Kidneys Flashcards
(36 cards)
Nephritic Syndrome
OHHA
oliguria
hematuria
HPN
azotemia
Nephrotic Syndrome
EPHAL
edema
proteinuria - >3.5 g/d
hyperlipidemia
hypoalbuminemia
MCC of nephritic syndrome in CHILDREN
GAHBS (M12, 4 and 1)
increased ASO
decreased C3
Poststreptococcal Glomerulonephritis (PSAGN)
LM: enlarged hypercellular glomeruli
EM: subepithelial humps on GBM
IF: granular deposits of IGG, C3
Syndrome of progressive loss of renal function
CRESCENTS - proliferation of PARIETAL epithelial cells + leukocytes infiltrating the glomerulus
Crescentic (Rapidly Progressive) Glomerulonephritis
Antibodies against the non-collagenous domain of a3 chain of COLLAGEN TYPE IV – necrotizing hemorrhagic interstitial pneumonitis and RPGN
MALE, ACTIVE SMOKERS
HEMOPTYSIS and RENAL FAILURE
RPGN Type I (GOODPASTURE SYNDROME)
IF: linear IgG and C3 deposits along the GBM
Type III RPGN
Pauci-immune (presence of ANCA)
Granulomatosis with Polyangiitis (ANCA-associated vasculitis)
Glomerular diseases presenting as Nephrotic Syndrome
Minimal Change Disease
FSGS
Membranous nephropathy
MPGN type I
Dense deposit disease (MPGN type II)
Signature finding in nephrotic syndrome
Diffuse effacement of foot processes
MCC in CHILDREM
(-) azotemia
STEROID RESPONSIVE
normal glomerulus on LM
“lipoid nephrosis”
podocyte effacement
Minimal Change Disease (MCD)
ASSOCIATIONS:
Respiratory infections
prophylactic immunizations
NSAIDs
2nd MCC in ADULTS
(-) azotemia
STEROID RESISTANT
Membranous Nephropathy (MGN)
uniform diffuse thickening of the capillary wall
ASSOCIATIONS:
SLE
Infections
EM: SPIKE AND DOME appearance
effacement of foot processes
MCC in ADULTS
(+) azotemia
Focal Segmental Glomerulosclerosis (FSGS)
ASSOCIATIONS:
HIV
Sickle Cell Anemia
Heroin
EM: DIFFUSE EFFACEMENT of foot processes
Nephritic/Nephrotic syndrome
50% of patients progress to ESRD
(+) immune complex deposition
activation of classical and alternative
MPGN TYPE I
LM: DOUBLE CONTOUR TRAM TRACK APPEARANCE
EM: subendothelial electron dense deposits
IF: granular C3 deposits WITH IgG
Nephritic/Nephrotic syndrome
50% of patients progress to ESRD
(-) immune complex deposition
activation of classical and alternative
DENSE DEPOSIT DISEASE (TYPE II)
EM: ribbon like
IF: granular or linear C3 W/O IgG
MC type of glomerulonephritis worldwide
GIT or GUT infection – gross hematuria
IgA Nephropathy (BERGER DISEASE)
post infectious hematuria
Systemic IgA deposition
MC in children 3-8 y/o
PURPURIC SKIN LESION
Henoch Schonlein Purpura (HSP)
kidneys, intestines, joints
MCC of ESRD
Diabetes
KIMMELSTIEL-WILSON NODULES
LARGE END STAGE KIDNEYS
Amyloidosis
DM
HIV
PCKD
Defective assembly of type IV collagen
AR
90% –> ESRD (males)
EYES - lens dislocation, posterior cataracts, corneal dystrophy
ALPORT SYNDROME
Defective assembly of type IV collagen
AR
90% –> ESRD (males)
EYES - lens dislocation, posterior cataracts, corneal dystrophy
EARS - nerve deafness
KIDNEYS - hematuria
ALPORT SYNDROME
EM: early - THIN GBM
late - “BASKET WEAVE” APPEARANCE
Hallmarks of Interstitial Nephritis
(-) nephritic or nephrotic syndrome
(+) defects in tubular function
2nd MCC of AKI
Tubulointerstitial Nephritis Caused by Drugs and Toxins
Acute Drug Induced Interstitial Nephritis
2-40 days after drug exposure
fever, eosinophilia, rash
RENAL ABNORMALITIES - hematuria, mild proteinuria, leukocyturia
withdrawal of offending drugs causes recovery BUT slow
TYPE I or IV Hypersensitivity
MCC of Renal Artery Stenosis
stenosis – renal ischemia – increased RAAS activity – SECONDARY HPN
Atherosclerosis
fibromuscular dysplasia - 2nd MC
Morphology of Renal Artery Stenosis
Diffuse ischemic atrophy w/ MILD arteriolosclerosis in IPSILATERAL kidney
SEVERE arteriolosclerosis in CONTRALATERAL kidney
