Pathology of Nephrotic Syndrome II Flashcards

1
Q

Primary criterion for nephrotic syndrome

minor criterion

A

1) albuminuria, hypoalbuminemia, edema, hyperlipidemia
2) malnutrition, thrombosis, incr infection

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2
Q

Causes of proteinuria (2)

A

1) loss of polyanion
- -> destabilization of foot processes and lose size selectivity and charge selectivity

2) normally basement membrane does not filter large molecules

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3
Q

7 y/o boy over last 2-3 weeks listless,

55% weight –> now 90% weight

4g protein in urine

albumin = 1.9

diagnosis?

A

nephrotic syndrome

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4
Q

1) hypercellularity ?

2) inflamm cells =?
3) basement membrane thickening?

4) scarring?

diagnosis?

A

1) hypercellularity = no

2) inflamm cells = open capillary loops so no
3) basement membrane thickening? = look at tubule size

4) scarring? no

diagnosis = normal by light microscopy

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5
Q
A
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6
Q
A

fenestrated epithelium

foot process effacement = injury to endo cell = separate and retract—> creates holes

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7
Q

Minimal change nephropathy

1) clinically: ___ syndrome
2) on light microscopy, EM, IF
3) therapy
4) prognosis

A

1) nephrotic syndrome
2) light = no change

EM = foot process effacement

IF = negative

3) steroids
4) good

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8
Q

RIGHT = hypercellular? inflamm cells? basement membrane? scarring?

LEFT = scarring? focal or segmental or diffuse or global?

A

RIGHT =

slightly hypercellular
no inflamm cells
basement membrane thickening hard to see
but okay
scarring present

LEFT = too much pink disease = sclerosis
focal @ part of total glomeruli
segmental = @ individual glomerulus

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9
Q

45 y/o male otherwise well
shoes are too tight can’t lace up boot
too lethargic
15 lbs weight gain over 2 weeks
pitting edema
periorbital swelling

albumin = 1.7
cholesterol = 250
protein in uria = 4 (> 3.5g)

diagnosis

A

FSGS

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10
Q

FSGS

1) __ syndrome
2) on IF

on EM

3) pathogenesis
4) therapy
5) prognosis

A

1) nephrotic
2) normal on IF

foot process effacement on EM

3) hyperfiltration, hereditary forms
4) steroids = high relapse though
5) ESRD

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11
Q

FSGS most common causes

A

1) idiopathic/hereditary
2) HIV assoc (Rapid progr form of FSGS
3) heroin
4) secondary - reduced renal mass or initially normal (end stage diabetes)

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12
Q

hypercellular?
inflamm cells?
segmental scars?
basement membrane?

diagnosis?

A

not hypercellular
no inflamm cells
no segmental scars
thicker and fuzzier basement membrane
—> membranous nephropathy

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13
Q

left = linear or granular

right = basement membrane deposits?

inflamm cells?

A

left = granular immune complex deposits
C3, C5a, IgG

right =

capillary loop outlined
with dark immune complex deposits along
basement membrane = subepithelial

no incr in inflamm = on downstream side
washed out inflamm cells in urine

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14
Q

membranous GN

1) ___ syndrome
2) morphology on light microscopy

EM?

IF?

3) therapy
4) prognosis

A

1) nephrotic
2) GBM thickening = spikes

EM = subepithelial deposits

IF = granular GBM

4) steorids
5) ESRD

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15
Q

Stages of membranous nephropathy

A

1) injury to glomerular epith cell
2) responds by incr basement membrane to wall off injurious agent
3) overlap of basement membrnae on top
4) agent dissolved away

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16
Q

arrows?

A

abnormal
membrane

arrows = deposits are blanching

17
Q

Membranous GN

1) most offen in which patients
2) assoc with …

A

1) adults
2) bugs = infection, drugs (RA), tumors (malignancy), rheum (SLE)

18
Q

left = basement membrane?

hypercellular?

endocapillary prolif?

inflamm cells?

A

left = basement membrane thickening

hypercellular
diffuse endocapillary proliferation
some inflamm cells

19
Q

right = linear or granular?

A

left = large deposits
in between layers of double contour
tram tracking

right = globular = not linear or granular

20
Q
A

right = subendothelial
deposits , normal basement membr

21
Q

52 y/o woman
over last 3 weeks = flu-like symptoms
dysuria
can’t sleep
+edema
+rales too many RBC in urine
RBC casts
creatinine = 3.5
albumin = 1.7
4+ proteins in urine

diagnosis?

A

nephrotic + nephritic syndrome (due to RBC casts = glomerulonephritis and creatinine = 3.5)
hypoalbuminemia, pitting edema, and proteins in urine

22
Q

MPGN

1) usually __ syndrome
2) on light microscopy

in IF

in EM

3) therapy
4) prognosis

A

1) nephritic/nephrotic
2) cell prolif, GBM thickening - double countours = tram tracking

EM = subendo deposits

IF = granular GBM

3) steroids, interferon
4) ESRD

23
Q

Renal amyloidosis

1) 2 light chain types
2) present with ___
3) histology shows
4) congo red stain ___

A

1) AA vs. AL
2) proteinuria
3) amorphous fluffy pink in glomeruli and vessels
4) apple green birefringence

24
Q
A

renal amyloidosis

25
Q

most common causes of ESRD

A

1) diabetes
2) HTN/vascular disease
3) glomerulonephritis

26
Q

DM

1) ___ arteriolar disease
2) more or less severe than HTN

DM glomerulosclerosis

histology

A

1) hyaline
2) more

histology = diffuse mesangial expansion, more matrix than cells = mesangial lysis, basement membrane thickening, hyperfiltration,

27
Q
A

left = nodules of pink
pushing everything away
and killing mesangial cells in middle

right = thickened
lamina
densa

28
Q

other renal path assoc with diabetes

A

1) vascular atherosclerosi sand arteriolosclerosis due to ischemia in kidney
2) pyelonephritis due to renal scarring and renal papillary necrosis

29
Q

Hypertensive renal disease presents as

A

1) finely granular surface = scarred glomeruli
2) medial and intimal thickening/hyaline deposition in vessels

30
Q

malignant accelerate hypertensive
renal disease

1) initial event is …
2) result is …
3) kidneys respond by …

A

1) renal vasculature injury
2) fibrinoid necrosis + hyperplasti carteriolitis
3) secrete more renin

31
Q

uremia due to …

A

severe loss of all renal function

32
Q

uremia effect on excretion

drug excretion in chronic renal failure

A

azotemia = BUN, creatinine, drug toxicity

problem with drug metabolism –> accum more drug –> toxic

33
Q

endocrine effects of uremia

A

1) EPO = anemia of chronic disease
2) renin-angiotensin –> HTN
3) vitamin D activ –> osteomalacia

34
Q
A