Nephrotic Syndrome

Question 1

Minimal Change Disease pathology

Answer 1

Effacement of podocytes/foot processes on EM

Question 2

Minimal Change Disease findings
MCC of what?
Urine finding 
S & S (3)
What/who to look for?

Answer 2

MCC of nephrotic syndrome in children
Proteinuria
Hypoalbuminemia
Edema (periorbital, sacral, and scrotal)
HTN

**Look for sudden onset edema in a child with hx of infections and thrombotic events

Question 3

Minimal Change Disease tx

Answer 3

Glucocorticoids (excellent prognosis)

Question 4

Focal Segmental Glomeruloscerlosis etiology

Answer 4

1. Idiopathic
2. IV drug use
3. HIV
4. Obesity

Question 5

Focal Segmental Glomeruloscerlosis pathology

Who to look for?

Answer 5

Sclerosis is FOCAL (<50% glomeruli) and SEGMENTAL (only part of each glomeruli)
**Look for an African American man with uncontrolled HTN

Question 6

Focal Segmental Glomeruloscerlosis findings:
which patients (3)
Urine
Biopsy finding

Answer 6

• Increased prevalence among African Americans, Latinos, and HIV patients
• Microscopic hematuria
• Biopsy shows sclerosis in capillary tufts

Question 7

Focal Segmental Glomeruloscerlosis treatment (4)

Answer 7

1. Glucocorticoid
2. ACE-i
3. Statin
4. +/- cyclosporine

Question 8

Membranous nephropathy History/PE
Associated with (4)

Answer 8

Associated with solid-tumor malignancies, infections (HBV, malaria), autoimmune (SLE), and drugs (NSAIDs, gold)

Question 9

Membranous nephropathy histology

Answer 9

“Spike and Dome” appearance due to granular deposits of IgG and C3 at the basement membrane

Question 10

Membranous nephropathy treatment (4)

Answer 10

1. ACE-i
2. Statin
3. Cyclophosphamide
4. Prednisone

Question 11

Membranoproliferative glomerulonephritis (MPGN) pathology (3)

Answer 11

1. “Tram Track” appearance
2. Subendothelial “humps” of IgG on GBM–> formation of second GBM
3. Mesangial cells proliferate between the GBMs

Question 12

Membranoproliferative glomerulonephritis (MPGN) clinical associations (3)

Answer 12

1. SLE
2. Subacute bacterial endocarditis
3. Hepatitis C

Question 13

Membranoproliferative glomerulonephritis (MPGN) treatment (3)

Answer 13

1. Treat underlying cause
2. Glucocorticoids
3. +/- cyclophosphamide

Question 14

Diabetic nephropathy pathology (2)

Answer 14

1. Diffuse hyalinization

2. Nodular glomerularsclerosis (Kimmelstiel-Wilson nodules)

Question 15

Diabetic nephropathy history and labs (3)

Answer 15

1. Hx of poorly controlled diabetes
2. Thickened GBM
3. Increased mesangial matrix

Question 16

Diabetic nephropathy treatment (3)

Answer 16

1. ACE-i or ARB
2. Aggressive BP control
3. Aggressive glycemic control

Question 17

Renal amyloidosis pathology

Answer 17

Abnormal amyloid proteins deposit in tissues (heart, kidney, liver, brain, muscle)

Question 18

Renal amyloidosis clinical associations

Answer 18

Multiple myeloma

Chronic inflammatory diseases (RA, TB, IBD)

Question 19

Renal amyloidosis treatment (2)

Answer 19

1. Prednisone
2. Melphalan
3. BMT if multiple myeloma is causative

Question 20

Renal amyloidosis histology

Answer 20

Congo red stain shows “apple-green birefringence”

Question 21

Lupus nephritis (or nephrosis)

Answer 21

SLE –> variable changes:

• immune deposits
• proliferation of mesangial cells
• thickening of GBM

Question 22

Lupus findings

Answer 22

Proteinuria
+ANA
+Anti-dsDNA antibodies
**LM: endothelial deposits cause “wire loops”

Question 23

Lupus treatment (4)

Answer 23

1. Glucocorticoid
2. ACE-i
3. Statin
4. Immunosuppressant (cyclophosphamide)