Nephrotic & Nephritic Syndromes Flashcards
Minimal Change Disease
Nephrotic syndrome Kids 1-7 Podocyte effacement somehow Selective proteinuria- albumin Benign, normal renal funct Good prognosis, use steroids But relapse common Related to Hodgkins Lymphoma
Nephrotic Syndrome
Podocyte problem Proteinuria (>3G/day) Hypoalbuminemia & lose antiThrombin3 protein Generalized edema Lipiduria+Lipidemia (liver make more) Hypercoaguable state
FSGS
Focal Segmental GlomSclerosis
Nephrotic Syndrome Adults continuation of MCD but worse Hypertension, hematuria, decr'd GFR Injury to podocytes Hyaline deposits turn sclerotic in mesangium (plasma proteins and lipid) IgM in hyaline places Secondary to HIV, heroin
Membranous Nephropathy
Nephrotic Syndrome Adults 30-60 Gold, Mercury, NSAIDS Hep B/C, SLE, malignancies Immune complexes "Spike and Dome" appearance
MPGN
MembranoProliferative GlomNephritis
Nephrotic/Nephritic Syndrome
“Tram Track” appearance
Splitting of GBM via mesangial extension
Hypercellular, mesangial prolif, leukocytes
Chronic Hep B/C, SLE, ENDOCARDITIS
MPGN I: Immune complexes and lots IgG, C3, C1q, C4 etc
MPGN II/DDD: Excess complement activation; only have C3; ribbon GBM appearance
Nephritic syndrome
Lots inflammation and hematuria
Acute onset
oliguria, azotemia, and hypertension
Post streptococcal glomerulonephritis
Kids 3 to 4 weeks after a skin/pharyngeal infection... Impetigo Latent time= Ab production Decreased serum C3 hypercellular Subepithelial "humps" Brown urine with RBC casts most people fully recover
Berger’s IgA nephropathy
Older children and young adults after upper respiratory infection
Lots IgA= lots immune complex deposition in mesangium
Usually benign
associated with HSP disease purple spots, abdominal G.I. bleed
Reoccurring hematuria
Hereditary nephritis: Alport syndrome
Mutation in Alpha-5 chain of Type4 collagen GBM, lens of eye, ear cochlea get Eye & ear symptoms
Histologic EM basket weaving appearance
proteinuria “foam cells” LM
X-linked
Hereditary nephritis: Thin basement membrane disease
Really similar to Alport syndrome mutation Alpha3 and Alpha4 Type4 collagen
no eye/ear symptoms
Benign
does not progress to renal failure isolated hematuria
Rapidly progressive Crescentic glomerulonephritis
Severe version of nephritic syndrome hallmark of crescents
severe azotemia, oliguria, hematuria, and hypertension
Anti-GBM Ab glomerulonephritis
Ab against Type4 collagen of GBM
If also damage lung alveoli= Goodpasture syndrome with hemoptysis pulmonary hemorrhage
Large swollen kidney with petechiae treatment plasmapheresis
Linear pattern of IgG and C3
Crescentic with hypercellularity in Bowmans space
Immune complex mediated Crescentic glomerulonephritis
Severe immune complex business i.e. SLE, IgA Bergers nephropathy, post streptococcal glomerulonephritis
Plasmapheresis does not work need to treat with immunosuppressive therapy
Granular pattern of IgG and C3
Pauci-immune Crescentic glomerulonephritis
Has ANCA antineutrophil cytoplasmic anti-bodies
mostly treat with immunosuppressive therapy
systemic vasculitides: wegener’s granulomatosis and polyangiitis
Chronic glomerulonephritis
Kidney gets small and retracted eventually get uremia
lots of hyalinization and sclerotic formation
