nephrotic syndrome

Question 1

where is the injury of the glomeruli in nephrotic syndrome ?

Answer 1

podocyte injury

Question 2

what are the different causes of nephrotic syndrome ?

Answer 2

minimal change disease
focal segmental glomerulosclerosis
membranous nephropathy
diabetic
amyloidosis
MPGN

Question 3

what is the pathology associated with minimal change disease and what is the other name for it ?

Answer 3

other name for it is lipoid nephrosis
effacement of the podocytes ( flattening of the podocytes)
normal glomeruli fat cells may be seen in the PT cells

Question 4

what is the trigger for the effacement of the podocytes ?

Answer 4

cytokines

Question 5

what disease is highly associated with minimal change disease ?

Answer 5

hodgkin lymphoma

Question 6

what are the findings on light microscopy vs immuno ve electron microscopy for minimal change disease?

Answer 6

light - no changes
immuno - no changes
electron - effacement of the podocytes

Question 7

what are the triggers that may be responsible for minimal change disease ?

Answer 7

anything that triggers cytokines release
viral infections (URI)
allergic reaction
recent immunization

Question 8

what is different about the proteinuria associated with MCD ?

Answer 8

selective proteinuria - only albumin found in the urine

Question 9

what is the most common cause of nephrotic in children and what is the classic case associated ?

Answer 9

MCD
classically - child with recent URI

Question 10

what is the treatment for MCD ?

Answer 10

very responsive to steroids

Question 11

what is the pathology associated with FSCS ?

Answer 11

only parts of the glomeruli are involved with sclerosis ( collagen deposition) , there is collapse of the basement membrane and hyaline deposition

Question 12

what is seen on electron microscopy in FSGS ?

Answer 12

effacement of the foot processes of the podocytes

Question 13

FSGS vs minimal change disease ?

Answer 13

FSGS is the more severe version of MCD however FSGS does not respond to steroids

Question 14

what are the secondary causes associated with FSGS ?

Answer 14

HIV infection
sickle cell disease
obesity
congenital malformations
more common in black people

Question 15

what is the pathology associated with membranous nephropthy ?

Answer 15

thick glomerular basement membrane
absence of hypercellularity ( not proliferative)

Question 16

why is the GBM thick in membranous nephropathy ?

Answer 16

because of the immune complex deposition

Question 17

what is seen on immuno in membranous nephropathy ?

Answer 17

granular deposits of IgG and C3 staining

Question 18

what new pattern of the BM is associated with membranous nephropathy ?

Answer 18

spike and dome appearance in the subepithelial deposits ( electron dense deposits)

Question 19

what staining is best to be used to visualize the spike and dome appearance of the membranous nephropathy ?

Answer 19

silver staining

Question 20

findings in light microscopy vs immuno vs electron in membranous nephropaty ?

Answer 20

light - thickening of the GBM
electron : subepithelial deposits
immuno : granular IgG/C3

Question 21

what are the autoantibodies in membranous nephropathy formed against ?

Answer 21

phospholipase A2 receptor (PLA2R)

Question 22

where is PLAR2 expreesed ?

Answer 22

on podocytes

Question 23

wat are the secondary causes of membranous nephropathy ?

Answer 23

SLE
DPGN
solid tumors
hep B hep c

Question 24

nephrotic with lupus ?

Answer 24

membranous nephropathy

Question 25

what drugs are associated with causing membranous nephropathy ?

Answer 25

penicillamine gold NSAIDS all the drugs used to treat rheumatoid arthritis

Question 26

most common cause of nephrotic 3amatan in adults ?

Answer 26

membranous nephropathy

Question 27

what are the changes that occur in the kidney due to diabetes ?

Answer 27

also called diabetic glomerulosclerosis 1) hyperfiltration there is an increase in GFR initially then an eventual decrease in GFR 2) thickening of the glomerular basement membrane due to non enzymatic glycosylation

Question 28

what is amyloidosis ?

Answer 28

extracellular build up of amyloid proteins

Question 29

what is the classic biopsy finding associated with amyloidosis ?

Answer 29

apple green birefringence congo red stain

Question 30

what is the cause of nephrotic syndrome in multiple myeloma ?

Answer 30

renal amyloidosis

Question 31

what other finding is associated with multiple myeloma in the urine ?

Answer 31

bence jones proteinuria

Question 32

what type of amyloid sheets are associated with renal amyloidosis ?

Answer 32

beta pleated sheets damage to the renal parenchyma

Question 33

what light microscopy finding is associated with diabetic glomerulosclerosis?

Answer 33

kimmelsteil wilson nodules which are hyaline bundles that appear pink on microscopy

Question 34

what are the triggers associated with minimal change disease ?

Answer 34

4 I idiopathis infection immunization immune stimulus may be secondary to lymphoma

Question 35

what is the hematological association with MCD ?

Answer 35

loss of anithrombin causing renal vein thrombosis

Question 36

what are the light microscopy changes vs electron microscopy seen in FSGS ?

Answer 36

segmental sclerosis and hyalinosis electron microscopy : effacement of the podocyte processes

Question 37

what is the mechanism associated with FSGS ?

Answer 37

can be idiopathic or secondary to HIV , sickle cell disease, obesity or congenital malformations and a higher incidence in black people

Question 38

what risk is carried with membranous nephropathy ?

Answer 38

risk of thromboembolism

Question 39

what is the mechanism in association with membranous nephropathy ?

Answer 39

antibodies to phospholipase A 2 receptor or secondry to drugs - NSAIDs, gold , penicillamine

Question 40

what is the pattern seen on light microscopy vs electon vs immuno in membranous nephropathy ?

Answer 40

light - diffuse capillary and GBM thickening immuno - granular due to immune complex deposition electron - spike and dome appearance of subepithelial deposits

Question 41

what is the elctron appearance of amyloidosis ?

Answer 41

mesangial expansion by amyloid fibrin

Question 42

what are the renoprotective anti hypertensive drugs ?

Answer 42

ACE inhibitors and ARBS