SG Diseases

Question 1

Describe acute nephrotic syndrome

Answer 1

Proteinuria > 3.5g
See oval fat bodies: lipid in urine
- Hypoalbuminemia
- Hyperlipidemia (compensation by liver)

Question 2

Clinical picture of acute nephrotic syndrome

Answer 2

Weight gain - dep edema, ascities

Hypercoag state

Question 3

Does nephrotic syndrome edema respond to diuretics?

Answer 3

No b/c low intravasc vol

Question 4

Clinical picture of acute nephritic syndrome

Answer 4

Edema face + hands
Acute HTN
Oliguria
BUN:Cr > 15

Question 5

Is urine sediment abnormal during nephritic syndrome?

Answer 5

Yes - high urine sediment
RBCs
RBC casts
Moderate proteinuria

Question 6

Describe rapidly progressive renal glomerular nephritis, RPGN (renal failure)

Answer 6

Rapid loss glomerular filtration 
Severe progressive of nephritic
Acute rise Cr + urine sediment
1. Edema (weight gain)
2. Proteinuria - indicates glomerular process (not high enough for nephrotic)
3. HTN

Question 7

What would you see on biopsy if the pathologic process of RPGN is of glomerular origin?

Answer 7

Crescents in most glomeruli

Question 8

Describe chronic renal failure

Answer 8

Gradual deterioration of renal fxn
↓GFR
HTN + edema - late in disease once ↓↓GFR

Question 9

Name the causes of low complement glomerular nephritis

Answer 9

1. Post-strep GN
2. SLE
3. MPGN (Hep C related)
4. Secondary MPGN - SLE of HBV
5. Atheroembolic renal
6. HUS/TTP - check peripheral blood smear

Question 10

What is the light microscopy for post-strep GN

Answer 10

Hypercellular throughout - more mesangium

Obliterated capullary lumina

Question 11

IF and EM for post-strep GN

Answer 11

IF: “granular” lumpy bumpy due to deposit of IgG + IgM + C3 on basement membrane
EM: sub-epi deposits of Ig in humps

Question 12

Ddx for nephrotic syndrome

Answer 12

Minimal change (kids)
Membranous nephropathy - Hep B, SLE
Focal Seg GS - HIV
Mesangial proliferative 
Diabetes
Amyloid
Membrano-proliferative (nephritic or nephrotic)

Question 13

What would you see for minimal change disease

Answer 13

EM only - effacement of foot processes

LM and IF are normal!!

Question 14

What are the 3 categories of RPGN?

Answer 14

ALL THE SAME ON LM

1. Granular IF = immune complex mediated
2. Linear IF = anti-GBM
3. Nothing IF = Pauci-immune

Question 15

Quiz 1: pt with facial + hand edema, low FE Na, proteinuria, hematuria, HTN - which syndrome

Answer 15

Acute nephritic
Think:
- Post infectious GN