SM_208a: Nephrosis Flashcards

(37 cards)

1
Q

_____ indicates nephrosis

A

> 3.5 g protein per 24 hours indicates nephrosis

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2
Q

_____ in the urine indicate nephritis

A

RBCs in the urine indicate nephritis

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3
Q

Juxtaglomerular apparatus senses _____

A

Juxtaglomerular apparatus senses flow

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4
Q

Fluorescent microscopy looks for ______

A

Fluorescent microscopy looks for IgG, IgM, IgA, and complement components C1q and C3

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5
Q

____ means involving some glomeruli, whereas ____ means involving all glomeruli

A

Focal means involving some glomeruli, whereas diffuse means involving all glomeruli

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6
Q

_____ means involving part of the glomerulus, whereas _____ means involving the entire glomerulus

A

Segmental means involving part of the glomerulus, whereas global means involving the entire glomerulus

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7
Q

This is a _____ glomerulus

A

This is a normal glomerulus

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8
Q

This is a _____ glomerulus

A

This is a crescent glomerulus

(glomerulus compressed to the side)

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9
Q

This is a _____ glomerulus

A

This is a hyaline glomerulus

(thick membrane)

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10
Q

This is a _____ glomerulus

A

This is a tram-track glomerulus

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11
Q

This is a _____ glomerulus

A

This is a wire-loop glomerulus

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12
Q

Describe the pathogenesis and mediators of glomerular diseases

A

Pathogenesis and mediators of glomerular diseases

  • Circulating immune complexes
  • Immune complex deposition in-situ: anti-GBM sntibodies, anti-other antibodies (anti-glomerular, planted)
  • Mediators: cells (neutrophils, macrophages) and complement
  • Epithelial injury
  • Renal ablation
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13
Q

Renal ablation is when ______ and is _____ to reverse

A

Renal ablation is progressive attempts to compensate for kidney injury cause residual glomeruli to hypertrophy and reach a point where they are not functional anymore and is generally irreversible

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14
Q

Describe the characteristics of minimal change disease

A

Minimal change disease

  • Very young kids after an upper respiratory tract infection
  • Chief complaint by parents: kid is swollen (edema)
  • LM: normal
  • FM: negative
  • EM: effacement of podocyte foot processes
  • Treatment: corticosteroids w/ good prognosis
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15
Q

On EM, minimal change disease will manifest as _____

A

On EM, minimal change disease will manifest as effacement of podocyte foot processes

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16
Q

Treatment of minimal change disease involves _____

A

Treatment of minimal change disease involves corticosteroids

17
Q

Minimal change disease occurs in ____ and is responsive to ____

A

Minimal change disease occurs in children and is responsive to corticosteroids

18
Q

Describe focal segmental glomerulosclerosis

A

Focal segmental glomerulosclerosis

  • Pattern of glomerular injury demonstrating partial scarring of some glomeruli
  • Generally in adults
  • May be primary, drug-induced, complicate other diseases (HIV + heroin), or rarely be inherited
  • LM: sclerosis affecting some parts of some glomeruli
  • FM: non-specific (IgG, IgM, complement) and depends on underlying disease (IgA in IgA-induced nephropathy, full house in lupus)
  • EM: loss of foot processes and podocyte detachment
19
Q

On LM, focal segmental glomerulosclerosis manifests as _____

A

On LM, focal segmental glomerulosclerosis manifests as sclerosis affecting some parts of some glomeruli

20
Q

The ____ glomerulus is damaged, ____ glomerulus is partially damaged, and ____ glomerulus is normal

A

The left glomerulus is damaged, middle glomerulus is partially damaged, and right glomerulus is normal

21
Q

Focal segmental glomerulosclerosis occurs in ____ and is _____ to steroids

A

Focal segmental glomerulosclerosis occurs in adults and is not responsive to steroids

22
Q

____ and ____ are necessary to differentiate minimal change disease from focal segmental glomerulosclerosis

A

Clinical information and LM are necessary to differentiate minimal change disease from focal segmental glomerulosclerosis

