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NYCC Visceral Pathology > Nephrotic & Nephritic Syndromes > Flashcards

Nephrotic & Nephritic Syndromes Flashcards

1
Q

nephrotic syndrome

Increased ___ allows loss of protein from plasma into the urine

A

glomerular capillary permeability

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2
Q

nephrotic syndrome

Increased glomerular capillary permeability allows loss of…

A

protein from plasma into the urine

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3
Q

Nephrotic syndrome may be subclassified as…

A

primary vs secondary

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4
Q

Primary nephrotic syndrome results from ___
Secondary nephrotic syndrome is secondary to ___

A

Primary results from primary glomerular disease unrelated to a systemic disease
Secondary is secondary to systemic disease that affects other organs as well as the kidneys

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5
Q

What is the most common cause of secondary nephrotic syndrome in adults?

A

Diabetic glomerulosclerosis

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6
Q

Diabetic glomerulosclerosis is characterized by ___, ___, and ___

A

proteinuria, hypoalbuminemia, and edema

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7
Q

How does glomerular damage lead to proteinuria and hypoproteinemia?

A

Increased permeability of glomerular capillaries to protein

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8
Q

nephrotic syndromes

Proteinuria and hypoproteinemia can lead to decreased plasma oncotic pressure
What is the result of this?

A

Edema

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9
Q

What causes 90% of primary nephrotic syndrome cases in children younger than 5?

A

Minimal change disease

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10
Q

nephrotic syndromes

Minimal change disease involves extensive fusion of…

A

podocyte cell foot processes of epithelial cells

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11
Q

What is the most common cause of primary glomerular diseases in adults?

A

Focal segmental glomerulosclerosis

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12
Q

What is the pathology that involves segmental obliteration of glomerular capillaries by accumulation of acellular matrix and hyaline deposits, along with adhesion to the Bowman capsule?

A

Focal segmental glomerulosclerosis (nephrotic)

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13
Q

nephrotic syndromes

Focal segmental glomerulosclerosis involves segmental obliteration of ___ by ___

A

obliteration of glomerular capillaries by accumulation of acellular matrix and hyaline deposits

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14
Q

nephrotic syndromes

Focal segmental glomerulosclerosis involves segmental obliteration of glomerular capillaries by accumulation of acellular matrix and hyaline deposits
It also involves adhesion to ___ and fusion of ___

A

adhesion to Bowman capsule and fusion of diffuse foot process

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15
Q

nephrotic syndromes

Focal segmental glomerulosclerosis is associated with which patients?

A

IV drug users and HIV-infected patients

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16
Q

nephrotic syndromes

Membranous glomerulonephritis reflects ___ accumulation in glomerular capillaries

A

subepithelial immune complex

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17
Q

What is the most common primary glomerular cause of nephrotic syndrome in white and Asian adults in the US?

A

Membranous glomerulonephritis

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18
Q

Which nephrotic syndrome involves extensive fusion of podocyte cell foot processes of epithelial cells and primarily affects children?

A

Minimal change disease

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19
Q

Which nephrotic syndrome involves accumulation of acellular matrix and hyaline deposits, adhesion to the Bowman capsule, and fusion of diffuse foot processes?

A

Focal segmental glomerulosclerosis

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20
Q

Which nephrotic syndrome reflects subepithelial immune complex accumulation in glomerular capillaries?

A

Membranous glomerulonephritis

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21
Q

What sort of hematuria and proteinuria may exist with nephritic syndrome?

A

Hematuria may be microscopic or grossly visible; proteinuria varies

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22
Q

Nephritic syndrome involves a ___ GFR

A

decreased

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23
Q

What are the results of decreased GFR caused by nephritic syndrome?

A
  • Elevated blood urea nitrogen and serum creatinine
  • Oliguria
  • Salt and water retention changes
  • Hypertension
  • Edema
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24
Q

What is the etiology of nephritic syndromes?

A

Often due to some immunologic mechanism

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25
Q

nephritic syndromes

What is the most common childhood vasculitis?

A

Henoch-Schonlein purpura

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26
Q

nephritic syndromes

Where on the body does Henoch-Schonlein purpura appear?

A

Purpura appears on buttocks

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27
Q

nephritic syndromes

What is the etiology of Henoch-Schonlein purpura?

A

Vascular localization of immune complexes containing mostly IgA

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28
Q

Is minimal change disease nephrotic or nephritic?

A

Nephrotic

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29
Q

Is focal segmental glomerulosclerosis nephrotic or nephritic?

A

Nephrotic

30
Q

Is membranous glomerulonephritis nephrotic or nephritic?

A

Nephrotic

31
Q

Is Henoch-Schonlein purpura nephrotic or nephritic?

A

Nephritic

32
Q

nephritic syndromes

Henoch-Schonlein purpura is identical to ___

A

IgA nephropathy

33
Q

Is Goodpasture’s syndrome nephrotic or nephritic?

A

Nephritic

34
Q

nephritic syndromes

What antibody is found in Goodpasture’s syndrome?

A

Anti-glomerular basement membrane antibody

35
Q

nephritic syndromes

What organs are affected by Goodpasture’s syndrome?
How so?

A

Lungs by hemoptysis and kidneys by hematuria

36
Q

Is IgA nephropathy nephrotic or nephritic?

A

Nephritic

37
Q

nephritic syndromes

IgA nephropathy is also known as ___

A

Berger’s syndrome

38
Q

nephritic syndromes

IgA nephropathy involves ___ containing IgA

A

immune complexes

39
Q

nephritic syndromes

What makes IgA nephropathy and Henoch-Schonlein purpura identical?

