Nephrotic syndrome

Question 1

Nephrotic syndrome causes

Answer 1

Minimal change disease
Membranous nephropathy
Focal segmental glomerulosclerosis
Amyloidosis
Diabetic glomerulonephropathy

Question 2

Minimal change disease

• Triggers:
• Common age group
• Dx

Answer 2

1. Primary (idiopathic):
   Recent infection
   Immunization
2. Secondary: lymphoma; cytokine mediated damage

Diagnosis: EM: Effacement of podocyte foot processes

Question 3

Focal segmental GMN

• causes
• demographics/age group

Answer 3

Causes;
1. Primary (idiopathic)
2. Secondary:
HIV
Sickle cell disease
Heroine abuse
Massive Obesity
Interferon tx 
Congenital malformation 

Demographics: African American and Hispanics.

Diagnosis:
EM: podocytes similar to minimal change
LM: Hyalinosis and segmental sclerosis
IF: Focal deposits of IgM, C3, C1

Question 4

Membranous nephropathy:
Causes
(list of drugs and infections)
Diagnosis

Answer 4

1. Primary
   - Antibodies to phospholipase A2 receptor

2.Secondary

-DRUGS:
NSAIDS
Penicillamine
Gold
-INFECTIONS:
HBV
HCV
Syphilis 
OTHER:
SLE
Solid Tumors

Diagnosis:
LM: Diffuse Capillary thickening
EM: Spike and dome appearance of sub epithelial deposits.
IF: Granular due to IC deposits.

Question 5

Diabetic GMN

Pathophysiology

Answer 5

1. Hyperglycermia;
   Mesangial expansion=
   GBM thickening and
   Increased permeability
2. Hyperfiltration; glomerulosclerosis
   - Glomerular HTN
   - Increased GFR

Diagnosis:
LM: Mesangial expansion, GBM thickening, Eosinipholic nodular glomerulosclerosis

Question 6

Signs and symptoms of nephrotic syndrome

Answer 6

Massive proteinuria (>3.5g/day)
Hypoalbuminemia
Edema
Hyperlipidemia
Frothy Urine with Fatty Casts

Question 7

Nephrotic syndrome pathophysiology

Answer 7

Glomerular filtration charge barrier disruption;

1. direct sclerosis of podocytes
2. systemic damage of podocytes.

Question 8

Signs and symptoms of Nephritic syndrome

Answer 8

Inflammatory process
Hematuria; RBC casts in urine
Azotemia
Oligouria
HTN
Hypercellular/inflammed glomeruli on biopsy