Pathoma: Nephrotic Syndrome

Question 1

The hallmark of nephrotic syndrome is proteinuria exceeding _____________.

Answer 1

3.5 grams per day

Question 2

What are the five major traits of nephrotic syndrome?

Answer 2

Edema
Hyperlipidemia
Lipiduria
Proteinuria
Hypoalbuminemia

Question 3

What three risk factors does nephrotic syndrome increase?

Answer 3

Hypercoagulable
Infection risk
Vitamin D deficiency

Question 4

Minimal change disease is usually __________. It can be associated with __________.

Answer 4

idiopathic; Hodgkin’s disease

Question 5

What causes the effacement of podocytes?

Answer 5

Cytokines

Question 6

Why does Hodgkin’s lymphoma lead to minimal change disease?

Answer 6

Overproduction of cytokines by the Reed-Sternberg cells

Question 7

Minimal change disease leads to loss of __________, but not ___________.

Answer 7

albumin; immunoglobulin

Question 8

Although FSGS is most often idiopathic, it has these associations: ____________.

Answer 8

African-American and Hispanic males
Age 20 - 40
HIV
Heroin
Sickle cell

Question 9

FSGS will have ________ immunofluorescence and __________ immune deposits.

Answer 9

no; no

Question 10

Other than minimal change disease, which kind of nephrotic syndrome has effacement of the podocyte processes?

Answer 10

FSGS

Question 11

FSGS has a __________ response to steroids.

Answer 11

poor

Question 12

Again, membranous nephropathy is associated with these four things: _____________.

Answer 12

Bugs: HBV, HCV
Drugs: NSAIDs, penicillamine
Tumors
Rheum: SLE

Question 13

Where do the immune deposits lie in membranous nephropathy?

Answer 13

Sub-epithelium

Question 14

The “dome and spike” appearance of membranous nephropathy results from ____________.

Answer 14

membrane forming around immune deposits

Question 15

The “tram-track” membrane appears in __________.

Answer 15

membranoproliferative glomerulonephritis

Question 16

Where are the immune deposits in membranoproliferative glomerulonephritis?

Answer 16

Sub-endothelium or basement membrane

Question 17

Membranoproliferative glomerulonephritis is broken into two types: _____________.

Answer 17

Type I: sub-endothelial (HBV and HCV)
Type II: basement membrane (C3 nephritic factor–an antibody that stabilizes C3 convertase and leads to overactivation of complement)

Question 18

By what pathophysiology does diabetes mellitus lead to nephrotic syndrome?

Answer 18

High blood sugar leads to non-enzymatic glycosylation of the arteriolar basement membrane, which leads to hyalinization. This predominantly affects the efferent arteriole, leading to increased GFR and subsequent nephrotic syndrome. (This is also why ACE inhibitors are good for diabetics!)

Question 19

What histologic sign is indicative of diabetic glomerulosclerosis?

Answer 19

Kimmelstiel-Wilson nodules (areas of hypocellularity in the mesangium)