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USMLE Renal > Nephrotic Syndromes > Flashcards

Nephrotic Syndromes Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the characteristics of nephrotic syndrome?

A
  • Oedema
  • Proteinuria (>3.5g/day)
  • Hypoalbuminemia
  • Hypogammaglobulinemia
  • Hypercoagulable state
  • Hyperlipidemia and hypercholsterolemia
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2
Q

What will the urine look like on nephrotic syndrome?

A

Frothy

- Will have fatty casts

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3
Q

Why is nephrotic syndrome associated with a hypercoagulable state?

A

Antithrombin III is lost in the urine

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4
Q

What coagulation factors does ATIII affect?

A

2, 9, 10, 11

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5
Q

Why is nephrotic syndrome associated with an increased risk of infection?

A

Loss of IgGs in urine (hypogammaglobinemia)

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6
Q

What is the most common nephrotic syndrome in children?

A

Minimal change disease

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7
Q

What can primary minimal change disease be caused by?

A
  • Idiopathic
  • Immunisation
  • Immune stimulus
  • Infection

4 i s

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8
Q

What can secondary minimal change disease be due to?

A

Lymphoma (cytokine-mediated change)

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9
Q

What is minimal change disease treated with?

A

Corticosteroids

- Primary disease has excellent response

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10
Q

What is minimal change disease also known as?

A

Lipoid nephrosis

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11
Q

What histology show in minimal change disease?

A

Light Microscopy - Normal glomeruli (lipid may be seen in PCT cells)

Negative immunoflouresence

Electron Microscopy - Effacement of podocyte foot processes

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12
Q

What groups of people have a higher risk of Focal Segmental Glomerulosclerosis?

A

Black people

Secondary disease may be due to:

  • HIV
  • Sickle cell
  • Heroin
  • Obesity
  • Interferon treatment
  • Congenital malformations
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13
Q

What can FSGS be treated with?

A

Steroids - inconistent response

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14
Q

What will light microscopy show in FSGS?

A

Segmental sclerosis and hyalinosis

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15
Q

What will Immunoflouresence show in FSGS?

A
  • Often negative

- May be positive for nonspecific focal deposits of IgM, C3, C1

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16
Q

What will electron microscopy show in FSGS?

A

Effacement of foot processes similar to minimal change disease

17
Q

What is membarnous nephropathy also known as?

A

Membranous glomerulonephritis

18
Q

What is membranous nephropathy’s response to corticosteroids like?

A

Poor response

19
Q

What is primary membranous nephropathy due to?

A

Antibodies to phospholipase A2 receptor (anti-PLA2R)

20
Q

What is secondary membranous nephropathy due to?

A
  • Infection: HCV, HBV
  • Autoimmune: SLE
  • Medications (NSAIDs, Penicillamine, Gold)

IMA Proud member of the spike and dome club

21
Q

What will light microscopy show in membranous nephropathy?

A

Diffuse capillary and GBM thickening

22
Q

What will immunoflouresence show in membranous nephropathy?

A

Granular due to immune complex (IC) deposition

23
Q

What will electron microscopy show in membranous nephropathy?

A

“Spike and Dome” appearence of epithelial deposits

24
Q

What chronic conditions can predispose to amyolid deposition?

A
  • AL amyloid
  • AA amyloid
  • Prolonged dialysis
25
Q

What will light microscopy show in Amyloidosis?

A

Congo red stain will show apple green birefringence under polarised light due to amyolid deposition in mesangium

26
Q

What is the mst common cause of end stage renal failure in the USA?

A

Diabetic glomerulonephropathy

27
Q

Describe the pathophysiology of diabetic glomerulo-nephropathy?

A

Hyperglycemia

  • > Nonenzymatic glycation of tissue proteins
  • > Mesangial expansion; GBM thickening and increased permeability
  • > Hyperfiltration (glomerular HTN and increased GFR)
  • > Glomerular hypertrophy and glomerular scarring (glomerulosclerosis)
  • > Further progression of nephropathy
28
Q

What will light microscopy show in diabetic glomerulonephropathy?

A
  • Mesangial expansion
  • GBM thickening
  • Eosinophilic nodular glomerulosclerosis (Kimmelstiel-Wilson lesions)

USMLE Renal (11 decks)

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