinuria and RBC in urine 3. Active Urinary sediment - Dysmorphic RBVc and RBC casts 4. Inflammatory 5. Hypertension

Question 4

Mechanisms and examples of diseases that present with Nephrotic syndrome?

Answer 4

1. 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

Question 5

Mechanisms and examples of diseases that present with Nephritic syndrome?

Answer 5

1. 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

Question 6

Factors that predispose to immune complex entrapment and formation:

Answer 6

1. High Plasma flow rate 2. High intraglomerular pressure 3. High Glomerular hydraulic permeability

Question 7

The spectrum of immune complex disease is dependent on what 2 factors>

Answer 7

1. Nature of antigen involved 2. Site of immune complex deposition

Question 8

What are the sites of immmune complex deposition (5)

Answer 8

1. Subepithelial 2. Membranous 3. Subendothelial 4. Mesangial 5. Basement membrane

Question 9

Subepithelial deposits of immune complex is associated with what glomerular syndrome?

Answer 9

Nephrotic = Subepithelial deposits

Question 10

Disease with subepithelial deposits of immune complexes?

Answer 10

(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)

Question 11

Disease with subendothelial and mesangial deposits of immune complexes?

Answer 11

(Nephritic syndrome) 1. Focal or diffuse proliferative SLE 2. Post-infectious glomerulonephritis (early stage) 3. IgA nephropathy (prominently in mesangium)

Question 12

Name 3 diseases associated with these clinical presentations: 1. Urine protein > 3.5 g/day 2. Hypoalbuminemia (

Answer 12

1. Membranous Nephropathy 2.Minimal change disease 3. Focal segmental glomerulosclerosis (disease of nephrotic syndrome)

Question 13

Name 2 diseases associated with these clinical presentations: 1. Renal failure over day/weeks 2. proteinuria (

Answer 13

1. ANCA vasculitis 2. Lupus nephritis (rapidly progressive glomerularnephritis)

Question 14

Name 2 diseases associated with these clinical presentations: 1. Hypertension 2. Renal Insufficiency 3. Proteinuria (often > 3g/day) 4. Shrunken smooth kidney

Answer 14

1. Diabetic Nephropathy 2. Hypertensive nephropathy (Chronic glomerularnephritis diseases)

Question 15

Name these two Urinary sediments. Which glomerular syndrome are these found in? Insert pic!

Answer 15

A = Oval Fat bodies B. Maltese Cross Nephrotic Syndrome

Question 16

Syndrome associated with an abnormal glomerulus without inflammation?

Answer 16

Nephrotic syndrome

Question 17

Syndrome associated with an abnormal glomerulus with inflammation?

Answer 17

Nephritic syndrome

Question 18

Buzz word association game: Foot process effacement (on electron microscopy)

Answer 18

Minimal Change Disease

Question 19

Buzz word association game: Spike and Dome (on electron microscopy)

Answer 19

Membranous Nephropathy

Question 20

Buzz word association game: Subepithelial humps (on electron microscopy)

Answer 20

Post-infectious Glomerulonephritis

Question 21

Buzz word association game: Tram tracks

Answer 21

Membranoproliferative Glomerulonephritis

Question 22

Buzz word association game: Basket weave

Answer 22

Alports Syndrome

Question 23

Buzz word association game: Wire Loops

Answer 23

Lupus Nephritis

Question 24

Buzz word association game: Onion-Skin

Answer 24

1. Hypertensive nephropathy or 2. Scleroderma

Question 25

Function of the golmerular filtration barrier?

Answer 25

Prevents the filtration of from blood elements and proteins into the urinary space pf bowman’s capsule - selecticity based on: Charge, size and shape

Question 26

Selectivity of golmerular filtration barrier for proteins:

Answer 26

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

Question 27

Type of Proteinuria (seen with any glomerulonephritis) in which albumin is the dominant protein in the urine?

Answer 27

Glomerular

Question 28

Type of Proteinuria in which LMW proteins are seen?

Answer 28

Tubular -secondary to tubulointerstitial disease

Question 29

Type of Proteinuria in which production and hence filtration exceeds the reabsorption capacity?

Answer 29

Overflow e.g. Multiple myeloma

Question 30

What protein does the urine dipstick measure?

Answer 30

ALBUMIN! normal = absent abnormal = 1+, 2+, 3+

Question 31

Normal range for proteinura?

Answer 31

40-80 mg/day in healthy individual -150mg/day is upper range of normal

Question 32

Nephrotic range of proteinuria? (High yield) - 24-hour urine collection? - Spot urine protein creatinine ratio?

Answer 32

• 24-hour urine: > 3.5g - Spot urine protein creatinine ratio: >3.5

Question 33

General management for primary nephrotic and nephritic syndromes? - prognosis based on?

Answer 33

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)