Nephrotic Syndrome Flashcards
What are the signs of nephrotic syndrome?
Edema, proteinuria, hypoalbuminemia, hyperlipidemia. Key cell involved is the visceral epithelial cell, the podocyte. Non-inflammatory. Inactive urinary sediment No dysmporphic red cells or casts)
What are the signs of Nephritic syndrome?
active urinary sediment, dysmorphic red cells/ casts, inflammation, hypertension. Key cell is endothelial cell.
What is active urinary sediment?
Red blood cell casts or dysmorphic red cells
What is microalbuminuria
30-300 mg.day of albumin in the urine, low grade proteinuria indicative of mild glomerular filter malfunction. SHould be no protein in urine.
What is a cast?
cylindrical formations of cells or proteinaceous material.
Most common cast type?
Hyaline cast
Hyaline cast looks like?
Colorless, homogeneous, transparent
What makes up a hyaline cast?
Tamm Horsfall protein which is secreted by renal tubular cells, also contain albumin in some cases.
second most common cast type?
granular
Ganular casts look like
Pale yellow or grey
What makes up granular casts
aggregates of plasma protein or breakdown of cellular casts
Granular casts indicate what?
significant renal disease
Fatty casts look like
yellow tan hyaline casts
fatty casts formed by breakdown of what?
lipid rich epithelial cells
Maltese cross pattern of fatty casts is indicative of what?
lipiduria of nephrotic syndrome
red blood cell casts indicate what?
glomerular damage
wbc casts indicative of what?
pyelonephritis, interstitial nephritis
The urinary sediment in nephrotic syndrome can have what types of casts?
hyaline (these are common in all types of renal disease), granular (significan disease), fatty, white blood cell
What are the two paths towards mechanism of disease with nephrotic syndrome?
Inflammation present, usually from glomerulus. Inflammation not present
Non-inflammatory nephrotic synd mechanisms?
podocyte injury, subepithelial immune complex formation, glomerular capillary wall deposition
Nephrotic syndrome mechanism with glomerular inflammation?
mesangial or capillary wall immune complex formation and comlement activation in IgA nephropathy, acute post strep glomerulonephritis, antibodies directed at GBM in anti-GBM disease, necrotizing injury and inflammation of the of the glomerular capillaries in diseases associated with ANCA
What properties of glomerular filtration predispose to immune complex disease?
1) high plasma flow rate
2) high intraglomerular pressure
3) high glomerular permeability
Post-infectious glomerulonephritis and, specifically, post-streptococcal glomerulonephritis features immune complexes where in the early course of the disease?
subendothelial cells
post-infectious glomerulonephritis features immune complexes where in later course of disease>
subepithelial cells.
