Proteinuric and nephrotic conditions and secondary glomerular disease Flashcards
What is seen in nephrotic syndrome? (6)
- massive proteinuria
- hypoalbuminaemia
- oedema
- hyperlipidaemia
- +/- lipiduria
- not associated with increased cellularity
What is the most common cause of nephrotic syndrome in children?
minimal change disease
What is seen on light microscopy in minimal change disease?
normal
What is seen on direct immunofluorescence in minimal change disease?
normal
What is seen on electron microscopy in minimal change disease?
diffuse effacement of podocyte foot processes
What is the proteinuria like in minimal change disease? (2)
- highly selective proteinuria
2. small albumin»_space;> others
What is thought to be the cause of minimal change disease? (4)
- some soluble permeability factor
- immature T cells
- CD34+ stem cells
- cytokine mediated
What is the prognosis of minimal change disease?
95% of children responds well to steroids
What are the different settings of focal segmental glomerular sclerosis? (4)
- primary/idiopathic
- adaptive
- secondary
- glomerular tip lesion variant
What is the cause of primary/idiopathic focal segmental glomerular sclerosis? (2)
- cytokine
2. permeability factor
What is the cause of adaptive focal segmental glomerular sclerosis?
hydrodynamic shear stress
What is the cause of secondary focal segmental glomerular sclerosis? (5)
- Heavy (obesity)
- HIV
- Heroin
- Haematological - sickle cell
- secondary to Hyerfiltration
What is the proteinuria like in focal segmental glomerular sclerosis?
less selective than minimal change disease
What is seen on light microscopy in focal segmental glomerular sclerosis?
- juxtamedullary deep glomeruli
2. focal segmental sclerosis
What is the prognosis of focal segmental glomerular sclerosis?
50% end stage renal failure in 10 years
What is associated with membranous nephropathy? (7)
- HBV
- HCV
- Lupus
- Hodgkin’s lymphoma
- syphilis
- malaria
- schistosomiasis
What vessel is most susceptible to thrombosis due to membranous nephropathy?
renal vein
Why is thrombosis a risk in membranous nephropathy?
due to loss of antithrombin III un urine
What is the pathology of membranous nephropathy?
antigen-antibody in glomerular basement membrane and subepithelial to the podocytes
What is seen on immunofluorescence with membranous nephropathy?
glomerular and subepithelial immune complexes made of C3 and IgG
How does proteinuria occur in membranous nephropathy?
- C3 is part of complement
- membrane attack complex injures podocyte
- non-selective proteinuria
What type of proteinuria occurs in membranous nephropathy?
non-selective proteinuria with loss of albumin and globulin
What is seen on light microscopy in membranous nephropathy? (2)
- no increase in cellularity
2. thickened glomerular basement membrane
What is seen on electron microscopy in membranous nephropathy?
- subepithelial immune complex deposition
- podocyte foot process effacement
- thickened glomerular basement membrane in “spikes and domes”