Nephrotic & Nephritic Syndromes Flashcards
nephrotic syndrome
Increased ___ allows loss of protein from plasma into the urine
glomerular capillary permeability
nephrotic syndrome
Increased glomerular capillary permeability allows loss of…
protein from plasma into the urine
Nephrotic syndrome may be subclassified as…
primary vs secondary
Primary nephrotic syndrome results from ___
Secondary nephrotic syndrome is secondary to ___
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
What is the most common cause of secondary nephrotic syndrome in adults?
Diabetic glomerulosclerosis
Diabetic glomerulosclerosis is characterized by ___, ___, and ___
proteinuria, hypoalbuminemia, and edema
How does glomerular damage lead to proteinuria and hypoproteinemia?
Increased permeability of glomerular capillaries to protein
nephrotic syndromes
Proteinuria and hypoproteinemia can lead to decreased plasma oncotic pressure
What is the result of this?
Edema
What causes 90% of primary nephrotic syndrome cases in children younger than 5?
Minimal change disease
nephrotic syndromes
Minimal change disease involves extensive fusion of…
podocyte cell foot processes of epithelial cells
What is the most common cause of primary glomerular diseases in adults?
Focal segmental glomerulosclerosis
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?
Focal segmental glomerulosclerosis (nephrotic)
nephrotic syndromes
Focal segmental glomerulosclerosis involves segmental obliteration of ___ by ___
obliteration of glomerular capillaries by accumulation of acellular matrix and hyaline deposits
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 ___
adhesion to Bowman capsule and fusion of diffuse foot process
nephrotic syndromes
Focal segmental glomerulosclerosis is associated with which patients?
IV drug users and HIV-infected patients
nephrotic syndromes
Membranous glomerulonephritis reflects ___ accumulation in glomerular capillaries
subepithelial immune complex
What is the most common primary glomerular cause of nephrotic syndrome in white and Asian adults in the US?
Membranous glomerulonephritis
Which nephrotic syndrome involves extensive fusion of podocyte cell foot processes of epithelial cells and primarily affects children?
Minimal change disease
Which nephrotic syndrome involves accumulation of acellular matrix and hyaline deposits, adhesion to the Bowman capsule, and fusion of diffuse foot processes?
Focal segmental glomerulosclerosis
Which nephrotic syndrome reflects subepithelial immune complex accumulation in glomerular capillaries?
Membranous glomerulonephritis
What sort of hematuria and proteinuria may exist with nephritic syndrome?
Hematuria may be microscopic or grossly visible; proteinuria varies
Nephritic syndrome involves a ___ GFR
decreased
What are the results of decreased GFR caused by nephritic syndrome?
- Elevated blood urea nitrogen and serum creatinine
- Oliguria
- Salt and water retention changes
- Hypertension
- Edema
What is the etiology of nephritic syndromes?
Often due to some immunologic mechanism
nephritic syndromes
What is the most common childhood vasculitis?
Henoch-Schonlein purpura
nephritic syndromes
Where on the body does Henoch-Schonlein purpura appear?
Purpura appears on buttocks
nephritic syndromes
What is the etiology of Henoch-Schonlein purpura?
Vascular localization of immune complexes containing mostly IgA
Is minimal change disease nephrotic or nephritic?
Nephrotic
Is focal segmental glomerulosclerosis nephrotic or nephritic?
Nephrotic
Is membranous glomerulonephritis nephrotic or nephritic?
Nephrotic
Is Henoch-Schonlein purpura nephrotic or nephritic?
Nephritic
nephritic syndromes
Henoch-Schonlein purpura is identical to ___
IgA nephropathy
Is Goodpasture’s syndrome nephrotic or nephritic?
Nephritic
nephritic syndromes
What antibody is found in Goodpasture’s syndrome?
Anti-glomerular basement membrane antibody
nephritic syndromes
What organs are affected by Goodpasture’s syndrome?
How so?
Lungs by hemoptysis and kidneys by hematuria
Is IgA nephropathy nephrotic or nephritic?
Nephritic
nephritic syndromes
IgA nephropathy is also known as ___
Berger’s syndrome
nephritic syndromes
IgA nephropathy involves ___ containing IgA
immune complexes
nephritic syndromes
What makes IgA nephropathy and Henoch-Schonlein purpura identical?
