Nephrotic Syndrome Flashcards
(23 cards)
What is nephrotic syndrome?
Glomerular disorders characterized by proteinuria (>3.5g/day).
What are some of the findings in Nephrotic Syndrome?
Hypoalbuminemia (pitting edema)
Hypogammagloninemia (increased risk of infection)
Hypercoagulable state (loss of antithrombin 3)
Hyperlipidemia
Hypercholesterolemia
What is the most common cause of nephrotic syndrome in children?
Minimal Change Disease
What are the characteristic findings in minimal change disease?
Normal glomeruli on H&E stain.
Effacement of foot processes on EM.
No immune complex deposition, - IF.
Great response to steroids (unique for nephrotic syndromes).
What is the most common cause of nephrotic syndrome in US adults?
Focal Segmental Glomerulosclerosis.
What are the characteristic findings in focal segmental glomerulosclerosis?
LM-> sclerosis of some glomeruli
EM->Effacement of podocytes
IF-> IgM and C3
What is the most common nephrotic syndrome in Caucasian adults?
Membranous nephropathy
What are the characteristic findings in membranous nephropathy?
LM->Thick glomerular basement membrane on H&E
EM->subepithelial deposits, “spike and dome”
IF-> Granular IgG and C3.
What is the name of the nephrotic syndrome that is characterized by a thickened GBM and with “tram-track” appearance?
Membranoproliferative glomerulonephritis
What are the two types of membranoproliferatrive glomerulonephritis?
Type 1-> subendothelial associated with HBV and HCV
Type 2-> Intramembranous deposition, C3 nephritic factor
What leads to the nonenzymatic glycosylation of the vascular basement membrane resulting in hyaline arteriolosclerosis?
Diabetes mellitus which leads to increase glucose concentrations.
What specific structures are altered in DM?
Glomerular efferent arteriole is more effected than afferent leading to high glomerular filtration pressure. Can cause microalbuminuria.
What are the histological hallmarks of DM?
Nodular glomerular sclerosis, Diffuse capillary BM thickening, Diffuse mesangial sclerosis
What is the most commonly involved organ in systemic amyloidosis?
THE KIDNEY
What is characteristic findings in systemic amyloidosis?
Apple-green birefringence under polarized light with Congo red
What are the two etiologies of membranous glomerulonephrolpathy?
1) idiopathic-> autoimmune possibly?
2) secondary-> SLE, drugs, tumors, infections (Hep C, B)
What is the pathogenesis of MPGN type 1 (primary form) and who is most often affected?
- Immune complex deposition.
- Most likely to affect young adults and occasionally children
What is the pathogenesis of MPGN type 1 (secondary form) and who does it affect?
- Almost exclusively affects adults.
- Frequently associated with chronic antigenemia, HCV, SLE, metastasis of cancers.
What two nephrotic glomerular diseases have a higher incidence in adults than kids?
- Membranous glomerulopathy
- Focal Segmental glomerulosclerosis
What will chronic DM lead to in the kidney?
Advanced renal hyaline arteriosclerosis
What are the characteristic findings on EM for SLE/ diffuse proliferative lupus nephritis?
Subendothelial Immune deposits that correspond to “wire loops” by LM.
What are the changes that occur in the glomerulus in response to diffuse proliferative lupus nephritis?
-marked increase incellularity, increased glomerular size, the glomerulus appears stuffed into bowmans capsule
What are the findings on IF in SLE and diffuse proliferative lupus nephritis?
Mesangial and capillary wall (subendothelial) IgG localization
