renal review Flashcards
what are the typically proteinuria values of nephrotic and nephritic syndromes?
nephrotic > 3.5g/24h
nephritic < 3.5g/24h
do you have a problem making urine in nephrotic or nephritic syndromes?
nephritic
No problem in nephrotic, typically have an excess
what primary glomerular lesions lead to nephrotic syndrome?
MCD FSGS membranous glomerulopathy membranoproliferative glomerulonephritis (often nephritic) IgA nephropathy (often nephritic)
what systemic diseases can lead to nephrotic syndrome?
diabetes mellitus
SLE
amyloidosis
how do we diagnose MCD (what do we see on LM, EM, and IF)?
LM: normal glomeruli
IF: no staining, looks normal
EM: diffuse effacement of foot processes
what are the clinical features of FSGS?
proteinuria: nephrotic or non-nephrotic range
hematuria, hypertension
patients with FSGS usually do not respond well to what type of medication?
steroids
is FSGS rapidly or slowly progressing?
slowly
what population is most susceptible to FSGS?
black african american
how many of the glomeruli are damaged in FSGS?
<50%
what is the worst variant of FSGS?
collapsing glomerulopathy
idiopathic or HIV associated
how do we tell the difference between MCD and FSGS on LM?
you can see segmental sclerosis in FSGS
what is the hallmark of membranous glomerulopathy histologically?
GBM spikes on silver stain (jones)
what do you see on IF in membranous glomerulopathy?
granular IgG
C3 on capillary wall
what do you see on EM in membranous glomerulopathy?
subepithelial deposits regularly distributed along GBM
what is the typical presentation of glomerulonephritis (MPGN)?
proteinuria - typicaly nephrotic, but may be mild
hematuria, may be accompanied by nephritic syndrome
hypocomplementemia (low serum C3)
proliferation and thickening of capillary wall
most common form of MPGN
type 1 - lupus, hep C
what causes type II MPGN?
c3 nephritic factor
what is pathological about MPGN Type I?
hypercellular glomeruli: increased mesangial and infiltrating mononuclear cells in global distribution
thick-walled capillary loops: double contour or “tram track”
crescents (Rare)
what do we see on IF of MPGN type I?
granular C3 along capillary walls at the periphery of lobule (central sparing) often with IgG and IgM
what do we see on EM of MPGN type I?
immune deposits in subendothelial and mesangial locations
what two diseases are common etiologies of MPGN type I?
HCV and lupus
what is MPGN type II?
dense deposit disease
autoimmune disease with autoantibodies (C3 nephritic factor) directed at C3bBb
what are the clinical symptoms of acute nephritic syndrome?
hematuria +/- RBC casts
hypertension
azotemia, oliguria (usually transient)
edema, proteinuria variable (<3g/24h)