Nephrotic syndrome

Question 1

What is the GFB made of?

Answer 1

Fenestrated capillaries
Basement membrane
Podocytes and their foot processes

Question 2

What is the barrier supposed to keep out?

Answer 2

RBC, WBC, proteins

Question 3

There are two diseases that make up glomerular nephritis. What happens in nephrotic syndrome?

Answer 3

Podocytes are damaged/effaced

Podocyte injury → podocyte effacement → proteinuria (3.5g lost per day)

Question 4

What are three things lost?

Answer 4

Albumin
Antithrombin III
Immunoglobulins

Question 5

What happens when the liver tries replacing lost albumin?

Answer 5

Production of lipoproteins LVL and VLDL. These can end up in the urine causing lipiduria.

Question 6

Hypoalbuminemia symptoms?

Answer 6

Edema: ankles, ascites, peri orbital
RAAS activation

Question 7

What happens when RAAS is activated?

Answer 7

Increased BP and Na+/H2O retention, worsening edema

Question 8

What happens in low antithrombin III?

Answer 8

Less anti-clot potential, therefore increased risk of clot and CVA, renal vein thrombosis, DVT, PE

Question 9

Low immunoglobulins cause?

Answer 9

Increased risk of infection, strep pneumoniae

Question 10

Causes of nephrotic syndrome? (5)

Answer 10

1. Minimal change disease
2. Membranous nephropathy
3. Focal segmental glomerular sclerosis
4. Diabetic nephropathy
5. Amyloid nephropathy

Question 11

Minimal change disease cause?

Answer 11

1˚ = idiopathic
2˚ = NSAIDS, Hodgkin’s lymphoma, infection
T cells produce cytokines that attack podocytes.

Question 12

Membranous nephropathy?

Answer 12

1˚ = anti PLA2 receptor antibody
2˚ = HBV, HCV, syphilis
immune complex deposition in podocytes = complement activation = damage to podocytes + GBM thickening (spike and dome pattern)

Question 13

FSGS?

Answer 13

1˚ = idiopathic
2˚ = HIV, heroin, sickle cell
Hyalinosis and sclerosis of GFB = effacement

Question 14

Diabetic nephropathy?

Answer 14

Most common cause of nephropathy.
increased blood sugar → efferent arteriole hyaline arteriosclerosis → increase in intraglomerular barrier pressure → increase in GFR → increase in GBM thickening + sclerosis → podocyte stretching → CKD

Question 15

Amyloid nephropathy?

Answer 15

AL (L for light chain) in multiple myeloma

Any inflammatory disease, such as rheumatoid arthritis.

increase in abnormal proteins → deposit in podocyte causing inflammation → GBM thickening + sclerosis

Question 16

Which disease wont progress to CKD?

Answer 16

MCD

Question 17

Urinalysis and microscopy, difference between nephritic and nephrotic?

Answer 17

Nephrotic → 3+ protein (greater than 3.5g/day), lipiduria (fat oval bodies)

Nephritic → 1+ protein, RBC (RBC casts), WBC

Question 18

24 hour urine protein or UARC (spot)

Answer 18

Nephrotic → greater than 3.5g/day loss

Nephritic → less than 3.5g/day loss

Question 19

Serum albumin and lipid panel in nephrotic?

Answer 19

Low albumin, high lipids in blood.

Question 20

Treatment of proteinuria, hyperlipidemia, edema, hypercoagulable state, infection risk?

Answer 20

1. proteinuria → ace inhibitor/arb lowers BP therefore GFR therefore protein loss
2. hyperlipidemia → diet change, statins
3. edema → diuretics, fluid restriction, sodium restriction
4. hypercoagulable state (antithrombin 3 loss) → anticoagulants
5. increased infection risk → vaccine