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Renal > Nephrotic Syndrome 1 > Flashcards

Nephrotic Syndrome 1 Flashcards

1
Q

What are some key features of nephrotic syndrome?

A

edema, proteinuria, hypoalbuminemia, hyperlipidemia, non- inflammatory, inactive urinary sediment, normal or mild elevation of serum creatine

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2
Q

What is the key cell involved in nephrotic syndrome?

A

visceral epithelial cells – podocytes

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3
Q

What are some key features of nephritic syndrome?

A

acive urinary sediment, dysmorphic RBCs, RBC casts in urine, Inflammation, HTN, elevated serum creatinine, crescents on kidney biopsy

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4
Q

What is the key cell involved in nephritic syndrome?

A

endothelial cell

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5
Q

What two diseases are associated w/ podocyte injury?

A

minimal change disease and focal segmental golmerulosclerosis

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6
Q

What is involved w/ subepithelial space immune complex formation and complement activation?

A

membranous nephropathy and late stage of post-infectious glomerulonephritis

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7
Q

What is associated w/ glomerular capillary wall depostion diseases?

A

amloidosis, light chains deposition disease, diabetic nephropathy

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8
Q

What is involved w/ subendothelial space or mesangial immune complex formation and complement activation? Nephritic syndrome

A
  1. post-infectious glomerulonephritis
  2. IgA nephropathy
  3. lupus nephritis
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9
Q

What is a disorder that has Ab’s directed at the glomerular BM?

A

goodpastures

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10
Q

What can lead to necrotizing injury and inflammation of vascular and GCW?

A

ANCA diseases

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11
Q

What is associated w/ IgA nephropathy?

A

macroscopic hematuria

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12
Q

What are the different clinical presentations of glomerular disease?

A

asymptomatic, macroscopic hematuria, nephrotic syndrome, nephritic syndrome, rapidly progressive glomerulonephritis, and chronic glomerulonephritis

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13
Q

What causes immune complexes to form and get trapped in glomeruli?

A
  1. high plasma flow rate
  2. high intraglomerular pressure
  3. high glomerular hydraulic conductivity
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14
Q

What is the spectrum of immune complex disease dependent on?

A

nature of Ag involved and site of immune complex

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15
Q

If there is generalized edema, what should on look for next?

A

proteinuria

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16
Q

What can been seen in urinary sediment?

A

oval fat bodies and maltese cross

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17
Q

T or F. One can see xanthelasma in nephrotic syndrome.

A

T

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18
Q

How can one make sense of nephrotic and nephritic syndrome if that have some common findings?

A
  1. Nephrotic syndrome - abnormal glomerulus w/out inflammation
  2. Nephritic syndrome – abnormal golmerulus w/ inflammation
19
Q

What are the 3 purposes of a kidney biopsy?

A
  1. diagnosis
  2. prognosis
  3. guide therapy
20
Q

Buzz word - foot process effacement = ?

A

minimal change disease (but not specific)

21
Q

spike and dome = ?

A

membranous nephropathy

22
Q

subepithelial humps =?

A

post-infectious glomerulonephritis

23
Q

tram tracks = ?

A

membranoproliferative glomerulonepritis

24
Q

basketweave = ?

A

alport syndrome

25
Q

wire loops = ?

A

lupus nephritis

26
Q

onion-skin = ?

A

hypertensive nephropathy or scleroderma

27
Q

What are 3 things that are filtration in glomerulus depends on?

A
  1. charge
  2. size
  3. shape of substance
28
Q

Why don’t we normally filter albumin even though it is the right size to be filtered?

A

the podocytes are negatively charged which repels albumin which is also negatively charged

29
Q

What is found in the BM of the glomerulus?

A
  1. laminin
  2. COLLAGE IV
  3. heparan sulfate PGs
  4. integrin
  5. agrin
30
Q

What is the size restriction for filtration?

A
  1. uncharged macromolecules 4nm completely restricted
31
Q

What proteins of the slit diaphragm are involved in proteinuria?

A
  1. podocin
  2. TRPC6
  3. Actinin-4
  4. NEPH-1
  5. Cadherine
  6. FAT
  7. Nephrin
32
Q

What happens to the glomerular permeability in nephrotic syndrome?

A
  1. lower excretion of small MW substances
  2. increased clearance of large MW substances
  3. increased excretion of IgG due to loss of size barrier
33
Q

What is seen w/ glomerular proteinuria?

A

albumin is dominany protein in urine

34
Q

What is seen w/ tubular proteinuria?

A

low MW proteins

35
Q

What protein does urine dipstick measure?

A

albumin

36
Q

How much protein is normally excreted by a healthy kidney?

A

40-80mg/day, 150mg/day is the upper range of normal

37
Q

What is the normal urine albumin/creatinine ratio?

A

<30 mg/g

38
Q

What is an abnormal urine dip stick reading?

A

1+, 2+, 3+

39
Q

What is the standard proteinuria test?

A

24-hr urine collection, normal <150mg

40
Q

What is the general management for primary nephrotic syndrome?

A

Goal is to preserver kidney function

41
Q

How do you treat the proteinuria?

A
  1. Supportive measures involved controling the HTN
  2. Steroids
  3. Immunosuppressive drugs
42
Q

What can be used to control HTN?

A
  1. low salt diet
  2. ACE inhibitor
  3. Angiotensein receptor blocker
43
Q

What is the function of the glomerular capillary wall?

A

selective permeability barrier

44
Q

What 3 layers make up the glomerular capillary wall?

A
  1. endothelium
  2. glomerular BM
  3. podoctyte visceral epithelial cell layer

Renal (33 decks)

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