Day 4 5/15/15

Question 1

Pathophysiology of Nephrotic Syndrome

Answer 1

• glomeruli are affected by inflammation or hyalinization that allows proteins such as albumin to pass through the cell membrane and appear in the urine
• circulating factors may bind to glomerular membranes and cause loss of the negative charge or membrane separation

Question 2

Complications of Nephrotic Syndrome

Answer 2

• protein deficiency
• hypercholesterolemia
• hyponaturemia
• hypokalemia
• progression to chronic renal failure

Question 3

Causes and Conditions Associated with Nephrotic Syndrome

Answer 3

• glomerulonephritis
• minimal change disease
• focal and segmental glomerular sclerosis
• congenital nephrotic syndrome
• familial nephrotic syndrome
• generalized systemic diseases
• therapeutic agents
• infections
• malignancy

Question 4

Minimal Change Nephropathy

Answer 4

Clinical: Nephrotic syndrome
Morphol: No/ minimal change
Pathogen: Unknown – circulatory factor
- EM: foot process effacement 
- IF: negative
Therapy: steroids
Prognosis: Good

Question 5

Focal Sclerosis

Answer 5

Clinical: nephrotic syndrome
Morphol: focal segmental glomerular sclerosis
Pathogen: unknown, circulatory factor, hyperfiltration, hereditary forms, HIV associated, Heroin
Therapy: steroids- high relapse rate
Prognosis: some progress to ESRD

Question 6

Membranous GN

Answer 6

Clinical: nephrotic syndrome
Morphol: GBM thickening (spikes)
Pathogen: chronic immune complex
-EM: subepithelial deposits
-IF: granular GBM
Therapy: steroids
Prognosis: some progress ESRD

Question 7

Membranous Glomerulopathy (MPGN)

Answer 7

• occurs most often in adults
• often associated with other diseases
• diagnosis requires further workup (rule out bugs, drugs, tumors, and rheum)

Clinical: usually nephritic/nephrotic
Morphol: cell proliferation, GBM thickening- double contours
Pathogen: chronic immune complex
-EM: subendothelial deposits
-IF: granular GBM
Therapy: steroids, interferon
Prognosis: some progress to ESRD

Question 8

Uremia

Answer 8

-group of manifestations which occur when there is severe loss of all renal functions

• Regulation of water and electrolytes
• pH - acidosis
• H2O, Na+ - fluid retention, edema, CHF, HTN
• K+ - cardiac arrythmias
• PO4 - secondary hyperparathyroidism
• -azotemia
• -drugs: toxicity
• -erythropoietin: anemia
• -renin: angiotensin- HTN
• -vit D activation- osteomalacia