Nephrotic Syndrome Flashcards
Nephrotic syndrome occurs when the glomerula of the kidney becomes damaged. The podocytes either become damaged or disappear altogether, increasing how porous the glomerulus is. What can we measure to confirm nephrotic syndrome?
1 - creatinine
2 - urea
3 - protein
4 - glucose
3 - protein
- damage allows large negative proteins to pass through glomerulus
Nephrotic syndrome can be characterised by large volumes of protein in the urine over a 24h period because their is loss of or damage to the podocytes surrounding the basement membrane. How much protein can be lost?
1 - >0.5g/24h
2 - >1.5g/24h
3 - >2.5g/24h
4 - >3.5g/24h
4 - >3.5g/24h
-classed as severe proteinuria
- typically causes hypoalbuminemia (<30 g/L)
- can see this in nephritic syndrome, but we also see haematuria
If a patient presents with hypoalbuminaemia in the absence of proteinuria (>3.5g/24h), which of the following diagnoses should be considered?
1 - Heart failure
2 - Thyroid disease
3 - Liver cirrhosis
4 - Infections
5 - IBD
6 - Malnutrition
7 - all of the above
7 - all of the above
Nephrotic syndrome is damage to the nephrons of the kidneys. In patients with nephrotic syndrome, how can urine appear?
1 - tea like colour
2 - frothy
3 - haematuria
4 - all of the above
2 - frothy
- proteins in the urine causing urine to appear frothy
Nephrotic syndrome is damage to the nephrons of the kidneys. It causes large amounts of protein to be lost in the urine. What can this lead to?
1 - oedema
2 - dehydration
3 - hyperkalaemia
4 - hypernatraemia
1 - oedema
- if albumin is lost then this fluid will move into the interstitial space
Which of the following is NOT typical in the nephrotic syndrome triad?
1 - hyperlipidaemia
2 - oedema
3 - low serum albumin
4 - proteinuria (>3.5g/25h)
1 - hyperlipidaemia
In nephrotic syndrome there is a large loss of proteins in the urine, which is predominantly albumin, which causes oedema. The liver, which produces albumin then increases production of albumin, which subsequently causes what?
1 - hyperglycaemia
2 - hyperlipidaemia/ hypercholesterolemia
3 - hyperalbuminaemia
4 - all of the above
2 - hyperlipidaemia/ hypercholesterolemia
- can be high in serum and urine called Lipiduria
In nephrotic syndrome there is a large loss of proteins in the urine, which is predominantly albumin, which causes oedema. These patients become hyper-coagulable due to loss of coagulation proteins in the urine. Which protein specifically is lost in the urine?
1 - factor III (anti-thrombin)
2 - factor Xa
3 - tissue factor
4 - factor V
1 - factor III (anti-thrombin)
- anti-thrombin III inhibits the coagulation cascade
- patients at increased risk of venous thromboembolism especially in the renal vein
- protein C and S can also be lost
Why are patients with nephrotic syndrome at increased risk of infection?
1 - due to anaemia
2 - due to WBC loss in urine
3 - loss of immunoglobulins in urine
4 - all of the above
3 - loss of immunoglobulins in urine
- typically WBC are lost in nephritic syndrome
Why do patients with nephrotic syndrome often have an abnormal thyroid profile?
1 - due to anaemia
2 - due to WBC loss in urine
3 - auto-antibodies induce apoptosis
4 - loss T4-binding globulin (TBG) in urine
4 - loss T4-binding globulin (TBG) in urine
- just like other proteins the protein transferring T4 is loss in urine
- induces increased activity of the thyroid gland
What is the most common disease causing primary glomerular diseases resulting in nephrotic syndrome in children?
1 - Henoch schonlein purpura (HSP)
2 - Diabetes
3 - Infection
4 - Minimal change disease
4 - minimal change disease
- reason for this in children remains unknown
- normally diagnosed between 1-6y/o
Minimal change disease is the leading cause of nephrotic syndrome, but why is it called minimal change disease?
1 - only moderate change in kidney function and can still cause AKI and CKD
2 - cannot see podocyte effacement on light microscopy
3 - kidney dysfunction does not impact upon patients health
4 - all of the above
2 - cannot see podocyte effacement on light microscopy
Although the exact pathophysiology of minimal change disease remains unknown, which cell has been identified as a potential cause due to a release of cytokines?
1 - mast cells
2 - B cells
3 - T cells
4 - Natural killer cells
3 - T cells
Which condition is minimal change disease often associated with?
1 - leukaemia
2 - hodgkins lymphoma
3 - SLE
4 - pericarditis
2 - hodgkins lymphoma
Although difficult to see from a biopsy on light microscopy, we can diagnose minimal change disease in another way. Which of the following is NOT useful when diagnosing minimal change disease?
1 - oedema
2 - proteinuria
3 - hyperlipidaemia
4 - lipiduria
5 - hypoalbuminaemia
6 - hypogammaglobulinemia
6 - hypogammaglobulinemia
- for some reason it is mainly albumin that is lost in the urine
Which of the following are characteristics of Focal and Segmental Glomerulosclerosis?
1 - sclerosis of the glomerulus
2 - only part of the glomerulus is affected
3 - only some of the nephrons in the kidney are affected
4 - all of the above
4 - all of the above
Although the exact pathophysiology of Focal and Segmental Glomerulosclerosis remains unknown, which of the following is the most common cause?
1 - idiopathic
2 - antigen-immune complexes
3 - cytokines from T cells
4 - all of the above
1 - idiopathic
- thought that glomerula contents leak out and cause sclerosis of glomerulus
