Nephrotic syndrome Flashcards
Nephrotic syndrome
Massive prOteinuria, 3.5 g/day, frothy urine, hyperlipidemia, fatty cast, edema
Associated with thromboembolism (hypercoagulation state due to AT III loss in urine)
Increased risk of infection (loss of IgG)
Nephrotic syndromes
1) focal segmental glomerulosclerosis
2) membranous nephropathy
3) minimal change disease (lipoid nephrosis)
4) amyloidosis
5) membraneproliferative glomerulonephritis
6) diabetic glomerulonephropathy
Focal segmental glomerulosclerosis
LM=segmental sclerosis and hyalinosis
EM=effacement of foot process similar to minimal change
Most common cause of nephrotic syndrome in adults
Causes: HIV Heroine Obesity IFN CKD (due to congenital absence or surgical removal)
Membranous nephropathy
LM=diffuse capillary and GBM thickening
EM=”spike and dome” appearance with subepithelial deposits
IF=granular
SLE’s nephrotic presentation
2nd most common cause of primary nephrotic syndrome in adults
Causes: Idiopathic or drugs infection, SLE, solid tumor
Minimal change disease (lipoid nephrosis)
LM=normal glomeruli
EM=foot process effacement
Selective loss of albumin, not globulin, caused by GBM polyanion loss
May be triggered by a recent infection or an immune stimulus
Most common in children.
Respond to corticosteroid.
Amyloidosis
LM=congo red stain shows apple-green birefringence under polarized light
Associated with chronic condition: MM, TB, RA
Membranous-proliferative glomerulonephritis (MPGN)
Type I= subendothelial IC deposits with grandular IF
“tram-track” apperance due to GBM splitting caused by mesangial ingrowth
Type II=intramembranous IC deposits
“dense deposits”
Can also present as nephritic syndrome
Type I: HBV and HCV
Type II: C3 nephritic factor
Diabetic glomerulonephropathy
Nonenzymatic glycosylation (NEG) of GBM thus increased permeability and thickening
NEG of efferent arterioles -> increase GFR -> mesangial expansion.
LM-mesangial expansion, GBM thickening, eosinophilic nodular glomerulosclerosis
Kimmelstiel-Wilson lesion
