Nephrotic Syndrome I - Nichols

Question 1

What are the features of nephrotic syndrome

Answer 1

edema

proteinuria

hypoalbuminemia

hyperlipedemia

Question 2

does nephrotic syndrome typically have inflammatory cells/

Question 3

Are the creatinine levels normal, highly elevated or highly decreased in nephrotic syndrome?

Answer 3

normal or mildy elevated

Question 4

In nephrotic syndrome, what are the casts like that are found in the urine?

Answer 4

they are inactive, typically wihtout dysmorphic red cells or red cell casts

Question 5

What is the most important clinical presentation of glomerular disease to recognize?

Question 6

What is a common cause of rapidly progressive glomerulonephritis?

Question 7

What are hyaline casts?

Answer 7

colorless, homogeneous and transparent casts common in healthy urine

Question 8

how do hyaline casts form?

Question 9

what is the second most common type of cast and when does it occur?

Answer 9

granular type, resulting from aggregation of plasma proteins ie albumin or the breakdown of cellular casts.

composed of find granules are usually grey or plae yellow

composed larger coarse granules are darker, often black

indicate significant renal disease

Question 10

what are yellow-tan hyaline casts with fat globule inclusions “oval fat bodies”

Question 11

what cast type is indicative of glomerular damage?

Question 12

what are white blood cell casts indicative off?

Question 13

what are nephrotic syndrome mechanisms that don’t have glomerular inflammation?

Answer 13

podocyte injury in minimal mchange disease and focal segmental glomerulosclerosis

subepithelial immune compmlex formation and complement activation in mebranous nephropathy

glomerular capillary wall deposition in diabetic nephropathy, amyloidosis and light chain deposition disease

Question 14

what are nephrotic syndrome mechanisms with glomerular inflammation?

Answer 14

mesangial or capillary wall immune complex formation and complement activation in IgA nephropathy and acute post=strep glomer.

abs directed at the gbm

necrotizing injury and inflammation of the glomerular capillaries in disease associated with antineutrophil cytoplasmic autoantibodies.

Question 15

what are the normal glomerular properties that allow for immune complexes being formed and trapped in glomeruli?

Answer 15

high plasma flow rate through them

high intraglomerular pressure

high glomerular hydraulic conductivity (permeability)

Question 16

subepithelial deposits tend to cause nephrotic or nephritic syndrome?

Question 17

is nephrotic or nephritic typically more severe? why?

Question 18

what is the main site of hindrance for larger mculs in the kidney?

Question 19

what is the upper limit of normal albuminuria?

Question 20

urine dipsticks can detect albumin at what minimum concentration?

Question 21

what is the earliest clinical manifestation of diabetic nephropathy, the most common cause of end-stage renal disease requiring dialysis?

Question 22

what are various methods of protein measurement of urine?

Answer 22

dipstick, 24hr urine collection, spot urine protein/creatinine ratio

Question 23

in nephrotic syndrome, loss of ? grams of protein per day in the urine is common?