Nephrotic Syndromes Flashcards
List 6 Purely Nephrotic Syndromes
- ) Minimal-Change Disease
- ) Focal-Segmental Glomerulosclerosis
- ) Membranous Nephropathy
- ) Diabetic Nephropathy
- ) Lupus Nephritis
- ) Renal Amyloidosis
List 2 Mixed Nephrotic/Nephritic Syndromes
- ) Membranoproliferative Nephropathy Type I
2. ) Membranoproliferative Nephropathy Type II/III
Describe the Hx, Labs, and Treatment/Prognosis of:
Minimal Change Disease
Description/Hx: Most common cause of nephritic syndrome in children. Can happen in adults. Associated with malignancy, esp. Hodgkin’s and NSAID use. Sudden onset with tendency for thrombotic events and edema.
Labs: LM = normal, EM = fusion of epithelial foot processes (podocyte fusion) with lipid-laden renal cortices.
Tx/Prognosis: Steroids, excellent prognosis.
Describe the Hx, Labs, and Treatment/Prognosis of:
Focal Segmental Glomerulosclerosis
Description/Hx: Idiopathic, IV drug use, HIV, obesity. Most common nephrotic syn. in adults. Typical patient is young AA man w/ hypertension.
Labs: Microscopic hematuria; biopsy shows sclerosis in capillary tufts.
Tx/Prognosis: Prednisone, cytotoxic therapy, ACEI/ARBs to decrease proteinuria.
Describe the Hx, Labs, and Treatment/Prognosis of:
Membranous Nephropathy
Description/Hx: Accounts for ~30% of adult nephrotic syn. Ass. with solid-tumor malignancies, infections (HBV, Malaria), autoimmunty (SLE), NSAIDs.
Labs: “Spike and Dome” on IM. Granular deposits of IgG and C3 at the basement membrane.
Tx/Prognosis: Prednisone and cytotoxic therapy.
Describe the Hx, Labs, and Treatment/Prognosis of:
Diabetic Nephropathy
Description/Hx: Diffuse hyalinazation and nodular glomerulosclerosis ( Kimmelstiel-Wilson lesions). Longstanding diabetics.
Labs: Thickened GBM and mesangial matrix.
Tx/Prognosis: Tight control of BG, ACEIs/ARBs
Describe the Hx, Labs, and Treatment/Prognosis of:
Lupus Nephritis
Description/Hx: Associated with Lupus, the prognosis of which is ass. with the degree of renal damage. Can present as mixed nephrotic/itic.
Labs: Mesangial proliferations, subendothelial IC deposition.
Tx/Prognosis: Prednisone and cytotoxic therapy may slow disease progression.
Describe the Hx, Labs, and Treatment/Prognosis of:
Renal Amyloidosis
Description/Hx: Pts. have multiple myeloma or chronic inflammatory disease (RH, MTb).
Labs: Nodular glomerulosclerosis with fibrils on EM, apple-green birefringence with congo red stain.
Tx/Prognosis: Prednisone and Melphalan.
Describe the Hx, Labs, and Treatment/Prognosis of:
Type I Mixed Nephrotic/ritic Syndrome (Membranoproliferative Nephropathy)
Description/Hx: Ass w/ HBV, HCV, SLE, and subacute bacterial endocarditis. Cyroglobulinemia
Labs: “Tram-Track” double-layered basement membrane. Subendothelial and mesangial deposits of IC. Low C3.
Tx/Prognosis: Corticosteroids and cytotoxic agents.
Describe the Hx, Labs, and Treatment/Prognosis of:
Type II/III Mixed Nephrotic/ritic Syndrome
(Membranoproliferative Nephropathy)
Description/Hx: Idiopathic
Labs: Intramembranous dense deposits. Occurs by way of C3 nephritic factor.
Tx/Prognosis: Corticosteroids and cytotoxic agents.
Primary Causes of FSGS
AA & Hispanics, obesity, HIV, Heroin
Primary Causes of Membranous Nephropathy
Adenocarcinoma (Breast, Lung), NSAIDs, HBV, SLE
Primary Causes of Membranoproliferative GS
HBV, HCV, Lipodystrophy
Primary Causes of Minimal Change Disease
NSAIDs, Lymphoma
Primary Causes of IgA Nephropathy
URI
