Renal Disorders III Flashcards
Causes of nephrotic syndrome
- primary: minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy
- secondary: diabetic nephropathy
Minimal change disease: who does it affect
- most common in children (peak 2-6yrs)
Minimal change disease appearance on light and immunofluorescence microscopy
NORMAL
Treatment for minimal change disease
- response well to steroids
Key feature of minimal change disease: electron microscopy
- diffuse epithelial foot process effacement
Focal segmental glomerulosclerosis (FSGS): who does it affect
- common in african americans
FSGS signs
- hypertension
- microscopic hematuria
FSGS biopsy signs
LM- segmental sclerosis
IF- mild IgM and C3 or negative
EM- diffuse epithelial cell injury
FSGS treatment
- response to steroids is variable (UNLIKE minimal change disease)
FSGS key features
- segmental glomerular sclerosis (LM)
- epithelial foot process effacement (EM)
Membranous nephropathy biopsy
LM: thickened capillary loops
IF: granular capillary loop pattern
EM: sub epithelial deposits (SPIKES)
Special stain done with membranous nephropathy and purpose
- silver stain: can see SPIKES better
Spikes in membranous nephropathy: pink vs. black
- pink = deposits
- black = basement membrane
Membranous nephropathy key feature
- sub epithelial immune deposits causing “spikes” by silver stain
Membranous nephropathy causes and clinical course
- idiopathic: 85%
- secondary: 15%
- clinical course: chronic, waxing and waning of proteinuria
Conditions associated with membranous nephropathy
- idiopathic
- autoimmune diseases: lupus erythematosus
- infectious diseases: hepatitis B
- drugs: penicillamine
- miscellaneous: malignancies
Diabetic nephropathy presentation
- proteinuria, nephrotic syndrome or chronic kidney disease
Histologic finding with diabetic nephropathy
- nodular glomerulosclerosis
Thrombotic microangiopathy: leads to what
- microangiopathic hemolytic anemia: schistocytes
- thrombocytopenia
- kidney injury
Features of thrombotic microangiopathy
- fibrinoid necrosis of arteriole
- fragmented red cells in arteriolar wall
- onion skinning of arteriole
Causes of thrombotic microangiopathy
- hemolytic uremic syndrome/thrombotic thrombocytopenic pupura
- malignant hypertension
- anti phospholipid syndrome
Adult polycystic kidney disease (APKD): cause
- autosomal dominant inheritance
- defect in PKD1 gene (Cr 16) which encodes the polycystin-1 protein
APKD: result
- multiple expanding cysts in the kidney that eventually destroys kidney
- asymptomatic until 4th decade
Symptoms of APKD
- flank pain and hematuria
- saccular aneurysms in circle of willis can lead to subarachnoid hemorrhage and death
Nephrotic syndrome signs
- edema
- proteinuria, >3.5 g/24hours
- hypoalbuminemia, plasma levels
