nephrotic syndrome Flashcards
where is the injury of the glomeruli in nephrotic syndrome ?
podocyte injury
what are the different causes of nephrotic syndrome ?
minimal change disease
focal segmental glomerulosclerosis
membranous nephropathy
diabetic
amyloidosis
MPGN
what is the pathology associated with minimal change disease ?
effacement of the docyte ( flattening of the podocytes)
what is the trigger for the effacement of the podocytes ?
cytokines
what disease is highly associated with minimal change disease ?
hodgkin lymphoma
what are the findings on light microscopy vs immuno ve electron microscopy ?
light - no changes
immuno - no changes
electron - effacement of the podocytes
what are the triggers that may be responsible for minimal change disease ?
anything that triggers cytokines release
viral infections (URI)
allergic reaction
recent immunization
what is different about the proteinuria associated with MCD ?
selective proteinuria - only albumin found in the urine
what is the most common cause of nephrotic in children and what is the classic case associated ?
MCD
classically - child with recent URI
what is the treatment for MCD ?
very responsive to steroids
what is the pathology associated with FSCS ?
only parts of the glomeruli are involved with sclerosis ( collagen deposition) , there is collapse of the basement membrane and hyaline deposition
what is seen on electron microscopy in FSGS ?
effacement of the foot processes of the podocytes
FSGS vs minimal change disease ?
FSGS is the more severe version of MCD however FSGS does not respond to steroids
what are the secondary causes associated with FSGS ?
HIV
sickle cell patients
heroin users
patients being treated with interferons - hepatitis C and hep B
loss of nephrons
associated with obesity
what is the pathology associated with membranous nephropthy ?
thick glomerular basement membrane
absence of hypercellularity ( not proliferative)
why is the GBM thick in membranous nephropathy ?
because of the immune complex deposition
what is seen on immuno in membranous nephropathy ?
granular deposits of IgG and C3 staining
what new pattern of the BM is associated with membranous nephropathy ?
spike and dome appearance in the subepithelial deposits ( electron dense deposits)
what staining is best to be used to visualize the spike and dome appearance of the membranous nephropathy ?
silver staining
findings in light microscopy vs immuno vs electron in membranous nephropaty ?
light - thickening of the GBM
electron : subepithelial deposits
immuno : granular IgG/C3
what are the autoantibodies in membranous nephropathy formed against ?
phospholipase A2 receptor (PLA2R)
where is PLAR2 expreesed ?
on podocytes
wat are the secondary causes of membranous nephropathy ?
SLE
DPGN
solid tumors
hep B hep c
nephrotic with lupus ?
membranous nephropathy
