Nephrotic syndrome Flashcards
What is nephrotic syndrome?
Increased filtration of macromolecules across the glomerular capillary due to structural and functional abnormalities of the glomerular podocytes
Hypoalbuminaemia
Oedema
Hypercholesterolaemia and hypertriglycarideaemia
What are glomerulopathies associated with nephrotic syndrome? (bland urine sediments)
Primary glomerular disease:
Minimal-change glomerular disease Membranous nephropathy
Focal segmental glomerulosclerosis Congenital nephrotic syndrome
Secondary glomerular disease:
Amyloidosis
Diabetic nephropathy
What are glomerulopathies associated with nephrotic syndrome? (active urine sediments- mixed nephrotic/nephritic)
Primary glomerular disease:
Mesangiocapillary glomerulonephritis Mesangial proliferative glomerulonephritis
Secondary glomerular disease:
Systemic lupus erythematosus Cryoglobulinaemic disease Henoch–Schonlein syndrome Idiopathic fibrillary glomerulopathy Immunotactoid glomerulopathy Fibronectin glomerulopathy
What causes membranoproliferazive glomerulonephritis?
Chronic infection (abscesses, IE,) Cfyloglobuminaemia secondary to hep C
What are the clinical features of nephrotic syndrome?
Oedema of ankles, genitals and abdominal wall
Periorbital oedema and arms in severe cases
Proteinuria
Hypoalbuminaemia
hyperlipidaemia
Complications- hypertension, thromboembolic disorders, peritonitis
What is nephritic syndrome?
When it occurs in glomerulus it’s glomerulonephritis
Kidney disease involving inflammation
What are the clinical features of nephritic syndrome?
Hematuria Proteinuria Hypertension Blurred vision Azotemia Oliguria
What causes nephritic syndrome?
Goodpasture’s
SLE
Rapidly progressive glomerulonephritis
IE
Cryoglobulinaemia (antibodies sensitive to cold)
Membranoproliferazive glomerulonephritis (MPGN)
Henoch-schonlein
Post-streptococcal
Post infectious- (mumps, legionella, hep B/C, schistosomiasis, malaria)
What are the features of rapidly progressive glomerulonephritis?
Acute nephritis, crescent shape GBM breaks 50's-60's- poor prognosis Focal necrosis with or without crescents and rapidly progressive renal failure over weeks to months Caused by: Anti-GBM antibody (good pastures) Immune complexes (SLE, IgA nephropathy) Idiopathic
What is tubulointerstitial nephritis?
Primary injury to the renal tubules and interstitium that results in decreased renal function
Acute- due to allergic drug reaction (penicillin/NSAIDs) and infections
Chronic- analgesic nephropathy, diabetes, toxins (lead)
What are the clinical features of tubulointerstitial nephritis?
Acute- fever, eosinophilia and eosinophiluria, AKI
Chronic- Polyuria, proteinuria uraemia
What occurs in minimal change disease?
Nephrotic syndrome Most common in children T cells attack the foot processes of podocytes (effacement), less of charge barrier so albumin can pass through Associated with Hodgkin's lymphoma No change seen on light microscopy
What is Goodpasture’s syndrome?
Autoimmune disease that affects lungs and kidneys
hemoptysis ans hematuria
Environmental factors: infection, smoking, oxidative stress
What are the histological descriptions of glomerular pathology?
Global: whole glomerulus is diseased
Segmental: small patches of one glomerulus are damaged
Diffuse: >50% glomeruli
Focal: <50% glomeruli
What are secondary factors causing deposition of antigens causing glomerulonephritis?
NSAID HSP Neoplasm SLE Amyloid Infection Diabetes Henoch Schonlein Purpura
What is chronic interstitial nephritis pathology?
Chronic pyelonephritis, irregular areas of scarring, chronic inflammatory infiltrate
Reflux associated chronic interstitial nephritis: incompetent vesicoureteric valves, predisposing inflammation + scarring. Presents in early adulthood
Obstructive chronic interstitial nephritis: anatomic abnormality leads to recurrent infections (prostate, retroperitoneal fibrosis), stones
How can diabetes damage the kidney?
Direct glomerular damage: basement membrane thickening, increased permeability of capillary wall + proteinuria, eventual glomerular hyalinisation —> CKD
Ischaemia due to arterial disease: atherosclerosis causes reduced eGFR and glomerular ischaemia
Ascending infection
What is nephritic syndrome pathology?
TETRAD: haematuria + red cell casts, oliguria, proteinuria, hypertension
Proliferative (increased cell numbers) + damage to basement membrane –> casts form from blood and protein
Primary causes: IgA nephropathy, Goodpastures
Secondary causes: SLE, HSP
What are the differences between IgA nephropathy and post-streptococcal glomerulonephritis?
IgA- 1-2 days after URTI. post-s- 1-2 weeks
IgA- young males, macroscopic haematuria
Post-s- proteinuria, low complement
What is acute tubular necrosis associated with?
Granular muddy brown urinary casts
Normal urea:creatinine ratio
