Flashcards in nephrosis 1 Deck (16):
what is the most common cause of nephrotic syndrome in children? What changes do you see?
MCD. No change by light microscopy. electron micro. shows podocyte changes (effacement and fusion and sometimes villous transformation)
What causes the changes seen in MCD?
disruption of SGPs leads to loss of neg. charge and then fusion of fp and aggregation of actin filaments
Diabetic nephropathy: pathogenesis
non enzymatic glycation of proteins, decreased proteoglycans, increased TGF-beta and ROS. Thickened GBM and TBM traps proteins and GFR declines
describe affect of DM on GFR
at first it increases (superhyperfiltration) due to poor HS-PG depostion->^pore size and decrease charge(->proteinuria). Then it declines due to protein trapping.
describe the proteinuria in DM
Initially (microalbuminuria) the selectivity for albumin is high then as you get more proteinuria its less selective
what meds do we prescribe in pts with early signs of diabetic nephropathy? Why?
ACEI. it reduces superhyperfiltration which damages glomerulus
inert fibrilar protein. criss-cross pattern. 8-10 nm thick. Birefringent due to beta-pleated sheets
what happens in amyloidosis?
proteins precipitate and deposite in mesangium w/o hypercellularity
Focal segmental glomerulo-sclerosis: what type of proteinuria? History of? what glomeruli? What happens? what gets deposited? Special cells/
nonselective. H/O MCD, Heroin, HIV, Ureter reflux. Juxtamedullary. SEGMENTAL deposits of IgM and C1q in hyaline segments. Foam cells (lipid in mesangial cells)
How does a low protein diet help in diabetic nephropathy?
you decrease the hyperfiltration and the proteinuria
Idiopathic membranous nephropathy (IMN): H/O? What deposits and where?
neoplasms, hepatitis, tx w/ gold or penicillamine. IgG and C3 immune-complex deposits in SUBEPITHELIUM, NOT mesangial matrix (as in lupus)
what are two subsets of IMN?
Antigen-excess dz, Heymann nephritis (autoab's against megalin and antiphospholipase A2 receptor)
SLE: first signs? other signs?
butterfly rash; proteinuria, hematuria, casts
Two principle presentations of SLE?
Diffuse (nephritic) and membranous (nephrotic). Diffuse has worse prognosis due to lots of abnormal serology (more ANAs, circulating immune complexes, cryo Igs, etc)
hwo can lupus nephritis progress?
nephrotic->nephritic but not other way around.