Nephrotic syndrome Flashcards
What lesion can be seen in diabetic nephropathy?
Kimmelstiel-Wilson lesion
What are the 4 main pathologies which cause nephrotic syndrome? Which one has the worst prognosis?
Focal segmental glomerulosclerosis
Minimal change disease (most common in children)
Membranous nephropathy (most common in adults)
Membranoproliferative nephropathy (worst prognosis)
Diabetic glomerulosclerosis
What is the triad in nephrotic syndrome?
Hypoalbuminaemia (< 30g/L)
Oedema
Proteinuria (> 3g/24hr)
Treatment of choice in minimal change disease?
1st line - oral prednisolone
2nd line - cyclophosphamide
What appearance do you see in membranoproliferative nephropathy histology?
Tram-tracking
What is the prognosis like in minimal change disease?
1/3 have one episode
1/3 have infrequent relapses
1/3 have frequent relapses which stop in adulthood
What are the stages of lupus nephritis? Which one has the worse prognosis?
WHO classification class I: normal kidney class II: mesangial glomerulonephritis class III: focal (and segmental) proliferative glomerulonephritis class IV: diffuse proliferative glomerulonephritis class V: diffuse membranous glomerulonephritis class VI: sclerosing glomerulonephritis
Class IV - diffuse proliferative glomerulonephritis has the worst prognosis
What is the appearance of class IV lupus nephritis on histology?
Wire-loop lesions
Name 2 changes you will observe on electron microscopy for minimal change disease
Podocyte fusion
Effacement of podocyte foot processes
What are some causes of minimal change disease?
Idiopathic (most of the time)
Drugs: NSAIDs, rifampicin
Malignancy: Hodgkin’s lymphoma, thymoma
Infectious mononucleosis
What is the prognosis for membranous nephropathy?
1/3 get spontaneous remission
1/3 remain proteinuric
1/3 get ESRF
What is the immunofluorescence like for membranous nephropathy?
positive for phospholipase A2 antibody
What is the electron microscopy appearance for membranous nephropathy?
Basement membrane thickening with subepithelial electron dense deposits.
‘spike and dome’ appearance
What are some causes of membranous nephropathy?
Lupus (most common) Malignancy - lung, colon, haematological (except Hodgkin's) Hep B/C Drugs - penicillamine, gold, captopril
What are some causes of membranoproliferative nephropathy?
Immune complex related:
Cryoglobulinaemia
Infection
Monoclonal gammopathy
C3 glomerulopathy:
genetic or acquired defect in the complement system
Membranoproliferative is in the middle of the spectrum –> has both haematuria and proteinuria
