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House Clinical Pathology > Nephrotic Syndrome > Flashcards

Nephrotic Syndrome Flashcards

1
Q

Nephrotic syndrome can be a mode of presentation of _______ diseases.

A

glomerular

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2
Q

Nephrotic syndrome

A Clinical syndrome that arises when the ___________ is sufficient to produce __________

A

urinary protein excretion

hypoproteinaemic oedema.

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3
Q

Functional anatomy of the kidney

A (Simple or complex?)

(Unilateral or bilateral?)

____peritoneal organ

A

Complex

bilateral

retro

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4
Q

Functional anatomy of the kidney

involved in:
______ of water & solute
 Regulation of —— and ____
concentration
 Maintenance of ______ balance
 Serve as ________ organ

A

Excretion

salt & water

acid base

an endocrine

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5
Q

Each kidney weighs about ________

The functional unit is the ______

A

150g

nephron

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6
Q

kidney’ nephron is divided into:

 The ______
 The ______
 The ______
 The ______

A

glomerulus

tubules

interstitium

blood vessels

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7
Q

GLOMERULUS

Consists anastomosing network of ______

A

capillaries

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8
Q

GLOMERULUS

lined by _________ —————

A

fenestrated endothelium

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9
Q

GLOMERULUS

The _______ epithelium (separated from the endothelial cells by the _______)

A

visceral

Glomerular basement membrane

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10
Q

GLOMERULUS

The ______ epithelium (situated on the ____________ & lines the _________)

A

parietal

Bowman’s capsule

urinary space

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11
Q

The filtration barrier consists of:

Thin layer of ______________

___________

_________

A

fenestrated endothelial cells

Glomerular basement membrane(GBM)

The podocytes

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12
Q

The Glomerular basement membrane(GBM)

lamina rara _____
lamina rara ______
lamina rara ______

A

densa

interna

externa

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13
Q

This filtration barrier function by discriminating against:
The _____ of the filtrate
The _____

A

size

Charge

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14
Q

This filtration barrier function by discriminating against:

The charge, accounted for by

__________ of the capillary wall

The _____ and _______ structure of the GBM

The many ________ present within the wall

A

Complex structure

collagenous porous & charged

anionic moieties

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15
Q

GBM consists of :

________
_______
_________
_________

A

type IV collagen
laminin
heparan sulphate
fibronectin

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16
Q

Type ___ collagen in ____ forms a network of structures to which _______

A

IV

GBM

other proteins attach.

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17
Q

________________

Aka heparan sulphate

A

polyanionic proteoglycan

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18
Q

Filtration barrier

The _____ serve as antigens & their genetic defects underlie some forms of _______.

A

glycoproteins

nephritis

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19
Q

The filtration barrier

The visceral epithelial cells(_____) are structurally (simple or complex?) with interdigitations embeded on _______

A

podocytes

Complex

lamina rara externa

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20
Q

The filtration barrier

Adjacent foot processes forms _________ bridged by ____________.

A

filtration slits

thin diaphragm

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21
Q

Mechanisms of glomerular injury
Pathogenesis linked to:

Genetic mutation –______ type mutation of ______; _____ syndrome (________ mutation)

Systemic _________ and ________

A

finnish; podocin

Alport; type 4 collagen

hypertension & atherosclerosis

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22
Q

Mechanisms of glomerular injury
Pathogenesis linked to:

Diabetes mellitus

__________ /________ reaction

Local activation of ________, etc

A

Hypersensitivity/ auto immune

T cell-like receptors

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23
Q

Nephrotic syndrome is a (specific or non-specific?) disorder in which the _____ are damaged, causing them to ________

A

non-specific

kidneys

leak large amounts of protein.

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24
Q

Nephrotic syndrome is 15 times more common in (children or adults ?) than in (children or adults?)

