Nephrotic Syndrome Flashcards Preview

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Flashcards in Nephrotic Syndrome Deck (29)
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1
Q

Where do the glomerular endothelial cells lie?

A

They line the inner side of the glomerular basement membrane (GBM)

2
Q

Where are the glomerular mesangial cells located?

A

Centrally

3
Q

What do the mesangial cells secrete?

A

Basement membrane-like matrix that acts as a structural support for the glomerulus.

4
Q

What are two other unique features of the mesangial cells?

A
  1. They have smooth muscle-like properties and can contract to affect surface area and filtration
  2. They have some macrophage-like properties, including the ability to secrete cytokines, growth factors, proteases, adn oxidants.
5
Q

What is the most important barrier to protein?

A

The filtration slit diaphragm between the poocytes.

6
Q

What constitutes the charge barrier?

A

The negatively charge basement membrane, and the negative coating on the endothelium and podocytes.

7
Q

What is the most important structure for the size barrier?

A

The slit pore diaphragm

8
Q

The primary protein in the slit diaphragm is ____

A

Nephrin.

It interlaces like a zipper and excludes many proteins. If nephrin is mutated, problems happen.

9
Q

How much albumin is normally excreted daily?

A

Less than 20mg

10
Q

What is the range for microalbuminuria?

A

30-300mg/day

11
Q

Of what is persistent microalbuminuria suggestive?

A

Early glomerular damage, often seen in diabetic patients.

12
Q

Albumin between ___ and ___ may be due to either glomerular or tubular disease.

A

300mg and 1-2gm/day

13
Q

Once albumin increases above ____, there is a defect in glomerular permeability

A

3gm/day

14
Q

Once albumin increases above 3gm/day, there is a defect in _____

A

Glomerular permeability

15
Q

If you have a patient with large (>20gm/day) amounts of protein, but a negative dipstick, what might they have?

A

Multiple myeloma.

They produce large amounts of monoclonal light chains, which end up in the urine because they are small. A dipstick only responds to albumin.

16
Q

What are the 5 hallmark findings of the nephrotic syndrome?

A
  1. Proteinuria
  2. Hypoalbuminemia
  3. Edema
  4. Hyperlipidemia
  5. Lipiduria
17
Q

Where does the hypoalbuminemia come from?

A

Increased catabolism of reabsorbed protein in the renal tubules and from the urinary losses

18
Q

Where does the edema come from?

A
  1. Decrease in serum albumin leads to a decrease in oncotic pressure and a movement of fluid into the interstitial space
  2. A defect in sodium excretion, resulting in volume expansion.
19
Q

Test presentation: Child or 55yo with edema, history of allergies, normal complement levels, hypoalbuminemia, normal microscopy, normal IF.

A

Minimal change disease.

20
Q

Treatment for minimal change disease

A

Steroid therapy

21
Q

Test presentation: African American or young adult, present with nephrotic syndrome, sclerosis in some glomeruli, negative IF. Patient may use heroine or have HIV.

A

FSGS

22
Q

Treatment for FSGS

A

Prolonged steroid therapy

23
Q

Test presentation: 55yo male, nephrotic presentation, normal complement, thickened GBM on light microscopy, spikes on silver stain, IF shows deposits on GBM. Maybe HepB, drugs, lupus, or cancer.

A

Membranous nephropathy

24
Q

Treatment for membranous nephropathy

A

Steroids and cytotoxic drugs. ACEi to lower proteinuria

25
Q

Test presentation: Female or adolescent child, hypertension, nephrotic syndrome, low C3 levels. Maybe HCV, rheumatoid factor.

A

MPGN

26
Q

Treatment for MPGN

A

It’s a pretty bad prognosis. Maybe alternate-day steroids, maybe anti-platelet agents. Antivirals in HCV patients.

27
Q

What is the most common cause of nephrotic syndrome in adults?

A

Diabetes.

28
Q

Treatment for diabetic nephropathy

A

Control the beetus

29
Q

T/F: SLE-caused nephrotic syndrome is accompanied by elevated ANA.

A

F. These patients actually have lower ANA than most other SLE patients.