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Renal - Gupta > Nephrotic Syndrome I > Flashcards

Nephrotic Syndrome I Flashcards

1
Q

Differentiate the following features of nephrotic and nephritic syndrome.
• Edema
• Proteinuria
• Urinary Sediment

A

NephrOtic:
• Edema - PROMINENT
• Proteinurea - in nephrotic rangeMore Severe
• INACTIVE urinary sediment

NephRITic:
• Edema - Mild
• Proteinurea
• ACTIVE urinary sediment with Dysmorphic RBCs and RBC casts

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2
Q

Differentiate the following features of nephrotic and nephritic syndrome.
• Blood Pressure
• Inflammatory?
• Serum Creatinine

A

NephrOtic:
• Blood Pressure - Normal
• NON-inflammatory condition
• Normal Serum Creatinine - possible slight elevation

NephRITic:
• Hypertension
• INFLAMMATORY
• Elevated Serum Creatinine

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3
Q

Differentiate the Key cells involved in nephrotic and nephritic syndrome.

A

NephrOtic:
• Visceral Epithelial Cell - PODOCYTE

NephRITic:
• Endothelial Cell

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4
Q

T or F: a urinary dipstick can be used to show proteinuria AND hematuria.

A

True

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5
Q

Comment on specificity of Hyaline casts.

A

Usually seen in CONCENTRATED urine with ANY renal pathology such as DEHYDRATION and use of DIURETICS, can be associated with PROTEINURIA too

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6
Q

When are White Cell Casts seen?

A
  • Nephritic Syndrome

* UTI

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7
Q

When are RBC casts seen?

A

ONLY in glomerular Disease

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8
Q

When are granular Casts seen?

A

• ANY cause such as ACUTE TUBULAR NECROSIS

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9
Q

Which is in contact with the urine podocytes or epithelium?

A

Podocytes - these are the cells that are messed up in nephrotic syndrome

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10
Q

What are the 3 groups of Podocyte injury that can lead to nephrotic syndrome?

A
  1. Injury can happen in PODOCYTES
  2. Injury can happen in Immune complex deposition in subepithelial space (Under the Podocytes)
  3. Glomerular Capillary Wall Deposition Diseases
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11
Q

What are some injuries that can happen to podocytes?

• what syndrome does this cause?

A
  • Minimal Change Disease
  • Focal Segmental Glomerulosclerosis

Nephrotic Syndrome*

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12
Q

What is a disease that causes Injury by Immune complex deposition in subepithelial space (Under the Podocytes)?
• diseases caused?

A

Membranous Nephropathy

Nephrotic Syndrome*

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13
Q

What causes are some diseases of the glomerular capillary wall that lead to nephrotic syndrome?

A

Diseases:
• Amyloidosis
• Light Chain Deposition Disease
• Diabetic Nephropathy

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14
Q

What what are 3 groups of mechanisms that can lead to Nephritic syndrome?

A
  • Subendothelial Space or Mesengial Immune complex formation and Complement Activation
  • Antibodies Directed at the Glomerular Basement membrane
  • Necrotizing Injury and Inflammation of the vascular and glomerular capillary wall
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15
Q

What are some diseases that cause Subendothelial Space or Mesengial Immune complex formation and Complement Activation?
• does this result in nephrotic or nephritic syndrome?

A
  • Post-infectious Glomerulonephritis
  • IgA nephropathy
  • Lupus Nephritis

Nephritic Syndrome

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16
Q

What are some disease that cause production of Antibodies Directed at the Glomerular Basement membrane?

A

Anti-Glomerular Basement Disease (Goodpastures syndrome)

Nephritic Syndrome*

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17
Q

What are some disease that cause Necrotizing Injury and Inflammation of the vascular and glomerular capillary wall?

A

ANCA associated diseases

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18
Q

What is the glomerulus such a common place for immune complex deposition?

A
  1. High Plasma Flow Rate (~20% of CO goes to the kidney)
  2. High Intraglomerular Pressure
  3. High Glomerular Hydraulic Conductivity (permeability)
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19
Q

What determines the spectrum of glomerular disease caused by immune complexes?

A
  • Nature of Antigen Involved (what its directed against)

* Site of Immune Complex Deposition

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20
Q

Where are immune deposits placed in Membranous Nephropathy?
• cause?
• Association?

A

SUBEPITHELIAL Deposits

Cause:
• Idiopathic

Associated with:
• Systemic Lupus Erythematous, Diabetes Mellitus, Hepatitis B, Drugs (gold, Penicillamine)

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21
Q

What is seen in the late course of membranous Nephropathy?

A

• Post-Infectious Glomerulonephritis

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22
Q

T or F: Anti-glomerular Basement membrane disease is usually Nephrotic with segmental Glomerulonephritis.

A

FALSE, is it usually NephrphRITic with CRESCENTRIC GN.

23
Q

What disease often presents with macroscopic asymptomatic hematuria that presents intermittently?

A

• IgA nephropathy (nephritic syndrome)

24
Q

What 3 diseases often present with large proteinuria?

A
  • Membranous Nephropathy
  • Minimal Change Disease
  • Focal Segmental Glomerulosclerosis
25
Q

What are some causes of rapidly progressive glomerulonephritis that can progress to renal failure in a period of days to weeks?

A
  • ANCA vascultis

* Lupus nephritis

26
Q

T or F: in hypertensive and diabetic nephropathy disease progression is fast.

A

False, disease progression is SLOW characterized by Proteinuria

27
Q

What are 4 key features to look for in someone with nephrotic syndrome?

