Nephrotic Syndrome

Question 1

Nephrotic Syndrome characteristics?

Answer 1

1. proteinuria
2. hypogammaglobinemia (loss of Ig’s in urine)
3. hypoalbuminemia (loss of albumin in urine)
4. Hypercoag state (loss of ATIII)
5. Hyperlipidemia, hypercholesterolemia

Question 2

why do you see hyperlipidemia and hypercholesterolemia in nephrotic syndrome?

Answer 2

Liver sensed thin blood produces more lipids to compensate

Question 3

Minimal Change Disease

Answer 3

1. most common nephrotic syn. in children
2. EM–effacement of foot processes
3. Only albumin loss (no Ig loss)
4. Good response to steroids (damage is mediated by tcell cytokines)

Question 4

What is Hodgkin’s lymphoma associated with?

Answer 4

Minimal change disease, bc excessive cytokine production damages glomeruli–> MCD

Question 5

Focal Segmental Glomerulosclerosis

Answer 5

1. Nephrotic in AA and hispanics
2. HIV, heroin, sickle cell
3. EM-effacement of foot processes
4. poor response to steroids

Question 6

Membranous nephropathy

Answer 6

1. nephrotic in caucasian adults
2. Hep B/C, SLE, NSAIDS, penicillimane
3. Thick basement membrane layer (H and E)
4. Type III, immune complex dep. (granular IF)
5. sub epithelial deposits (under podocyte foot process)
6. “spike and dome” on EM
7. Poor Response to steroids

Question 7

Membranoproliferative Glomerulonephritis

Answer 7

1. Immune Complex dep, Type III (granular IF)
2. “tram track” appearance
3. 2 types
4. poor response to steroids

Question 8

What are the two types of membranoproliferative glomerulonephritis?

Answer 8

Type I– subendothelial cell deposits (between endothelial cell and basement membrane) —Hep B/C
Type II- dense deposit dz–intramembranous.
C3 nephritic factor (stabilizes C3 convertase activates complement)

Question 9

Low levels of circulating C3. what kind of nephrotic syndrome?

Answer 9

Type II Membrano. prolifer.

Question 10

Diabetes Mellitus

Answer 10

1. Nonenzymatic glycosylation of vascular basement membrane
2. hyaline arteriosclerosis (efferent arteriole especially, thus high GFR–like Ang II)–Hyperfiltration injury
   basement membrane becomes leaky–>nephrotic syndrome
3. Kimmelsteil Wilson nodules (sclerosis of mesangium)

Question 11

Amyloidosis

Answer 11

1. Amyloid deposit in the mesangium

2. Apple green birefringence under polarized light after staining with Congo Red. Whatever that means.