nephrotic/nephritic syndromes

Question 1

Complications of nephrotic syndrome include what 5 things?

Answer 1

hypercoaguability due to urinary loss of anticoagulant proteins

hyperlipidemia due to the liver creating more lipoproteins

infection with encapsulated bacteria due to urinary loss of immunoglobulins and opsonization factors

protein malnutrition due to negative nitrogen balance

intravascular volume depletion due to low oncotic pressure

Question 2

How do we combat hypercoaguability in nephrotic syndrome

Answer 2

give prophylactic anticoagulation

Question 3

how do we combat hyperlipidemia in nephrotic syndrome

Answer 3

give statin

Question 4

how do we combat encapsulated bacterial infections in nephrotic syndrome

Answer 4

give prophylactic pneumonococcal vaccination

Question 5

Membranous nephropathy kidney biopsy and electron microscopy findings

Answer 5

kidney biopsy: diffuse glomerular basement membrane thickening, IgG and C3 granular deposits

EM: subepithelial deposits

Question 6

IgA nephropathy occurs after what insult

Answer 6

an upper respiratory infection

Question 7

IgA nephropathy ( neprhitic syndrome) pathogenesis

Answer 7

URI triggers overproduction of an abberent IgA which deposits in the mesangium of the kidney (complement is activated by there is weak complement fixing actvity of IgA so complement levels are normal)

cytokines and inflammation cause endothelial and mesangial proliferation and causes glomerular hypertension and decreased GFR

podocytes are also disrupted and cause increased membrane permeability with hematuria and RBC casts, mild proteinuria