NEPHROTIC SYNDROME

Question 1

What type of odema classically occurs when albumin levels are low?

Answer 1

Periorbital

Question 2

Why is there no inflammation associated with disease processes that cause nephrotic syndrome?

Answer 2

Damage occurs mainly to podocytes or basement membrane but not capillary endothelia

For this reason, damage is not exposed to inflammatory cells in the blood ⇒ no inflammation but there is a breakdown in barriers preventing proteins from entering Bowman space

Question 3

Which part of the filtration barrier is affected by minimal change disease?

what is this condition triggered by? What condition is minimal change disease associated with?

Answer 3

Podocytes become effaced = protein filtration barrier lost as well as anion charge barrier. This causes an increase in a lot of albumin

• Triggered by cytokines that cause damage to podocytes
• Associated with Hodgkin’s lymphoma

Question 4

What is the most common cause of Nephrotic syndrome in children?

what do you expect the renal function to be? What is the treatment?

Answer 4

Minimal change disease: classic presentation child with recent upper respiratory tract infection

• Renal function will be normal
• Steroids

Question 5

Which renal condition could be considered a severe version of minimal change disease? Which part of the filtration barrier is affected? What is the prognosis when compared to minimal change?

Answer 5

Focal segmental glomerulosclerosis

• Caused by podocyte injury: unknown cause but related to many conditions
• Often progresses to chronic renal failure and does not respond to steroids (in comparison to minimal change, which does)

Question 6

What is the most common cause of nephrotic syndrome in black and white people respectively?

Answer 6

• Black: focal segmental Glomerulosclerosis
• White: membranous nephropathy

Question 7

FSGS is associated with many conditions. List one infective, one congenital, and one lifestyle choice that is associated with this condition

Answer 7

• HIV
• Sickle-cell
• Heroin use (also massive obesity)

Question 8

Which cause of nephrotic syndrome is associated with thickening of the basement membrane? What is the thickening caused by?

Answer 8

Membranous nephropathy

auto antibodies against proteins on podocytes: most common antigen is phospholipase a two receptor, found in large amounts on surface of podocytes. High specificity

Question 9

If somebody with lupus develops nephrotic syndrome what is the most likely cause?

List three other things that cause this condition

Answer 9

Membranous nephropathy

• Tumours
• Hepatitis
• Rheumatoid arthritis drugs: penicillinamine, gold, NSAIDs

Question 10

Why do patients develop diabetic Nephropathy?

Answer 10

Glycosylation of basement membrane leading to leakage of proteins and sclerosis glomerulus

Can develop nephrotic syndrome

Question 11

What is the most commonly involved organ in systemic amyloidosis?

Answer 11

Kidney: nephrotic syndrome