Renal CIS - Nephrotic stuffs Flashcards
(54 cards)
What is the GFR associated with stage 5 CKD?
< 15 (or dialysis)
Stage 3 for 3 months is considered to be?
Chronic kidney disease
As GFR decreases what are the big impacts that occur (6 things) and in what order to they arise?
- HTN
- Increased PTH
- Anemia
- Increased phosphorous
- Acidosis/hyperkalemia
- Uremic syndrome
70% of chronic renal disease cases are caused by diabetes or HTN, with GN and the cystic diseases accounting for another 12%. What makes up the rest?
Prostatic obstruction and tubulointerstitial diseases
What are nine common presentations with chronic renal disease? And give the reason for each!
. Hypertension, edema, CHF (Na and H2O retention)
- Bone disease (Increased phosphate = decreased Ca++ = increased PTH = bone break down)
- Anemia (decreased EPO)
- Isosthenuria and broad waxy casts (problems concentrating urine and lipoprotein production by the liver)
- Acidosis (inability to secrete H+ normally)
- Hyperkalemia (inability to secrete K+)
- Progressive azotemia over months to years (end stage: fatigue weakness, malaise, nausea, vomiting, etc.)
- Paresthesias - (accumulation of toxic metabolites damages nerves)
- Bilateral small kidneys - (with fibrosis)
Riddle me the main three nephrotic spectrum diseases in primary renal disease.
Minimal change disease
Focal segmental glomerulosclerosis (FSGS)
Membranous
An AfroAmerican HIV patient on heroin is referred to you from the ED after presenting with pedal, periorbital edema, hypertension, and urine analysis showing oval fat bodies.
Renal biopsy shows podocyte injury with areas of sclerosis. What is the most likely diagnosis?
FSGS
What is cryoglobulin associated glomerulonephritis seen in, and due to?
Hepatitic C infection, and Type I MPGN (also secondary membranous glomerulopathy)
Idiopathic FSGS disease may be related to heritable abnormalities of any of several podocyte proteins, to polymorphisms in APOL1 gene * in those of African descent, or to increased levels of soluble urokinase receptors.
In what patients will you see FSGS?
- hispanic and black
- UV reflux
- Morbidly obese
- heroin users
- HIV
A 55 y/o male with non-Hodkins lymphoma presents with peripheral edema, 40 pound weight gain, and a history of recurrent infections over the past 6 months. The patient’s abdomen is prominent and he complains of dyspnea.
Urinalysis is shown. Serum vitamin D levels are low and albumin is 1.6 gm/dL. Spot urine for protein/creatinine ratio is 6.5 (6.5 gm/24 hours). Kidney biopsy shows thickened GBM with “spike and dome pattern” of subepithelial deposits. This patient has which type of renal nephrotic pathology?
Membranous
Membranous nephropathy is caused by immune complex deposition in the subepithelial area. What is the characteristic pattern of IgG and C3 deposition here?
“spike and dome”
What are ten causes of secondary membranous nephropathy?
- lymphoma
- carcinoma
- penicillamine
- gold
- SLE
- MCTD
- Thyroiditis
- Hep B or C
- Endocarditis
- syphilis
What is causing the characteristic depositions shown at points 1-5 in the attached image?
- Acute proliferative Gomerulonephritis (Post infections glomerulonephritis) (I think also)
- Membranous nephropathy
- Type I membranoproliferative glomerulopathy
- IgA nephropathy or Henoch Schonlein Purpura
- Minimal Change disease (I think)
What is the antigen in primary membranous nephropathy?
Phospholipase A2 receptor on the podocyte membrane.
A patient with membranous glomerulonephropathy suddenly develops nausea and vomiting with flank pain. Ultrasound shows bilateral kidney enlargement. The patient has developed renal:
A.infarction.
B.hemorrhage.
C.Infection.
D.vein thrombosis.
E.pelviceal obstruction
Vein Thrombosis
Fill in the labels on the arrows.
Is this serum electrophoresis normal or not?
No, the albumin is significantly decreased, with increased macroglobulin at alpha 2 and increased lipoprotein and fibrinogen at the Beta point.
Is this serum electrophoresis normal?
What is represented at Y?
Normal
Gamma Globulins
How do nephrotic syndromes influence the coagulation cascade?
Due to the loss of antithrombin III, proteins C and S, as well as increased fibrinogen, there is increased platelet aggregation and a hypercoagulable state.
This specimen was taken from a patient with non-selective proteinuria in excess of 3.5 g/day. On the left is a PAS stain, and on the right the specimen shows apple green birefringence. What stain was used on the right, and what is causing this nephrotic syndrome?
Congo red stain revealing apple green birefringence is indicative of amyloidosis.
In what three places will you likely see amyloid deposits in amyloidosis related nephrotic syndrome?
Glomeruli
Wall of arteries
wall of arterioles
A significantly overweight middle aged patient comes to you complaining of significant lower extremity edema. Urine dipstick is positive for glucose. Unable to live with themselves they decide to take their own life by eating themselves to death. On autopsy you take a sample of renal tissue and see the attached findings. What are the pink nodules shown here? What was the process by which this damage occured?
Kimmelstein-wilson nodules
- Non-enzymatic glycosylation of the glomerular basement membrane
- hyalinization of efferent arterioles
- hyalinization of mesangial matrix in the glomerulus
This specimen was taken from the famous athlete pictured. What do you see here? What is the major risk factor for this condition?
Collapsing glomerulopathy
Version of FSGS that is specific to HIV patients
In the attached image try to identify the diseases based on the deposition patterns shown. Then indicate what the main point of injury is, the normal findings, if it will progress to CKD and major associated disease processes.
