Nephrotic Syndrome Flashcards
A 6-year-old child presents with sudden-onset edema and heavy proteinuria. The renal biopsy shows no glomerular changes on light microscopy, negative immunofluorescence, and podocyte effacement on electron microscopy. What is the most likely diagnosis?
A. FSGS
B. Minimal change disease (MCD)
C. Membranoproliferative glomerulonephritis
D. Lupus nephritis
B
In which of the following conditions is minimal change disease commonly associated?
A. Rheumatoid arthritis
B. Hodgkin’s disease
C. Systemic lupus erythematosus
D. Sarcoidosis
B
Which of the following is the first-line treatment for MCD in adults?
A. Cyclosporine
B. Mycophenolate mofetil
C. Prednisone
D. Cyclophosphamide
C
What is the mechanism thought to be responsible for podocyte damage in MCD?
A. Immune complex deposition
B. Complement activation
C. T-cell-mediated injury
D. Antibody-mediated attack on podocytes
C
Which of the following statements regarding the relapse of MCD is TRUE?
A. Relapses occur in only 30% of children after the first remission.
B. Relapse rates decrease after puberty.
C. Relapse is uncommon in adults and usually responds to therapy.
D. Early relapse predicts a favorable long-term outcome.
B
Nil leasion
MCD
MCD on renal biopsy
No glomerular lesion by light microscopy and is negative for deposits by immunofluorescent microscopy
Small amounts of IgM in the mesangium
MCD Pathogenesis
Disturbance related to T-cell response or expression of CD80 or CD40
Presents clinically with the abrupt onset of edema and nephrotic syndrome accompanied by acellular urinary sediment.
MCD
Average urine protein excretion reported in 24 h is 10 g with severe hypoalbuminemia.
MCD
First line of therapy MCD
Prednisone
It refers to a pattern of renal injury characterized by segmental glomerular scars that involve some but not all glomeruli (focal);
FSGS
Represents up to onethird of cases of nephrotic syndrome in adults
FSGS
Treatment of patients with FSGS should include ______.
inhibitors of the renin-angiotensin system
Which of the following histologic findings is characteristic of focal segmental glomerulosclerosis (FSGS)?
A. Global glomerular sclerosis in all glomeruli
B. Segmental glomerular scarring in some glomeruli
C. Membranous deposits with “spikes” on silver stain
D. Endocapillary proliferation with crescent formation
B
Accounts for ~25% of cases of nephrotic syndrome in adults, with a peak incidence between the ages of 30 and 50 years and a male-to-female ratio of 2:1. I
Membranous Glomerulonephritis
The presence of subendothelial deposits or the presence of tubuloreticular inclusions strongly points to a diagnosis of ____
membranous lupus nephritis
Male gender, older age, hypertension, and the persistence of nephrotic-range proteinuria are associated with worse prognosis.
Membranous Glomerulonephritis
A 62-year-old woman with a history of hepatitis B infection presents with nephrotic syndrome. Renal biopsy shows subepithelial deposits on light microscopy. What is the most likely cause of her nephrotic syndrome?
A. Diabetic Nephropathy
B. Membranous Nephropathy (MGN)
C. Minimal Change Disease (MCD)
D. Focal Segmental Glomerulosclerosis (FSGS)
Answer: B. Membranous Nephropathy (MGN
A 45-year-old woman presents with nephrotic syndrome. She is diagnosed with primary membranous nephropathy. What is the most common autoantibody associated with this condition?
A. Anti-GBM antibody
B. PLA2R antibody
C. Anti-dsDNA antibody
D. C3 nephritic factor
B
A 28-year-old man presents with nephrotic-range proteinuria, hematuria, and sensorineural deafness. Renal biopsy reveals areas of thin and thickened GBM with “basket-weave” appearance. What is the most likely diagnosis?
A. Thin Basement Membrane Disease
B. Alport’s Syndrome
C. Membranous Nephropathy
D. Anti-GBM Disease
B
A 40-year-old man with a history of poorly controlled diabetes mellitus presents with proteinuria and declining GFR. Renal biopsy shows mesangial expansion, Kimmelstiel-Wilson nodules, and GBM thickening. What is the most likely diagnosis?
A. Focal Segmental Glomerulosclerosis (FSGS)
B. Diabetic Nephropathy
C. Membranous Nephropathy (MGN)
D. Minimal Change Disease (MCD)
B
“Some patients also develop eosinophilic, PAS+ nodules called Kimmelstiel-Wilson nodules.”
A 48-year-old African American man with hypertension and APOL1 polymorphism presents with nephrotic syndrome. What is the most likely renal lesion?
A. Focal Segmental Glomerulosclerosis (FSGS)
B. Membranous Nephropathy (MGN)
C. Minimal Change Disease (MCD)
D. Diabetic Nephropathy
A
A 50-year-old man presents with nephrotic syndrome and a history of long-standing type 1 diabetes. Which renal lesion is most likely?
A. FSGS
B. Kimmelstiel-Wilson nodules
C. Membranous Nephropathy
D. Minimal Change Disease
B
