Nephrotic Syndrome

Question 1

What are the signs of nephrotic syndrome?

Answer 1

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)

Question 2

What are the signs of Nephritic syndrome?

Answer 2

active urinary sediment, dysmorphic red cells/ casts, inflammation, hypertension. Key cell is endothelial cell.

Question 3

What is active urinary sediment?

Answer 3

Red blood cell casts or dysmorphic red cells

Question 4

What is microalbuminuria

Answer 4

30-300 mg.day of albumin in the urine, low grade proteinuria indicative of mild glomerular filter malfunction. SHould be no protein in urine.

Question 5

What is a cast?

Answer 5

cylindrical formations of cells or proteinaceous material.

Question 6

Most common cast type?

Answer 6

Hyaline cast

Question 7

Hyaline cast looks like?

Answer 7

Colorless, homogeneous, transparent

Question 8

What makes up a hyaline cast?

Answer 8

Tamm Horsfall protein which is secreted by renal tubular cells, also contain albumin in some cases.

Question 9

second most common cast type?

Answer 9

granular

Question 10

Ganular casts look like

Answer 10

Pale yellow or grey

Question 11

What makes up granular casts

Answer 11

aggregates of plasma protein or breakdown of cellular casts

Question 12

Granular casts indicate what?

Answer 12

significant renal disease

Question 13

Fatty casts look like

Answer 13

yellow tan hyaline casts

Question 14

fatty casts formed by breakdown of what?

Answer 14

lipid rich epithelial cells

Question 15

Maltese cross pattern of fatty casts is indicative of what?

Answer 15

lipiduria of nephrotic syndrome

Question 16

red blood cell casts indicate what?

Answer 16

glomerular damage

Question 17

wbc casts indicative of what?

Answer 17

pyelonephritis, interstitial nephritis

Question 18

The urinary sediment in nephrotic syndrome can have what types of casts?

Answer 18

hyaline (these are common in all types of renal disease), granular (significan disease), fatty, white blood cell

Question 19

What are the two paths towards mechanism of disease with nephrotic syndrome?

Answer 19

Inflammation present, usually from glomerulus. Inflammation not present

Question 20

Non-inflammatory nephrotic synd mechanisms?

Answer 20

podocyte injury, subepithelial immune complex formation, glomerular capillary wall deposition

Question 21

Nephrotic syndrome mechanism with glomerular inflammation?

Answer 21

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

Question 22

What properties of glomerular filtration predispose to immune complex disease?

Answer 22

1) high plasma flow rate
2) high intraglomerular pressure
3) high glomerular permeability

Question 23

Post-infectious glomerulonephritis and, specifically, post-streptococcal glomerulonephritis features immune complexes where in the early course of the disease?

Answer 23

subendothelial cells

Question 24

post-infectious glomerulonephritis features immune complexes where in later course of disease>

Answer 24

subepithelial cells.

Question 25

Clinical features of neprotic syndrome

Answer 25

High protein excretion (50mg/kg/day, 3.5g/day, 40mg/hour.
Hypoalbuminemia (less than 3.5 g/dl
hyperlipidemia is seen in nephrotic syndrome associated with increased hepatic cholesterol synthesis

Question 26

If there is generalized edema, look for what?

Answer 26

Proteinuria. These are both symptoms of nephrotic syndrome and the proteinuria can help you narrow down your scope

Question 27

Nephrotic syndrome

Answer 27

Abnormal filter (glomerulus) wthout inflammation. Filter is leaking

Question 28

Nephritic

Answer 28

Abnormal filter (glomerulus) with inflammation. Filter is bleeding

Question 29

Capillaries are ruptured,,,nephrotic or nephritic?

Answer 29

Nephritic

Question 30

Renal biopsy can guide diagnosis, treatment, and prognosis….When do you absolutely not do one though?

Answer 30

bleeding diathesis (susceptible to hemorrhage) or uncontrolled hypertension

Question 31

What features of the glomerulus prevent albuminuria?

Answer 31

Size (42 angstrom glomerular pore radius in the lamina densa) and charge (neg)

Question 32

dominant protein in urine durign glomerular disease?

Answer 32

albumin

Question 33

Dominant protein in the urine with tubular disorder>

Answer 33

low molec wt proteins. Because tubule is not reabsorbing them.

Question 34

Overflow proteinuria associated with what?

Answer 34

Multiple myeloma…pretty much, a ton of small molecular wt proteins are made and filtered through the glomerulus faster than they can be reabsorbed.

Question 35

urine dipstick measures what?

Answer 35

albumin

Question 36

How much albumin is excreted per day by healthy kidneys?

Answer 36

30 mg

Question 37

Dipstick detects proteinuria at what level?

Answer 37

300-500mg

Question 38

What is the most common cause of end stage renal disease?

Answer 38

diabetic nephropathy

Question 39

What is the eraliest clinical sign of diabetic nephropathy>

Answer 39

microalbuminuria

Question 40

If you need a fully quantitative result of urine protein analysis what do you do>

Answer 40

24 hour urine collection

Question 41

What is the limit of normal protein excretion in one day>

Answer 41

150

Question 42

mgnephrotic range proteinuria is associated with whatlevel of urine protein: creatinine ratio?

Answer 42

3.5