A

Children

Adults

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25
Q

Nephrotic syndrome

______ and ______ have higher incidence compared to ______
.

A

Hispanics and Africans

Caucasians

26
Q

CRITERIA for nephrotic syndrome

Proteinuria (>___g/day)
Hypoalbuminemia (< ___g/L)
___________

_________
_____________ state

A

3

25

Hyperlipidemia

Oedema

Hypercoagulation

27
Q

PATHOPHYSIOLOGY of nephrotic syndrome

Filtration of (low or high ?) molecular weight (cationic or anionic?) plasma proteins across the glomerular basement membrane is normally prevented by a _______ charged ________ of ____________ of _______

A

Low

anionic

negatively charged filtration barrier

proteoglycan molecules of heparan sulfate.

28
Q

PROTEINURIA in nephrotic syndrome

____eased charge selective properties of GBM
Altered ______ of foot processes of podocytes

A

Decr

slit diaphragm

29
Q

PROTEINURIA in nephrotic syndrome

Index of severity of glomerular lesion

Early (______)

-_______ (65kDa)
-_________
-_________ (80kDa)

Late (_______)
–____ (160kDa)

A

Selective

Albumin

Alpha 1-antitrypsin

Transferrin

Non-selective; IgG

30
Q

HYPOALBUMINAEMIA in nephrotic syndrome

___ loss of albumin

increased ______ of albumin

A

urinary

catabolism

31
Q

OEDEMA in nephrotic syndrome

Classical, due to reduced ________

Accumulation of ↑____+ in interstitial compartment and urine Na+ output.

A

oncotic pressure

Na

32
Q

OEDEMA in nephrotic syndrome

Accumulation of ↑Na+ in interstitial compartment and urine Na+ output. Evidence of this –
(1)__________ observed even before fall in the __________
(2) intravascular volume is _____________ in most patients with nephrotic syndrome

A

Na+ retention; serum albumin

normal or even increased

33
Q

Oedema in nephrotic syndrome

Starling forces are _____ in nephrotic syndrome until ____ in the disease because ____________ remains equivalent to _________

A

unchanged

late

interstitial fluid HP

plasma OP

34
Q

Oedema in nephrotic syndrome

sites of renal sodium retention are predominantly in the (proximal or distal?) nephron, not in the (proximal or distal?) nephron, as is expected by changes in _______

A

Distal

Proximal

Starling forces

35
Q

HYPER-CHOLESTEROLAEMIA in Nephrotic syndrome

____________ stimulating protein synthesis in the liver, including the ______

Diminution of _________ caused by reduced plasma levels of _______

A

hypoproteinemia

lipoproteins

lipid catabolism

lipoprotein lipase

36
Q

HYPER-CHOLESTEROLAEMIA in nephrotic syndrome

Mild cases, mostly _________

Severe cases, ↑__________→ ____ plasma

——- casts in urine

A

Mild

VLDL (TGs) ; turbid

Fatty

37
Q

Aetiologic classification of nephrotic syndrome

Can either be ______ or _____

A

Congenital

Acquired

38
Q

Aetiologic classification of nephrotic syndrome

Congenital:

-Congenital nephrotic syndrome of the _______ type. Autosomal recessive.

-Gene responsible for this disease entity identified (ie, ____).

A

Finnish; NPHS1

39
Q

Aetiologic classification of nephrotic syndrome

Acquired:
•Primary Causes: _______ aetiologies

•_____disease (e.g. SLE, rheumatoid arthritis, polyarteritis nodosa)

A

Post-infectious

Collagen vascular

40
Q

Histologic Classification of nephrotic syndrome

-__________

_——————

___________

___________

A

Minimal Change Disease (MCD) I

Membranous Nephropathy (MN)

Focal Segmental Glomerulosclerosis (FSGS)
- Diffuse Mesangial Hypercellularity

41
Q

Most common histologicak classification of nephrotic disease is ???

A

Minimal Change Disease (MCD):

42
Q

Histologic Classification of nephrotic syndrome
- Minimal Change Disease (MCD): ____% of (children or adults ?)
- Membranous Nephropathy (MN)-(children or adults?)

