Nephrotic Syndrome

Question 1

Présentation

Answer 1

Massive proteinuria (>3.5gm/24h)
Hypoalbuminemia (< 3gm/dL)
Generalized edema 
Hyperlipidemia
Lipiduria

Question 2

Causes

Answer 2

Primary glomulerar disease (GN)

Systemic disease

Question 3

Main micro presentation

Answer 3

Molecular defect in endothelium ,GBM ,Visceral epithelium

Question 4

What is highly selective proteinuria

Answer 4

Protein loss of on;l’y low molecular weight protein like albumin and transferrin

Question 5

What is poorly selective proteinuria

Answer 5

Higher molecular weight protein in urine like globulins

Question 6

Which on is better , selective or poorly selective proteinuria

Answer 6

Selective because means there’s less enlargement

Question 7

Lipid profile

Answer 7

Increased cholesterol

LDL, VLDL , TGs, Lp lipoprotein

Question 8

Lipoid nephrons is associated with

Answer 8

HLA B12
Hodgkin lymphoma, leukemia , NSAIDS ( seen in secondary type )
Upper respiratory tract infection and immunization

Question 9

Complications of renal nephrotic syndrome

Answer 9

Infections - staph , strep loss of immunoglobulins
Thrombosis
Thromboembolism - loss of endogenous anticoagulants

Question 10

Lipoid néphroses presentation

Answer 10

Edema
Massive proteinuria
No hematuria
Normal filtration rate

Question 11

LN histo

Answer 11

Normal glomeruli
Fat in renal tubular epithelial cells

Foot processes obliteration

Question 12

LN immunology

Answer 12

Negative- no antigen antibody rxn

Question 13

LN prognosis in children treated with steroids

Answer 13

Good

No permanent renal damage

Question 14

Prognosis in adults with LN treated with steroids

Answer 14

Variable

Question 15

Etiology focal segmental glomerular sclerosis

Answer 15

Unknown

Question 16

focal segmental glomerular sclerosis disease association

Answer 16

HIV
Infection
Heroin addiction 
Sickle cell disease
Glomerular scarring with minimal change

Question 17

Pathogenesis of focal segmental glomerular sclerosis

Answer 17

Accentuation of epithelial damage seen in minimal change disease
Entrapment of plasma proteins in hyper permeable foci of GBM with increased extracellular matrix deposition

Question 18

Clinical presentation focal segmental glomerular sclerosis

Answer 18

NS proteinuria with or without hematuria

Decreased GFR with High urea, high creatinine

Question 19

Immunology focal segmental glomerular sclerosis

Answer 19

IgM

C3

Question 20

Prognosis focal segmental glomerular sclerosis

Answer 20

Poor

Progress to chronic glomerulonephritis and renal failure

Question 21

Prognosis of children better or worse than adults focal segmental glomerular sclerosis

Answer 21

Better

Question 22

Commonest cause of nephrotic syndrome in adults

Answer 22

Membranous nephropathy

Question 23

Association to Membranous nephropathy

Answer 23

Malignancy 
Malaria 
Schistosomiasis 
Syphilis 
SLE
Drugs
Diabetes 
Thyroiditis

Question 24

Pathogenesis of Membranous nephropathy

Answer 24

Chronic antigen mediated disease
Idiopathic type - autoimmune disease linked to susceptibility genes to HLA
Secondary type - in situ antibodies

Question 25

Clinical presentation Membranous nephropathy

Answer 25

NS

Normal filtration function

Question 26

Membranous nephropathy affect mostly male or female

Answer 26

MALE

Question 27

Histo Membranous nephropathy

Answer 27

Spikes (GBM material ) and domes (ab antigen complex)

Question 28

Immuno Membranous nephropathy

Answer 28

Granular deposit is of IgG and complement along GBM

Mesangium free

Question 29

Prognosis of Membranous nephropathy in children

Answer 29

Better

Question 30

Does steroid therapy work well in Membranous nephropathy

Answer 30

No

Question 31

Do secondary Membranous nephropathy better than idiopathic in prognosis

Answer 31

Yes because if treatunderlying disease , better prognosus