E N D
2. What is the most common cause of nephrotic syndrome in US adults? Minimal Change Disease
Focal and Segmental Glomerulosclerosis
IgA Nephropathy
DM
Membranous Nephropathy
3. In glomerulonephritis, most urine cell casts originate from the glomerulus True
False
These choices are overwhelming me
4. Goals for Today Provide a conceptual framework to segregate glomerular diseases
What we will NOT DO: go into detail for every glomerular disease, Dr Popli will do this later!
We will NOT discuss RPGN
Do some questions
5. Glomerular apparatus
Endothelium
Basement membrane
Podocytes
6. Glomerular Disease Nephritic (a.k.a. acute glomerulonephritis)
Focal
Diffuse
May burn out to
Nephrotic
Also a disease in and of itself
7. Etiologies of Acute GN Ag-Ab complex deposition
Antibodies against the BM
Direct injury
Idiopathic
Inherited
All result in active inflammation in the glomerulus, and active sediment coming out in the urine
8. Nephritic Syndrome HTN
Proteinuria (trace to nephrotic range)
Active sediment
(Often dysmorphic) RBCs +/- casts
WBCs +/- casts
Varying complement levels
FENa almost always <1%
9. The hallmark of nephritic syndromes is an active urine sediment
10. Nephritic Syndromes with Low Complement Renal
Post-infectious
Strep
Hep B
Membranoproliferative GN Systemic
SLE
Endocarditis
cryoglobulinemia
11. Nephritic with Normal Complement Renal
IgA
Alports
ANCA+ RPGN Systemic
Goodpastures
Vasculitides
TTP/HUS
13. Complement levels help discriminate the etiology of nephrotic syndrome True
False
I like complements!
14. Nephrotic Syndrome >3g proteinuria/day
Albumin
Igs
TBG
Antithrombin III
Bland sediment (except fat)
Hypoalbuminemia (serum <3g/dL)
Hyperlipidemia
Fat droplets in urine (Maltese Crosses)
Ascites, effusionsbut not pulm edema
NORMAL complement (except active SLE)
15. Nephrotic Syndrome Renal
Minimal Change
Membranous
FSGS Systemic
DM
MM/Amyloidosis
SLE
22. Typically idiopathic, FSGS is similar to MCD in that there is diffuse loss of foot processes. As per its name, only has focal sclerosis in segments of the kidney especially around the juxta-medullary glomeruli.
Most common cause of idiopathic nephrotic syndrome in African Americans
Associated diseases
HIV
Obesity
Sickle cell anemia
Heme malignancies
Chronic vesicoureteral reflux FSGS
25. Membranous Nephropathy Usually idiopathic; most common cause of idiopathic nephrotic syndrome in adults
Some known causes/associations
Chronic infection: malaria, HBV, HCV, syphilis
Drugs: gold, penicillamine, NSAIDs
Autoimmune disease
May be manifestation of solid tumor malignancy
Pursue age-appropriate cancer screening
ALL glomeruli affected on biopsy: diffuse thickening of BM with immune complex spikes