Renal Flashcards
Describe Nephrotic syndrome
NephrOtic= prOteinuria frothy urine. Hyperlipidemia, fatty casts,edema. Associated with thromboembolism and risk of infection (loss of immunoglobulins).
Fatty casts with greater than 3.5 grams of protein in 24 hr urine sample. Will have pitting edema.
Possibility to go from nephritic–>nephrotic
Describe nephrItic syndrome
NephrItic= Inflammatory process. Why it involves glomeruli, leads to hematuria and RBC casts in urine. Associated with azotemia, oliguria, HTN.
Bc of inflammation, you will spill protein but only for a short period of time (or you’d have nephrotic)you will NOT have pitting edema, ascites, inflamed glomerulus, I
Oliguria? (Small amounts of urine) yes. Are you decreasing the absorption and not filtering Na? YEs. so does Na build up? Yes. Run risk of HTN.
Describe cast
It is a mold of whatever is going on in the nephron / tubule.
I.e. In glomerulonephritis (inflammation) you have damaged capillaries and get hematuria, so RBC will be seen in the casts.
It. In pyelonephritis where NEutrophils are invading interstitium and tubules there are casts of WBC showing an infection of kidney.
Describe focal segmental glomerulosclerosis
A type of nephrotic syndrome most common in AA and Hispanics. Idiopathic or associated with HIV, sickle cell, heroin abuse, obesity. Inconsistent tx: steroids.
BX shows some normal glomeruli and some weird but only in certain areas- focal. Renal BX also shows no deposits
Describe membranous nephropathy (glomerulonephritis)
Most common primary nephrotic syndrome in Caucasian males. LM shows thickened Glomerular basement membrane. Idiopathic or assoc with antibody toward phospholipase A (NSAIDS! Penicillamine). Poor steroid therapy
Minimal change dz (aka lipoid nephrosis)
Nephrotic syndrome. Most common in children from previous infection, immunization. Assoc with HL. Good response to corticosteroids.
I.e. EM of boy that had URI a week ago, now all swollen, has pitting edema throughout body (anasarca) and ascites (abdominal swelling in peritoneum), no HTN with nothing on renal bx but EM showed RBC in glomerular capillary lumen. Maltese crosses in urine
Describe amyloidosis
Nephrotic syndrome. Assoc with MM, TB, rheumatoid arthritis
Stain with Congo red, and after you polarize it, it has a “Granny Smith” apple green birefringence.
Name nephrotic syndromes
Focal segmental glomerulosclerosis - IVDA, AIDS
Membranous nephropathy - adults
Minimal change dz (lipoid nephrosis)- kids
Diabetic nephropathy
Amyloidosis
IGA nephropathy
Aka Berger dz. nephritic syndrome. IGA based deposited seen in mesangium. Seen in henoch scholein pura pura. Episodic hematuria with RBC casts.
Pt with pitting edema, over 3.5 gram per 24 hrs, fatty casts. BM is thicker?Or spike like lesions outside of GBM seen with silver stain?
Membranous glomerulonephritis (nephropathy)
Describe membranoproliferative glomerulonephritis
Nephrotic syndrome with two types:
Type I: assoc with hep C. How do you remember? Membranous- Hep B (also remember vasculitis polyarteritis nodosa) membranoproliferative- Hep C. Type I is a subendothelial deposit
Type II: less common. Assoc with Auto Ab against C3. It causes C3 convertase to become overactive and is constantly breaking complement down.
Describe diabetic glomerulosclerosis.
Re read
Crescent GN
Glomerulus surrounded by proliferating cells that are parietal cells bc not in glomerulus, has crescent shape.. TheWORST to have bc in 3 months ot will go into acute renal failure and die unless on dialysis. I.e. GOODPASTURES SYNDROME
NAme nephrItic syndromes
post-strep GN
crescent GN
IgA nephropathy
Alport syndrome
Describe Renal tube defects
FAB, Glittering Liquid. Fanconi Anemia (PCT), Bartter (thick ascending LOH), Gittelman (DCT), Liddell (collecting tube).