Immune complexes containing IgA
Is acute post-streptococcal glomerulonephritis nephrotic or nephritic?
Nephritic
nephritic syndromes
What age group is predominantly affected by acute post-streptococcal glomerulonephirits?
Children
nephritic syndromes
When does acute post-streptococcal glomerulonephritis occur?
Weeks after acute infection with S pyogenes (throat or skin)
Which nephritic syndrome involves immune complexes depositing within glomerulus containing streptococcal antigen or antibody cross reactivity to glomerular basement membrane?
Acute post-streptococcal glomerulonephritis
nephritic syndromes
What are the methods by which acute post-streptococcal glomerulonephritis damages the glomerulus?
- ICs deposit streptococcal antigen within glomerulus OR
- Ab cross reactivity to GBM
Is lupus nephritis nephrotic or nephritic?
Nephritic
nephritic syndromes
What are the characteristics of lupus nephritis?
Characteristic butterfly rash on face along with systemic illness
nephritic syndromes
What may be found in a blood test of a patient with lupus nephritis?
ANA positive
nephritic syndromes
Lupus nephritis involves what type of hypersensitivity?
Type III hypersensitivity
nephritic syndromes
What is deposited in the glomerulus with lupus nephritis?
Immune complexes depostion
Is hereditary nephritis nephrotic or nephritic?
Nephritic
nephritic syndromes
The most common form of hereditary nephritis is ___
X-linked
nephritic syndromes
Hereditary nephritis involves abnormal ___ in glomerular basement membrane
type IV collagen
nephritic syndromes
What are the results of abnormal type IV collagen in the glomerular basement membrane as seen in hereditary nephritis?
- Mesangial hypercellularity and matrix expansion
- Focal, followed by diffuse, glomerular sclerosis
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?
Hereditary nephritis
nephritic syndromes
What are some symptoms of hereditary nephritis?
Hematuria, followed by progressive hearing impairment
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?
Lupus nephritis
nephritic syndromes
Males with hereditary nephritis eventually develop ___ by ages 40-50
end stage renal disease
What is the renal pathology involving rapid loss of renal function with glomerular crescent formation?
Rapid progressive glomerulonephritis
Is rapid progressive glomerulonephritis nephrotic or nephritic?
Nephritic
nephritic syndromes
What other conditions are associated with rapid progressive glomerulonephritis?
- Goodpasture syndrome
- Vasculitis demonstrating ANCA
nephritic syndromes
What are some clinical features of rapid progressive glomerulonephritis?
- Severe hematuria
- Red blood cell casts (glomerular crescents)
- Proteinuria
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?
Rapid progressive glomerulonephritis
What is the triad of symptoms of Wegener granulomatosis?
- glomerulonephritis
- necrotizing vasculitis (small/med/visc. aa)
- upper respiratory involvement including sinuses (sinusitis; NOT asthma)
What is the treatment for Wegener granulomatosis?
Cyclophosphamide (chemotherapy)
(can be very severe)
What patients are affected by Churg-Strauss syndrome?
young child with asthma (expiratory wheeze)
What are the characteristics of Churg-Strauss syndrome?
- hematuria, low GFR, ^BUN, ^creatinine (nephritic synd.)
- HTN
- arteriolar involvement in lungs (biopsy shows eosinophilia)
- ANCA pos.
Which nephritic syndromes drive nephrotic syndrome?
- Goodpasture syndrome
- IgA nephropathy
- Henoch-Schonlein pupura
- Lupus nephritis
- Acute post-strep. glomerulonephritis
Nephritic syndromes that drive nephrotic syndrome fall under what type of nephrotic syndrome?
membranous glomerulonephritis
Which nephritic syndrome(s) is/are caused by type III hypersensitivity?
- IgA nephropathy
- Henoch-Schonlein pupura
- Lupus nephritis
- Acute post-strep. glomerulonephritis
Which nephritic syndrome(s) is/are caused by type II hypersensitivity?
Goodpasture syndrome
Which nephrotic syndromes are caused by the presence of Anti-neutrophilic cytoplasmic antibodies?
(ANCA)
- Wegener granulomatosis
- Churg-Strauss syndrome