A

Immune complexes containing IgA

40
Q

Is acute post-streptococcal glomerulonephritis nephrotic or nephritic?

A

Nephritic

41
Q

nephritic syndromes

What age group is predominantly affected by acute post-streptococcal glomerulonephirits?

A

Children

42
Q

nephritic syndromes

When does acute post-streptococcal glomerulonephritis occur?

A

Weeks after acute infection with S pyogenes (throat or skin)

43
Q

Which nephritic syndrome involves immune complexes depositing within glomerulus containing streptococcal antigen or antibody cross reactivity to glomerular basement membrane?

A

Acute post-streptococcal glomerulonephritis

44
Q

nephritic syndromes

What are the methods by which acute post-streptococcal glomerulonephritis damages the glomerulus?

A
  • ICs deposit streptococcal antigen within glomerulus OR
  • Ab cross reactivity to GBM
45
Q

Is lupus nephritis nephrotic or nephritic?

A

Nephritic

46
Q

nephritic syndromes

What are the characteristics of lupus nephritis?

A

Characteristic butterfly rash on face along with systemic illness

47
Q

nephritic syndromes

What may be found in a blood test of a patient with lupus nephritis?

A

ANA positive

48
Q

nephritic syndromes

Lupus nephritis involves what type of hypersensitivity?

A

Type III hypersensitivity

49
Q

nephritic syndromes

What is deposited in the glomerulus with lupus nephritis?

A

Immune complexes depostion

50
Q

Is hereditary nephritis nephrotic or nephritic?

A

Nephritic

51
Q

nephritic syndromes

The most common form of hereditary nephritis is ___

A

X-linked

52
Q

nephritic syndromes

Hereditary nephritis involves abnormal ___ in glomerular basement membrane

A

type IV collagen

53
Q

nephritic syndromes

What are the results of abnormal type IV collagen in the glomerular basement membrane as seen in hereditary nephritis?

A
  • Mesangial hypercellularity and matrix expansion
  • Focal, followed by diffuse, glomerular sclerosis
54
Q

A male patient presents with hematuria and reports that his hearing is getting progressively worse now.
What is the likely diagnosis related to the kidney?

A

Hereditary nephritis

55
Q

nephritic syndromes

What are some symptoms of hereditary nephritis?

A

Hematuria, followed by progressive hearing impairment

56
Q

A female patient presents with a characteristic butterfly rash on her face and evidence of systemic illness. A blood test reveals she is ANA positive.
What is the likely diagnosis related to the kidney?

A

Lupus nephritis

57
Q

nephritic syndromes

Males with hereditary nephritis eventually develop ___ by ages 40-50

A

end stage renal disease

58
Q

What is the renal pathology involving rapid loss of renal function with glomerular crescent formation?

A

Rapid progressive glomerulonephritis

59
Q

Is rapid progressive glomerulonephritis nephrotic or nephritic?

A

Nephritic

60
Q

nephritic syndromes

What other conditions are associated with rapid progressive glomerulonephritis?

A
  • Goodpasture syndrome
  • Vasculitis demonstrating ANCA
61
Q

nephritic syndromes

What are some clinical features of rapid progressive glomerulonephritis?

A
  • Severe hematuria
  • Red blood cell casts (glomerular crescents)
  • Proteinuria
62
Q

A patient presents reporting sudden changes in their urinating habits. They report a lot of blood in their urine. Upon urinalysis, severe hematuria is confirmed as well as proteinuria. A blood test reveals red blood cell casts.
What is the likely diagnosis?

A

Rapid progressive glomerulonephritis

63
Q

What is the triad of symptoms of Wegener granulomatosis?

A
  • glomerulonephritis
  • necrotizing vasculitis (small/med/visc. aa)
  • upper respiratory involvement including sinuses (sinusitis; NOT asthma)
64
Q

What is the treatment for Wegener granulomatosis?

A

Cyclophosphamide (chemotherapy)
(can be very severe)

65
Q

What patients are affected by Churg-Strauss syndrome?

A

young child with asthma (expiratory wheeze)

66
Q

What are the characteristics of Churg-Strauss syndrome?

A
  • hematuria, low GFR, ^BUN, ^creatinine (nephritic synd.)
  • HTN
  • arteriolar involvement in lungs (biopsy shows eosinophilia)
  • ANCA pos.
67
Q

Which nephritic syndromes drive nephrotic syndrome?

A
  • Goodpasture syndrome
  • IgA nephropathy
  • Henoch-Schonlein pupura
  • Lupus nephritis
  • Acute post-strep. glomerulonephritis
68
Q

Nephritic syndromes that drive nephrotic syndrome fall under what type of nephrotic syndrome?

A

membranous glomerulonephritis

69
Q

Which nephritic syndrome(s) is/are caused by type III hypersensitivity?

A
  • IgA nephropathy
  • Henoch-Schonlein pupura
  • Lupus nephritis
  • Acute post-strep. glomerulonephritis
70
Q

Which nephritic syndrome(s) is/are caused by type II hypersensitivity?

A

Goodpasture syndrome

71
Q

Which nephrotic syndromes are caused by the presence of Anti-neutrophilic cytoplasmic antibodies?

A

(ANCA)
- Wegener granulomatosis
- Churg-Strauss syndrome

NYCC Visceral Pathology (40 decks)

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