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Renal 2 > Path - Nephrotic Syndrome I > Flashcards

Path - Nephrotic Syndrome I Flashcards

1
Q

Compare edema in Nephrotic vs Nephritic syndrome

A

Nephrotic - edema prominent

Nephritic - edema mild

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2
Q

Compare proteinuria in Nephrotic vs Nephritic syndrome

A

Nephrotic - prominent

Nephritic - mild

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3
Q

Compare urinary sediment in Nephrotic vs Nephritic syndrome

A

Nephrotic - inactive

Nephritic - active = dysmorphic RBCs and RBC casts (signs of inflammation)

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4
Q

Compare blood pressure in Nephrotic vs Nephritic syndrome

A

Nephrotic - normal

Nephritic - HTN

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5
Q

Compare creatinine in Nephrotic vs Nephritic syndrome

A

Nephrotic - normal or mild elevation in serum creatinine

Nephritic - elevated serum creatinine

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6
Q

Key cell involved in Nephrotic syndrome?

A

Visceral epithelial cell (aka podocyte)

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7
Q

Key cell involved in Nephritic Syndrome?

A

Endothelial cell

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8
Q

Is inflammation present in nephrotic or nephritic syndrome? What UA finding supports this

A

Nephritic syndrome = inflammation (presence of dysmorphic RBC and RBC casts)

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9
Q

Albumin & Lipid levels in Nephrotic Syndrome?

A

Hypoalbubinemia

Hyperlipidemia

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10
Q

Most common type of cast found in urine? Name 1 instance you would observe this?

A

Hyaline casts, seen commonly in dehydration

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11
Q

Buzz words. Foot process effacement/fusion?

A

Minimal change disease, focal segmental glomerulosclerosis

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12
Q

Buzz words. Spike and dome?

A

Membranous nephropathy

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13
Q

Buzz words. Subepithelial humps?

A

Post infectious (streptococcal usually) glomerulonephritis

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14
Q

Buzz words. Tram tracks?

A

Membranoproliferative glomerulonephritis

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15
Q

Buzz words. Basketweave?

A

Alport syndrome

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16
Q

Buzz words. Wire loops?

A

Lupus nephritis

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17
Q

Buzz words. Onion skin?

A

Hypertensive nephropathy (arterioles) or scleroderma (larger vessels)

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18
Q

Immunofluorescence is negative in what 2 nephrotic syndromes? Why?

A

Minimal change disease, focal segmental glomerularnephritis. No immune complex deposition, only foot processes effacement/fusion

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19
Q

Xanthelasma present on eyelids in nephrotic syndrome. Why?

A

Due to hypercholesterolemia/hyperlipidemia seen in nephrotic syndrome

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20
Q

Nephrotic syndrome. Albumin level in blood (hyper or hypo)?

A

Hypoalbuminemia

21
Q

Nephrotic syndrome. Gammaglobuin level in blood?

A

hypogammaglobulinemia (increased risk for infection)

22
Q

Nephrotic syndrome. Coaguable state? Why?

A

Hypercoaguable due to loss of antithrombin III

23
Q

Hyperlipidemia in Nephrotic Syndrome results in what in urine?

A

Fatty casts in urine

24
Q

Maltese cross pattern. What is it?

A

Fatty casts in urine that indicate presence of cholesterol in urine

25
Q

Albumin radius is 3.6 nm. What is the significance of this?

A

Glomerular filtration barrier usually restricts molecules < 4 nm. Therefore, if not for the charge barrier on the membrane, albumin could leak through, producing hypoalbuminemia. KEY POINT: Charge is more important than size

26
Q

Alpha-actinin 4 defect = ?

A

Autosomal dominant FSGS

27
Q

Podocin defect = ?

A

Autosomal recessive steroid resistant FSGS

28
Q

TRPC6 defect = ?

A

Autosomal dominant FSGS

29
Q

NEPH 1 defect = ?

A

autosomal recessive Finish type, resembles Minimal Change Disease

30
Q

Beta 2 microglobulin filtration status (in normal non-nephrotic syndrome)?

A

Almost completely unrestricted to filter through

31
Q

Albumin filtration status (in normal non-nephrotic syndrome)?

A

Some albumin filtered through, but reabsorbed by proximal tubular cells

32
Q

IgG filtration status (normally, in non nephrotic syndrome)?

A

Completely restricted, molecular radius large (nearly 1.5x the size of albumin)

33
Q

Compare filtration status of small vs large dextran in nephrotic syndrome

A

lower excretion of small molecular weight dextran due to loss of filtration surface area and increased clearance of large molecular weight dextrans

34
Q

IgG filtration status in nephrotic syndrome?

A

Increased excretion of IgG (neutral charge) due to loss of size barrier

35
Q

Normal level of albumin excretion in healthy kidney?

A

40-80 mg/day

36
Q

Urine dipstick measures what protein? What concentration of this protein must be present for dipstick to pick it up?

A

Albumin, >300 mg/day

37
Q

Microalbuminuria = what level of albumin in urine? Significance of this?

A

= 30-300 mg/day; however, urine dipstick won’t pick it up since its below the dipstick threshold of 300 mg/day

38
Q

normal spot urine albumin/creatinine ratio?

A

< 0.15

39
Q

Urine albumin/creatinine ratio is good indicator of what?

A

Very good indicator of 24 hour urine profile for patient

40
Q

Tamm-Horsfall mucoprotein normal excretion amount?

A

normal = 30-50 mg /day

41
Q

Nephrotic range 24 hour urine proteinuria?

A

> 3.5 grams

42
Q

Nephrotic range spot urine protein/creatinine ratio?

A

>3.5

43
Q

2 main treatment methods of primary nephrotic syndrome?

A
  1. Provide supportive measures
  2. Provide disease modifiers
44
Q

3 supportive measures of primary nephrotic syndrome?

A

Want to control HTN via:

low salt diet, ACEI, & ARB

45
Q

2 main disease modifiers of primary nephrotic syndrome?

A
  1. Steroids
  2. Immunosuppresive drugs (cyclophosphamide, cyclosporin, mycophenolate mofeitil, tacrolimus)
46
Q

Name the 4 immunosuppresive drugs used in primary nephrotic syndrome?

A
  1. Cyclophosphamide
  2. Cyclosporin
  3. Mycophenolate Mofeitil
  4. Tacrolimus
47
Q

Treatment method for secondary nephrotic syndrome?

A
  1. Treat the cause
  2. provide supportive measures (same as primary nephrotic syndrome) with low salt diet, ACEI, ARB
48
Q

Immunosuppresion therapy for secondary nephrotic syndrome?

A

None. Secondary nephrotic syndrome does not respond to steroids or immunosuppressants.

Renal 2 (11 decks)

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