A
  1. Edema
  2. Proteinuria
  3. Hypoalbuminemia
  4. Hypercholesterolemia
28
Q

***How can all 4 common features of Nephrotic Syndrome be accounted for?

A

PROTEINURIA leads to protein loss (hypoalbuminemia) and EDEMA from reduced colloidal pressure in capillaries.

• In response to LOW plasma protein the LIVER kicks up ALL PROTEIN PRODUCTION leading to increased CHOLESTEROL (hypercholestolemia)

Lipoproteinlipase levels are also reduced leading to increased VLDL

29
Q

What are some common urinary sediments in Nephrotic Syndrome?

A
  • Oval Fat Bodies

* Maltese Cross

30
Q

T or F: Xanthelasma is a characteristic of nephritic syndrome.

A

FALSE, this is subcutaneous fat deposits around the eyes are associated with Nephrotic Syndrome

31
Q

NOTE: Hematuria, Proteinuria, Edema, and HTN can occur in both nephritic and nephrotic syndrome.

A

NOTE: Hematuria, Proteinuria, Edema, and HTN can occur in both nephritic and nephrotic syndrome.

32
Q

T or F: Nephrotic syndrome is more associated with inflammation.

A

FALSE, NEPHRITIC SYNDROME is most associated with inflammation

33
Q

What determines if something gets through the glomerulus?

A
  • Charge
  • Size
  • Shape
34
Q

NOTE: Uncharged molecules less than 1.8 nm filter freely through the glomerulus, Molecules greater than 4 nm are completely restricted
Charge Restriction prevents albumin from passing through

A

NOTE: Uncharged molecules less than 1.8 nm filter freely through the glomerulus, Molecules greater than 4 nm are completely restricted

35
Q

What structure provides the main size barrier across the glomerulus?
• Charge Barrier?

A

Size Barrier:
• Lamina Densa of the Glomerular Basement Membrane and Slit Diaphragm

Charge Barrier:
• Lamina rara interna and on Fenestrated Capillary Endothelium

36
Q

Assuming equal radius, rank the following on fractional clearance through glomerulus.
• Neutral, Anionic, Cationic

A

Greatest Clearance:
Cationic
Neutral
Anionic - Least

37
Q

T or F: Beta-2 microglobulins are typically restricted from coming through the basement membrane

A

FALSE, these usually pass freely through

38
Q

What happens to most proteins that make it through the glomerulus?

A

PROXIMAL TUBULE epithelial cells ENDOCYTOSE (via receptor mediated endocytosis) proteins into vesicles and HYDROLYZE them into AMINO ACIDS

Amino Acids are released out of the BASOLATERLAL side of the tubular cell to re-enter circulation

39
Q

Why do people with hypertension tend to have more protein in their urine?

A

• The amount of protein that enters Bowman’s space is proportional to the pressure in the Glomerulus

40
Q

Compare the size of proteins excreted by patients with normal kidney function and those with nephrotic syndrome.

A

•People with Nephrotic Syndrome tend to secrete Fewer Small Protein ans MORE LARGE PROTEINS

*This is due to loss of surface area at the expense of gaining big ass hone in the glomerulus

*Note: People with Nephrotic Syndrome also secrete more IgG

41
Q

What protein does the urine dipstick measure?

A

ALBUMIN

42
Q

Compare Proteinuria due to tubular dysfunction vs. Glomerular Dysfunction.

A

Tubular - Secondary to Tubulointerstitial Disease - LOW MOLECULAR WT. PROTs.

Glomerular - any type of Glomerulonephritis - ALBUMIN is dominant

SO URINE DIPSTICK LOOKS FOR GLOMERULAR DYSFUNCTION

43
Q

What is the normal amount of protein to be excreted daily by the kidneys?
• amt of Albumin?
• amt Tamm-Horsfall mucoprotein?
• Upper Limit of Normal?

A

40-80 mg/day

  • 30mg/day is Albumin
  • 30 - 50 mg/day is Tamm-Horsfall Mucoprotein

Upper limit of Normal= 150 mg/day

44
Q

How high is albumin if the dipstick changes color?

A

300 to 500 mg/day (10 to 15x the normal level)

45
Q

Since we can’t quantify the total amount of protein excreted in a day, what do we typically quantify?
• what is the normal amt for this?

A

Ratio of Albumin to Creatinine

Normal: less than 0.15

46
Q

What is the most important predictor of how will someone’s nephrotic syndrome is under control?

A

• Proteinuria

47
Q

What two angles do we attack nephrotic syndrome at?

A

Supportive Measures

Disease Modifiers

48
Q

What are some supportive measures used in nephrotic syndrome?

A

Supportive Measures:

• CONTROL HTN - low NaCl diet, ACE I’s, Angiotensin Receptor Blockers

49
Q

What are some disease modifiers used in nephrotic syndrome?

A

Disease Modifiers:

  1. Steriod
  2. Immunosuppressive Drugs - Cyclophosphamide, Cyclosporin, Mycophenolate Mofeitil, Tacrolimus
50
Q

If someone has a spot urine protien creatinine of 10.8, about how much protein are they pissing out per day?

A

• ~10 grams/day

51
Q

T or F: both BUN and Creatinine are typically elevated in Renal Failure

A

True

52
Q

How does treatment of Secondary Nephrotic Sydrome differ from that of primary?

A

• Secondary Nephrotic Syndrome requires treatment of the ROOT CAUSE

53
Q

What is microalbuminuria?

A
  • Microalbuminuria = 30-300 mg/day excretion of albumin

* This amount Can’t be detected by the dipstick

Renal - Gupta (17 decks)

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