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Flashcards in Nephrotic Syndrome 1 Deck (44):
1

What are some key features of nephrotic syndrome?

edema, proteinuria, hypoalbuminemia, hyperlipidemia, non- inflammatory, inactive urinary sediment, normal or mild elevation of serum creatine

2

What is the key cell involved in nephrotic syndrome?

visceral epithelial cells -- podocytes

3

What are some key features of nephritic syndrome?

acive urinary sediment, dysmorphic RBCs, RBC casts in urine, Inflammation, HTN, elevated serum creatinine, crescents on kidney biopsy

4

What is the key cell involved in nephritic syndrome?

endothelial cell

5

What two diseases are associated w/ podocyte injury?

minimal change disease and focal segmental golmerulosclerosis

6

What is involved w/ subepithelial space immune complex formation and complement activation?

membranous nephropathy and late stage of post-infectious glomerulonephritis

7

What is associated w/ glomerular capillary wall depostion diseases?

amloidosis, light chains deposition disease, diabetic nephropathy

8

What is involved w/ subendothelial space or mesangial immune complex formation and complement activation? Nephritic syndrome

1. post-infectious glomerulonephritis
2. IgA nephropathy
3. lupus nephritis

9

What is a disorder that has Ab's directed at the glomerular BM?

goodpastures

10

What can lead to necrotizing injury and inflammation of vascular and GCW?

ANCA diseases

11

What is associated w/ IgA nephropathy?

macroscopic hematuria

12

What are the different clinical presentations of glomerular disease?

asymptomatic, macroscopic hematuria, nephrotic syndrome, nephritic syndrome, rapidly progressive glomerulonephritis, and chronic glomerulonephritis

13

What causes immune complexes to form and get trapped in glomeruli?

1. high plasma flow rate
2. high intraglomerular pressure
3. high glomerular hydraulic conductivity

14

What is the spectrum of immune complex disease dependent on?

nature of Ag involved and site of immune complex

15

If there is generalized edema, what should on look for next?

proteinuria

16

What can been seen in urinary sediment?

oval fat bodies and maltese cross

17

T or F. One can see xanthelasma in nephrotic syndrome.

T

18

How can one make sense of nephrotic and nephritic syndrome if that have some common findings?

1. Nephrotic syndrome - abnormal glomerulus w/out inflammation
2. Nephritic syndrome -- abnormal golmerulus w/ inflammation

19

What are the 3 purposes of a kidney biopsy?

1. diagnosis
2. prognosis
3. guide therapy

20

Buzz word - foot process effacement = ?

minimal change disease (but not specific)

21

spike and dome = ?

membranous nephropathy

22

subepithelial humps =?

post-infectious glomerulonephritis

23

tram tracks = ?

membranoproliferative glomerulonepritis

24

basketweave = ?

alport syndrome

25

wire loops = ?

lupus nephritis

26

onion-skin = ?

hypertensive nephropathy or scleroderma

27

What are 3 things that are filtration in glomerulus depends on?

1. charge
2. size
3. shape of substance

28

Why don't we normally filter albumin even though it is the right size to be filtered?

the podocytes are negatively charged which repels albumin which is also negatively charged

29

What is found in the BM of the glomerulus?

1. laminin
2. COLLAGE IV
3. heparan sulfate PGs
4. integrin
5. agrin

30

What is the size restriction for filtration?

1. uncharged macromolecules 4nm completely restricted

31

What proteins of the slit diaphragm are involved in proteinuria?

1. podocin
2. TRPC6
3.Actinin-4
4. NEPH-1
5. Cadherine
6. FAT
7. Nephrin

32

What happens to the glomerular permeability in nephrotic syndrome?

1. lower excretion of small MW substances
2. increased clearance of large MW substances
3. increased excretion of IgG due to loss of size barrier

33

What is seen w/ glomerular proteinuria?

albumin is dominany protein in urine

34

What is seen w/ tubular proteinuria?

low MW proteins

35

What protein does urine dipstick measure?

albumin

36

How much protein is normally excreted by a healthy kidney?

40-80mg/day, 150mg/day is the upper range of normal

37

What is the normal urine albumin/creatinine ratio?

<30 mg/g

38

What is an abnormal urine dip stick reading?

1+, 2+, 3+

39

What is the standard proteinuria test?

24-hr urine collection, normal <150mg

40

What is the general management for primary nephrotic syndrome?

Goal is to preserver kidney function

41

How do you treat the proteinuria?

1. Supportive measures involved controling the HTN
2. Steroids
3. Immunosuppressive drugs

42

What can be used to control HTN?

1. low salt diet
2. ACE inhibitor
3. Angiotensein receptor blocker

43

What is the function of the glomerular capillary wall?

selective permeability barrier

44

What 3 layers make up the glomerular capillary wall?

1. endothelium
2. glomerular BM
3. podoctyte visceral epithelial cell layer