23
Q

Describe membranous nephropathy

A

Membranous nephropathy

  • Adults w/ slowly progrssive renal failure due to circulating immune complexes and immune complex formation
  • Occurs in many conditions: lupus, Hep B or C, heavy metal exposure, drugs, or primary
  • LM: diffuse thickening of capillary wall (wire-loop)
  • FM: variable - granular deposits of C3 and IgG, may be negative if primary, may have full house due to lupus
  • EM: subepithelial deposits along GBM containing Ig imparting a spike and dome pattern
24
Q

On LM, membranous nephropathy manifests as ____ of capillary walls

A

On LM, membranous nephropathy manifests as wire-loop appearance of capillary walls

25
On EM, membranous nephropathy manifests as \_\_\_\_
On EM, membranous nephropathy manifests as subepithelial deposits along GBM containing IG imparting a spike and dome pattern (dark deposits are progressively surrounded by lighter basement membrane materials and eventually reabsorbed)
26
There are ____ types of membranoproliferative glomerulonephritis
There are 2 types of membranoproliferative glomerulonephritis (histomorphic designation based on LM)
27
Describe MPGN type 1 / MPGN-IC
MPGN type 1 / MPGN-IC * Occurs due to circulating immune complexes * May complicate lupis, Hep B or C, chronic infections with chronic antigenemias, or be primaary * Prognosis depends on underlying disease LM: increased cellularity of glomerulus w/ pronounced lobulation, GBM may show tram-tracks on silver stain * FM: C3 + IgG * EM: variable
28
Describe MPGN type 2 / C3 glomerulopathy
MPGN type 2 / C3 glomerulopathy * Occurs due to C3 abnormality * Pathogenesis involves dysregulation of the alternative complement pathway and depletion of complement * May also present as nephritic syndrome * Poor prognosis * LM: increased cellulairty of glomerulus w/ pronounced lobulation, GBM may show tram-tracks on silver stain * FM: C3 * EM: variable
29
MPGN-IC manifests as _____ on FM
MPGN-IC manifests as C3 + IgG on FM
30
C3 glomerulopathy manifests as _____ on FM
C3 glomerulopathy manifests as C3 on FM
31
Describe diabetic nephropathy
Diabetic nephropathy * LM: diffuse thickening of GBM resulting in leakage of proteins into urine (proteinuria) * Nodules form: nodular sclerosis with Kimmelstiel-Wilson nodules as the key feature
32
Key pathologic feature of diabetic nephropathy on LM is \_\_\_\_\_\_\_
Key pathologic feature of diabetic nephropathy on LM is Kimmelstiel-Wilson nodule
33
Describe chronic glomerulonephritis
Chronic glomerulonephritis * End-stage of many kidney diseases * May be the stage at which the patient presents: presents as chronic renal failure, cannot tell what the underlying disease was * LM: diffuse sclerosis of most glomeruli, interstitial fibrosis, tubular atrophy
34
Describe tubulointerstitial nephritis
Tubulointerstitial nephritis * Infectious (acute pyelonephritis, chronic pyelonephritis and reflux nephropathy), and non-infectious (drug-induced interstitial nephritis, ischemia, metabolic derangements, physical damage) * Includes analgesic-induced nephropathy
35
Describe analgesic-induced nephropathy variant of tubulointerstitial nephritis
Analgesic-induced nephropathy variant of tubulointerstitial nephritis * Patients who use long-term large-dose analgesics (acetaminophen/phenacetin derivatives, aspirin, caffeine, codeine) are at increased risk of tubule damage * Pathogenesis: acetaminophen/phenacetin cause oxidative damage to tubules, and aspirin (prostaglandin synthesis inhibitor) results in vasoconstriction and edema
36
Acetaminophen/phenactin cause analgesic-induced nephropathy by \_\_\_\_\_\_
Acetaminophen/phenactin cause analgesic-induced nephropathy by causing oxidative damage to tubules
37
Aspirin causes analgesic-induced nephropathy by \_\_\_\_\_\_
Aspirin causes analgesic-induced nephropathy by inhibiting prostaglandins, which results in vasoconstriction and ischemia