Sketchy Path: The Nephrotic Syndrome

Question 1

The basement membrane is normally ___________ charged.

Answer 1

negatively (like the flat minus signs on the wall)

Question 2

One of the main processes disrupted in nephrotic syndrome is _____________.

Answer 2

the podocyte layer (like the scared foot soldier turning his back and cowering)

Question 3

____________ have been implicated in podocyte effacement.

Answer 3

Cytokines (like the fallen bag of coins by the foot soldier)

Question 4

_______________ cells do not play a role in nephrotic syndrome.

Answer 4

Inflammatory

They are involved in nephritic syndrome.

Question 5

Nephrotic syndrome is defined by what five signs and symptoms?

Answer 5

• Proteinuria: 3.5 grams per day (like the meat falling off the cart with 3.5 on it)
• Hypoalbuminemia (like the woman dropping her photo album)
• Peripheral edema (like the swollen King Edward)
• Hyperlipidemia (like the butter next to King Edward)
• Lipiduria (like the pigs in the yellow river by the woman with the albumin)

Question 6

Other than the five main symptoms and signs, what else can be lost in the urine of those with nephrotic syndrome?

Answer 6

• Antithrombin III (like the cage tumbling behind the wheelbarrow man)
• Gammaglobulin (like the fallen keys next to the beaver cage)

Question 7

Due to the loss of thrombin, _____________ can occur in nephrotic syndrome.

Answer 7

renal vein thrombosis (like the guy getting stabbed in his flank about the polymerized fibrin sticks)

Question 8

Patients may report that their urine is ___________.

Answer 8

frothy (like the wheelbarrow guy kicking up froth in the yellow river)

Question 9

Describe minimal change disease.

Answer 9

• Most common cause of nephropathy in children (like the children too young to fight)
• Occurs due to podocyte effacement)
• Only structural change is visible with EM
• Occurs after URI, allergies, or insect sting (like woman blowing her nose)

Question 10

Minimal change disease is a little different compared to the other nephrotic syndromes in that it causes the selective loss of ___________.

Answer 10

albumin (like the photos by the kids’ feet)

Question 11

Most people with minimal change disease respond to _____________.

Answer 11

steroids

Question 12

What does the “sclerosis” look like in FSGS?

Answer 12

Obliterated capillaries with hyaline deposition

Question 13

Electron microscopy of those with FSGS will show ______________.

Answer 13

fusion of the podocytes (like the grown-up version of the hugging foot soldiers near William Wallace)

Question 14

Unlike minimal change disease, FSGS ______________.

Answer 14

(1) causes loss of all proteins, not just albumin; (2) often progresses to end-stage renal disease (like the cracked kidney paper weights

Question 15

What can cause FSGS?

Answer 15

• Heroin abuse
• HIV
• Hepatitis
• Diabetes

Question 16

__________________ is thought to play a role in the development of diabetic nephropathy.

Answer 16

Nonenzymatic glycosylation of the basement membrane (like the purple candies stuck in the wall)

Question 17

_______________ are pathognomonic for diabetes.

Answer 17

Kimmelstiel-Wilson nodules (like the big candy hovering of the mesangium to represent hypocellular mesangium)

Question 18

Like FSGS, diabetic nephropathy can progress to _____________.

Answer 18

sclerosis with hyaline obliteration of the capillaries (like the second sclerosis dragon flag behind the candy catapult)

Question 19

In many cases, membranous nephropathy is caused by ________________.

Answer 19

antibodies against phospholipase A2 (like the foot soldier with the shield next to the pink membrane with a bunch of arrows in it)

Question 20

Where do antibodies and immune deposits accumulate in membranous nephropathy?

Answer 20

In the subepithelial space (like how the arrows are on the foot soldier!)

Question 21

Membranous nephropathy classically presents with ______________ on electron microscopy.

Answer 21

the “spike and dome” membrane between the immune deposits (like the archer with the spikey dome helmet)

Question 22

What can cause membranous nephropathy?

Answer 22

• Bugs: HBV, HCV (like the icosahedral lantern on the archer’s belt)
• Drugs including NSAIDs and penicillamine
• Tumors (like the archer’s crab emblem)
• Rheum (like the lupus wolf jumping onto the membrane)

Question 23

______________ can slow the progres of membranous nephropathy.

Answer 23

Steroids (like the moon shield protecting the foot soldier)

Question 24

Membranous nephropathy will show _______________ under IF.

Answer 24

bumpy deposits of IgG and C3b

Question 25

How does amyloidosis damage the glomerulus?

Answer 25

It causes obliteration of the capillaries (like the ArMored LaDieS kicking over the red shields).

Question 26

_______________ can help diagnose amyloidosis.

Answer 26

Congo staining (like the green smoke)