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Ch. 12 Kidney and Urinary Tract > Nephrotic Syndrome > Flashcards

Nephrotic Syndrome Flashcards

1
Q

Defining characteristic of nephrotic syndrome

A

> 3.5 g protein/day lost in urine

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2
Q

Serum findings in nephrotic syndrome

A

hypoalbuminemia (edema)

hypogammaglobulinemia (infections)

hypercoagulable state (loss of antithrombin III)

hyperlipidemia and hypercholesterolemia (liver compensates and tries to thicken the blood)

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3
Q

3 groups of nephrotic diseases

A

Affecting Podocytes

minimal change disease, focal segmental glomerulosclerosis

Immune Complex Depositions

membranous nephropathy, membranoproliferative glomerulonephritis

Systemic Disorders

DM, systemic amyloidosis

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4
Q

Minimal Change Disease

classic presentation

A

children

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5
Q

Minimal Change Disease

basic pathology

A

cytokine-mediated

effacement (flattening) of podocyte foot processes

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6
Q

Minimal Change Disease

condition association

A

Hodgkin Lymphoma

causes massive release of cytokines (causing B-Sx)

⇒ can also efface podocyte foot processes

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7
Q

Microscopic findings of minimal change disease

A

normal on H & E (that’s where it got its name)

negative immunoflouresence

effacement of podocyte foot processes (epithelium) on electron microscopy

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8
Q

Proteinuria in minimal change disease

A

selective: only lose albumin NOT immunoglobulin

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9
Q

Tx of minimal change disease

A

steroids

*special: responds very well to treatment!

only nephrotic syndrome that is treatable

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10
Q

Untreated minimal change disease may lead to the development of this condition

A

focal segmental glomerulosclerosis

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11
Q

Focal Segmental Glomerulosclerosis

basic pathology

A

effacement/flattening of podocyte foot processes

(idiopathic)

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12
Q

Focal Segmental Glomerulosclerosis

associated condition(s)

A

HIV, heroin use, sickle cell disease

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13
Q

Focal Segmental Glomerulosclerosis

histology

A

focal: only some glomeruli

segmental: only parts of affected glomeruli

sclerosis: sclerotic tissue on H&E stain

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14
Q

Focal Segmental Glomerulosclerosis

H&E

Immunoflouresence

Electron Microscopy

A

H&E: focal regions of segmental sclerosis in glomerulus

IF: negative

EM: effacement of foot processes

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15
Q

Membranous Neuphropathy

basic pathology

A

immune complex deposition

subepithelial layer (under foot processes)

podocyte foot processes proliferate

⇒ membranous layer around capillaries

ie thickened capillary walls

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16
Q

Membranous Nephropathy

associations

A

_SLE*_

solid tumors

HCV, HBV, some drugs

17
Q

Membranous Neuropathy

H&E

IM

EM

A

H&E: thick glomerular basement membrane

IM: granular immune complex depositions

EM: “spike and dome” appearance

18
Q

Membranoproliferative Glomerulonephritis

Type I

basic pathology

A

subendothelial deposition of immune complexes

19
Q

Membranoproliferative Glomerulonephritis

Type II

basic pathology

A

intramembranous immune complex deposition

within basement membrane

containing

C3 nephritic factor

binds C3 convertase and keeps it active, taking C3 out of the serum

20
Q

Membranoproliferative Glomerulonephritis

Type I and II

histological findings

A

H&E: “tram-track” appearance, thick basement membrane

IF: immunoglobulins (type I), C3 staining (type II)

21
Q

Membranoproliferative Disease

Type I

associations

A

HBV

HCV

22
Q

Membranous disease

deposits in subepithelial layer

A

membranous nephropathy

23
Q

Membranous disease

deposits in membranous layer

A

membranoproliferative glomerulonephritis

type II

24
Q

Membranous disease

deposits in subendothelial layer

A

membranoproliferative glomerulonephritis

type I

25
Q

Non-enzymatic glycocylation of dextrose onto vascular basement membrane causes this type of tissue damage

A

hyaline atherosclerosis

26
Q

DM causes the most damage to what part of the kidney?

A

effernet arteriole

27
Q

Why are ACE inhibitors best for DM patients?

A

hyaline atherosclerosis occurs perferentially in efferent arteriole

ATII also works on efferent arteriole

take away ATII effect negates some of the harm

prevents/lessens hyperfiltration

28
Q

Kimmelstiel-Wildon nodules

A

sclerosis of mesangium

seen in nephrotic syndrome due to DM

29
Q

Most commonly involved organ in systemic amyloidosis

A

kidney

30
Q

Amyloid deposits where in kidney

A

mesangium

31
Q

Amyloid under microscope

A

apple-green biofuringence

under polarized light

Congo red stain

Ch. 12 Kidney and Urinary Tract (7 decks)

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