Nephrotic syndrome Flashcards
Nephrin
forms interdigitations b/w interdigitations of podocyte foot processes
convection vs diffusion
convection: solvent drag takes particles across membrane (high-flow states). Diffusion= equilibration of gradients (low flow states)
how is protein reabsorbed?
intact and degraded in the PT
describe pathologic proteinuria
fixed amount. so it may be more concentrated when volume is lower
what are the four official signs of nephrotic syndrome? other unofficial signs?
3g/d proteinuria or urine prot:creat >2; hypoalbuminemia; edema; hypercholesterolemia; coagulopathy, endocrine, immune, etc
nephrosis vs nephritis: derangement, problem, EABV, edema, htn, cxr
low serum albumin, renal inflammation. peripheral edema, decreased GFR. decreased eabv, increased. significant, mild. sometimes htn, usually. normal heart, cardiomegaly/pulm edema
what are the two types of nephrotic patients?
pure nephrosis (albuminuria), nephrosis w/ nephritis (generalized proteinuria to such a degree they become hypoalbuminemic)
why is albumin filtered while larger macromolecule filtration decreases
podocyte effacement=less filtration surface, more tight fit, fewer large molecules. Albumin is increased due to loss in filter charge.
why do nephrotic pts have lipid problems
increased lipoprotein synthesis due to oncotic signal, hdl lost in urine, decreased LPL and LCAT. Albumin binds certain lipids to take them out of sol’n
hypercoagulability in nephrosis. Where? why/
Renal vein thrombosis. hemoconcentration, loss of protein s
What gene mutation is most likely in nephrotic syndrome
the one regulating nephrin: CD2AP
overfill theory: renin levels
low
how does nephrotic syndrome affect vit d?
you excrete vit d metabolites and so you get less GI Ca absorption so you increase PTH
