Nephrotic syndrome Flashcards

1
Q

significant proteinuria

A

nephrotic syndrome

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2
Q

hematuria and glomerulonephritis

A

nephritic syndrome

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3
Q

definition of proteinuria

A

> 3.5 gm in 24 hr

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4
Q

definition of hypoalbuminemia in salbumin

A

< 3.5 gm/dl

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5
Q

what do we see in nephrotic syndrome

A
  1. proteinuria
  2. hypoalbuminemia
  3. Edema
  4. hyperlipidemia and lipiduria
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6
Q

urine sediment in nephrotic syndrome

A

negative- non-active nl kidney function and blood pressure

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7
Q

Morbidity associated with Nephrotic syndrome

A
  1. Edema and effusions
  2. loss of IgG and complement
  3. Loss of ATIII
  4. loss of Vitamin D
  5. Hyperlipidemia and vascular disease
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8
Q

pathogenesis of proteinuria

A

injury to podocytes by either genetics, depositions or direct injury by ab, cytokines and toxins

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9
Q

3 primary glomerular diseases with nephrotic syndrome

A
  1. MCD- minimal change disease
  2. FSGS- focal segmental glomerulosclerosis
  3. MN- membranous glomerulopathy
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10
Q

secondary glomerular diseases with nephrotic syndrome

A
  1. diabetes
  2. SLE
  3. Amyloidosis
  4. medications- NSAIDS + Lithium
  5. Tumors/ infections/ vaccinations
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11
Q

three major causes of ESRD

A
  1. diabetes
  2. HTN
  3. Glomerular disorders
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12
Q

what are the advantages and disadvantages of dipstick ruine

A
  • Pro:
    1. quick
    2. semi-quantitive
    3. detects mainly labumin
  • Cons:
    1. does not detect microalbumin
    2. does not detect abnormal proteins
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13
Q

spot urine

A

protein to creatinine ratio

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14
Q

what do we expect to see in light microscopy for a pt. that has minimal change disease?

A

normal glomerulous

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15
Q

what do we see in electron microscopy with a pt. that hasa minimal change disease

A

abnormal podocytes: flat and unhappy

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16
Q

MCD:

  1. most common cause of
  2. peak incidence in children occur at ages
  3. in adults it is caused by the use of _____ which lead to immune dysfunction and cytokine/ direct toxicity
  4. hereditary chances
  5. response to steroids?
  6. prognosis?
A
  1. most common cause of NS in children
  2. peak incidence in children occur at ages 2-6
  3. in adults it is caused by the use of NSAIDS which lead to immune dysfunction and cytokine/ direct toxicity
  4. hereditary cases are rare and they are due to nephrin mutations
  5. responsive to steroids 6. good prognosis
17
Q

FSGS:

  1. most frequent in
  2. at risk populations
  3. possible genetic component?
  4. most common cause of
  5. primary form is
  6. secondary form is ________ due to
  7. prognosis?
  8. recurrence?
A
  1. most frequent in adults
  2. at risk populations- hispanics/ high BMI/ African Americans/ HIV +
  3. possible genetic component- yep
  4. most common cause of NS in the US
  5. primary form is idiopathic with some semblance to MCD
  6. secondary form is hyperfiltration due to obesity/solitary kidney/ transplant kidney
  7. prognosis is poor with progression to ESRD
  8. recurrence is possible in transplants
18
Q

Membranous nephropathy:

  1. occurs mostly in
  2. _____ renal function at presentation
  3. autoimmune disease
  4. rare cases associated with __________ (1 in 10 pt) , ___________ and _____________
  5. disease is acute or chronic
  6. response to steroids
A
  1. occurs mostly in adults 4-5th decade
  2. normal renal function at presentation
  3. autoimmune disease: most cases IgG class 4 against phospholipase A2-receptor (anti-PLA2R)
  4. rare cases associated with cancer associated ab (1 in 10 pt) , collagen- vascular disease and infection
  5. disease chronic
  6. response to steroids is poor
19
Q

Diabetic nephropathy:

  1. most common cause of
  2. up to 1/3 of DMI and DMII will
  3. first sign of diabetic nephropathy
  4. ________ develops in about 20yr
A
  1. most common cause of ESRD in the US (diabetes mellitus)
  2. up to 1/3 of DMI and DMII will develop diabetic nephropathy and kidney failure
  3. first sign of diabetic nephropathy is microalbuminuria

4 overt proteinuria develops in about 20yr

20
Q

course of Diabetic glomerulosclerosis

A
  1. hyperglycemia related to insulin deficiency
  2. non-enzymatic glycosylation of proteins
  3. biochemical changes of GBM
  4. increased synthesis of collagen IV
  5. GBM thickening and increased mesangial matrix
  6. Glomerulosclerosis
21
Q

apple green Birefringence

A

amyloidosis

22
Q

amyloidosis:

  1. deposition of
  2. disease of
  3. deposition in the glomeruli leads to
  4. deposition in heart leads to
  5. major types: ______ associated with lymphoma and _______ associated with Liver
A
  1. deposition of abnormally folded proteins- amyloid
  2. disease of adults
  3. deposition in the glomeruli leads to NS and kidney failure
  4. deposition in heart leads to CHF
  5. major types: AL which is deposition of immunoglobulin light chains associated with lymphoma and AA- deposition of serum amyloid-A-protein associated with Liver
23
Q
A

oval fat bodies

24
Q
A

focal segmental glomerulosclerosis-FSGS

25
focal segmental glomerulosclerosis-FSGS
26
membranous nephropathy- uniformly thick GBM
27
silver stain for collagen 4- not really distinct pt. has membranous
28
## Footnote immunofluorescence with IgG showing capillary loops in patient with membranous n
29
notice the subepithelial electron dense deposits- membranous nephropathy
30
membranous nephropathy pathogenesis
31
nodular sclerosis seen in patients with advanced diabetes- nodular diabetic glomerulosclerosis
32
nodular diabetic glomerulosclerosis- kimmelstiel wilson disease
33
EM of Diabetic nephropathy
34
pt. with amyloidosis
35
congo red stain of pt. with amyloidosis
36
polarized light of amyloidosis
37
fibrillary deposits in EM seen in amyloidos