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1

common clinical findings of somebody who has nephrotic syndrome

proteinuria
hypoalbuminemia
edema
hyperlipidemia
lipiduria

2

what is the most common cause of nephrotic syndrome in children?

min. change syndrome

3

what are some microscopic changes that can be found in min. change syndrome

loss of foot processes
smeared look over GBM

4

how would you treat a child that you suspect might have min. change disease?

corticosteroids

5

if child presence to clinic with
proteinuria
hypoalbuminemia
edema
hyperlipidemia
lipiduria

what will you treat them with?
what do you suspect that they have?

min. change disease
treat with corticosteroids

6

membranous GN special lab findings?

spike like projections
sub-epithelial immune deposits
no cellular proliferations
thickening of GBM

7

which nephrotic syndromes have spike like projections?

MGN

8

what are some secondary causes of MGN?

Hep. B
syphilis
malaria
malignant carcinoma of the lung
SLE
Drugs
NSAIDS

9

what is most common primary cause of MGN?

idiopathic

10

pt. comes in with nephrotic symptoms, you run a lab and find thickening of the GBM, sub-epithelial spikes, has no cellular proliferation...
what will be on the top of your differential dx.?

membranous GN

11

what are some special findings linked too FSGS?

sclerosis of focal spots of glomeruli involved and
segmental capillary tufts

12

what are some primary causes of FSGS?

nephrotic syndrome

13

what are some secondary causes of FSGS?

HIV
heroin

14

pt. has a history of heroin usage and nephrotic syndrome disorder, you do a lab test and find sclerosis of only some glomeruli and some capillary tufts what should be the top of you differential dx.?

FSGS

15

microscopically what are some findings of FSGS?

loss of foot processes
**Cell detachment**
Cytokines
blue collagen

16

which of the nephrotic syndromes can be caused by cytokines?

FSGS

17

which of the nephrotic syndromes uses trichome stain?

FSGS

18

which of the nephrotic syndromes can be seen as a final stage of pyelonephritis?

FSGS

19

which of the nephrotic syndromes has epithelial detachment?

FSGS

20

membranoproliferative GN (MPGN) involves which cells of the kidney?

mesangial cells

21

MPGN:
the proliferation of the mesangial cells split the GBM which leaves it looking like what microscopically?

tramtrack

22

what may be found microscopically in a pt. who has MPGN?

double contour of subendothelial
IgG and C3 --> immune complexes
infiltrating leukocytes
lobular pattern
splitting of GBM

23

can children get MPGN?

yes

24

what are some secondary causes of MPGN?

Hep c and b
SLE

25

what do MPGN and MGN have in common?

they both have immune complexes

26

which autoimmune disease has MPGN, increase of WBC's in mesangium, IgA deposits and edema within the capillary lumen?

henoch schonlein purpura (HSP)

27

what are some findings of alport nephritis?

unexplained hematuria
Hx. of nephritis
B/L sensorineural hearing loss
ocular lesions
alterations of GBM
familial ESR

28

what are the symptoms of pre eclampsia?

HEP =>
hypertension
edema
proteinuria

29

Eclampsia symptoms

HEP + coma, convulsions --> death

30

pregnant lady come to clinic with history of hypertension, you notice edema and proteinuria what should be on the top of your Dx.?

pre-eclampsia

31

pt. comes into the clinic with unexplained hematuria, B/L sensorineural hearing loss and ocular lesions what is on the top of your Dx.?

alport neohritis

32

you use a jones silver stain and notice IgA deposits, capillary lumina edema and increase of WBC's along with the pt. having nephrotic findings.. what should be on the top of Dx.?

henoch schontein purpura (HSP) MPGN

33

what are common clinical findings of acute proliferative GN?

azotemia
hematuria
oliguria
hypertension
some proteinuria and edema

34

what is an example of an endogenous cause of acute proliferative GN>

SLE

35

what is an example of an exogenous cause of acute proliferative GN?

streptococcus
HEP b
mumps
measels
checkenpox

36

what are some pathological findings of acute proliferative GN?

increase of glomerular tufts
proliferation of mesangial and endothial cells
neutrophilic and monocytic infiltration

37

in acute proliferation GN where are the immune complex deposits located?

subendothelial and intramembranous

38

what special appearance does acute proliferative GN appear like under microscope?

'lumpy bumpy'

39

what kind of immune complexes can you find in the capillary loops?

IgG

40

clinical:
an infant comes into the clinic and the mother says they got over 'strep' about 4 weeks ago and now she notices the child is barely peeing, he is lethargic and notices the pee is brown
what should you suspect as a Dx.?

acute proliferative GN (post streptococcus)

41

what are some findings of somebody that has rapidly progressive glomerulonephritis?

* severe oliguria
*crescence of glomeruli (ruptured GBM)
presence of monocytes and macrophages
fibrin

42

if a person has good pastures disease what kind of nephritic syndrome can you assume they are presenting with if have the common symtoms?

rapidly progressive glomerulonephritis

43

what type of HSR is goodpasture syndrome?

type 2

44

what might be a 2ry cause of rapidly progressive GN?

SLE

45

you run a lab on somebody who is presenting with azotemia
hematuria
oliguria
hypertension and you find macrophages and focal spots of ruptured GBM and crescence parietal cells what would be on the top of differential Dx.?

rapidly progressive GN

46

what is the leading cause of acute pyleonephritis?

ecoli

47

what are the two routes somebody can get pyelonephritis?

blood stream or ascending infection

48

what are some other organisms that cause acute pyelonephritis?

strep, staph, pseudomonas, klebsiella

49

what are some predisposing factors of acute pyelonephritis?

cytoscopy
catheterization
female
outflow obstruction
incompetent vesicoureteral orifice
diabetic

50

what are the pathological findings of a kidney that has acute pyelonephritis

enlarged
yellow abcesses
deeply congested between abcesses

51

you are dissecting a kidney are realize suppurative inflammation of renal pelvis and interstitium and yellow abscesses.. what did the person suffer from?

acute pylonephritis

52

what are the two causes of chronic pyelonephritis?

chronic obstructive pyelonephritis
chronic reflux associated with pylenophritis

53

what is the most common form of chronic pyelonephritis?

chronic reflux associated with pyelonephritis

54

what are some pathological findings of chronic pyelonephritis?

1.diffuse patches of fibrin and scarring
of pelvis and calyces
2.papillary blunting
3.interstitial fibrosis
4. contraction and dilation of tubules
5. arteriosclerosis

55

you do a dissection of kidney and your lab findings include:
glossy pink colloid appearance
contraction and dilation of tubules (cast filled)
scarring of pelvis and calyces &
arteriosclerosis

what is at the top of your Dx.?

chronic pyelonephritis

56

pt. presents to clinic with nocturia, polyuria and hypertension what should suspect?
especially if they have history of infection

chronic pyelonephritis