A

85

children

adults

43
Q

CLINICAL FEATURES of nephrotic syndrome

  • The most common sign is ______

-______ urine, due to a lowering of the _________ by the severe ______

A

oedema:

Foamy

surface tension

proteinuria

44
Q

CLINICAL FEATURES of nephrotic syndrome

oedema:

_______ oedema
_———— oedema
______ effusion and/or pulmonary ______.
-________

A

Orbital

Pitting pedal

Pleural; edema

Ascites

45
Q

Other clinical features of nephrotic syndrome

•hypertension is common

T/F

A

F

Rare

46
Q

Other clinical features of nephrotic syndrome

•_________ and _______ are uncommon and are seen commonly in nephritic syndrome.

A

Haematuria or oliguria

47
Q

In nephrotic syndrome , there is _____ease of Protein-bound substances eg calcium, thyroxine, cortisol, iron

A

Decrease

48
Q

TREATMENT of nephrotic syndrome

General measures (supportive)
-monitoring __________ and _____ regularly
-fluid _______
-________(IV _______)

A

fluid input/output

BP

restriction

diuretics; furosemide

49
Q

TREATMENT of nephrotic syndrome

Monitoring kidney function: -_____ daily and calculating _____
Prevent and treat any complications

A

EUCs(electrolytes, urea, creatinine)

GFR

50
Q

TREATMENT of nephrotic syndrome

Albumin infusions are generally not used because ______________

A

their effect lasts only transiently.

51
Q

TREATMENT of nephrotic syndrome

Prophylactic ________

Reduce _____ intake to 1000-2000 mg daily

Moderate amount of ___________food

Increase ________ fat intake

A

anticoagulation

sodium

high protein animal

unsaturated

52
Q

Specific treatment of underlying cause

__________ for the glomerulonephritides

Steroids: ______

A

Immunosupression

prednisolone

53
Q

Specific treatment of underlying cause

Relapses by prednisolone __mg/kg/day till urine is ____tive for protein. Then, ___mg/kg/day for ____

2nd line drugs (frequent relapse): ______,_______, or ______

A

2

Negative

1.5; 4weeks
cyclophosphamide, nitrogen mustard or cyclosporin

54
Q

Specific treatment of underlying cause

Stricter ______ control if diabetic.

Blood pressure control: ________

A

blood glucose

ACE inhibitors

55
Q

COMPLICATIONS of nephrotic syndrome

Venous thrombosis: due to ____ of _____ and ______ and the simultaneous increase in ______, especially ___,____,___,____

A

leak

anti- thrombin 3 and plasminogen

clotting factors

I, VII, VIII, X

56
Q

COMPLICATIONS of nephrotic syndrome

Infections: encapsulated bacteria such as. _______ and ______

__________ failure

Pulmonary ____

A

Haemophilus influenzae and Streptococcus pneumonia

Acute renal

edema

57
Q

PROGNOSIS of nephrotic syndrome

Depends on ______

Minimal change disease has (better or worse?) prognosis due to ________

FSGN often leads to _____

Other factors: level of _____, _____ and _______

A

cause

Better ; response to steroids

ESRD

proteinuria; B.P control ; GFR

58
Q

COMPLICATIONS OF nephrotic syndrome

Growth retardation: does not occur in ______. Seen in cases of ___________ or __________.

From ______, _____ (reduced protein intake), and ______ therapy (catabolism).

A

MCNS

relapses or resistance to therapy

proteinuria

anorexia; steroid

59
Q

COMPLICATIONS OF nephrotic syndrome

Vitamin D–binding protein deficiency causing
(1) malabsorption of ______ and development of _____ disease (eg, __________________)

(2) ________ because of impairment in mineralization

Vitamin D deficiency can occur.

A

calcium; bone; osteitis fibrosa cystica

osteomalacia

60
Q

COMPLICATIONS OF nephrotic syndrome

Thyroxine is reduced due to ________

____cytic ______chromic anaemia: Fe-therapy (sensitive or resistant?) .

A

decreased TBG.

Micro; hypo

resistant

House Clinical Pathology (45 decks)

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