Nephrotic syndrome

Question 1

What is the definition of nephrotic syndrome?

Answer 1

proteinuria >3.5 g/day

Question 2

What is the general cause of proteinuria?

Answer 2

increase BM permeability

Question 3

In addition to proteinuria, what are some other lab findings in nephrotic syndrome?

Answer 3

hypoalbuminemia - edema
hypogammaglobulinemia - infection
hypercoaguability - loss of antithrombin III
hyperlipidemia and hypercholesterolemia (liver attempts to make blood thick)

Question 4

What causes minimal change disease?

Answer 4

cytokines cause effacement of podocytes

Question 5

What cancer can be associated with minimal change disease?

Answer 5

hodkins lymphoma

Question 6

What is the treatment for minimal change disease?

Answer 6

steroids -disease is immunogenic

Question 7

What is the most common cause of nephrotic syndrome in:

1. asians
2. blacks
3. hispanics.
4. caucasians

Answer 7

asians and caucasians - membranous nephropathy

blacks and hispanics - focal segmental sclerosis

Question 8

What is seen pathologically in focal segmental sclerosis?

Answer 8

deposition of collagen in some parts of a few glomeruli

hyalinosis, effacement of foot processes

Question 9

What is seen pathologically in membranous nephropathy?

Answer 9

subeithelial deposits with spike and dome

thickened glomerular basement membrane

Question 10

What is believed to be the cause of primary membranous nephropathy?

Answer 10

anti-PLA2R antibodies on podocytes

Question 11

Describe the subepithelial deposits in membranous nephropathy?

Answer 11

cations, low avidity - free

Question 12

What are the pathological findings in membranoproliferative nephropathy?

Answer 12

mesangial deposits, GBM thickening

“tram track appearance”

Question 13

In type I MPF Nephropathy, what specifically is seen?

Answer 13

subendothelial deposits, mesangial deposits
hypercellularity
Capillary wall thickening

Question 14

What is type I MPF nephropathy associated with?

Answer 14

chronic infections

Question 15

Which arm of the complement pathway is activated in MPF nephropathy? What happens as a result?

Answer 15

type 1 - classical
type 2 - alternate

hypocomplementemia

Question 16

What is type II MPF nephropathy caused by?

Answer 16

anti- c3 nephritic factor

Question 17

What is another name for Type II MPF nephropathy?

Answer 17

dense deposit disease

-ribbon like zone of inc density w/in thickened GBM

Question 18

What is the only cause of nephrotic syndrome that can’t also be nephritic?

Answer 18

minimal change disease

Question 19

What is the most common cause of nephrotic syndrome in children?

Answer 19

minimum change disease

Question 20

How does diabetes cause nephrotic syndrome?

Answer 20

1. nonenzymatic glycosylation of protein –>increase in mesangial matrix and sclerosis
2. hyperfilitration leads to microalbuminuria and then eventually nephrotic syndrome

Question 21

What is the pathognomonic finding of the kidney in diabetes?

Answer 21

kimmelstein wilson nodules

-Nodules of pink hyaline material form in regions of glomerular capillary loops in the glomerulus

Question 22

Where does amyloid deposit in the kidney?

Answer 22

mesangium