Causes of Nephrotic Syndrome in Adults and Glomerular Lesions
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Questions and Answers

What is the manifestation of renal stones?

Renal colic, hematuria, and recurrent stone formation.

What are the four categories into which kidney diseases are divided based on the primarily affected component?

Glomerular, Tubular, Interstitial, Vascular.

What are the types of antigens involved in circulating immune complex-mediated glomerular diseases?

Endogenous (as in SLE) or Exogenous (bacterial, viral, parasitic, spirochetal infections) or Unknown.

What is the major pathway of antibody-initiated injury in Glomerulonephritis?

<p>Activation of the complement system.</p> Signup and view all the answers

What is the best-characterized disease in nephritis caused by in situ immune complexes?

<p>Anti-GBM antibody GN.</p> Signup and view all the answers

What is the mechanism of injury in Podocyte injury?

<p>Antibodies to visceral epithelial cell antigens.</p> Signup and view all the answers

What happens to individuals with renal disease that destroys sufficient nephrons?

<p>Progression to end-stage renal failure.</p> Signup and view all the answers

What are the key features of the Nephrotic Syndrome?

<p>Massive proteinuria, hypoalbuminemia, generalized edema, hyperlipidemia, and lipiduria.</p> Signup and view all the answers

What is the most frequent cause of the nephrotic syndrome in children?

<p>Minimal-Change Disease (MCD)</p> Signup and view all the answers

What is the most common cause of the nephrotic syndrome in adults?

<p>Focal and Segmental Glomerulosclerosis (FSGS)</p> Signup and view all the answers

What is the main characteristic of protein loss in Minimal-Change Disease (MCD)?

<p>Selective proteinuria</p> Signup and view all the answers

What is the most common glomerular disease revealed by renal biopsies worldwide?

<p>IgA nephropathy</p> Signup and view all the answers

What is the characteristic histological manifestation of Membranoproliferative Glomerulonephritis (MPGN)?

<p>GBM thickening and proliferation of glomerular cells</p> Signup and view all the answers

What are the systemic causes of nephrotic syndrome in adults?

<p>Diabetes, Amyloidosis, SLE</p> Signup and view all the answers

What is the pathogenesis of type I Membranoproliferative Glomerulonephritis (MPGN)?

<p>Caused by circulating immune complexes</p> Signup and view all the answers

What are the characteristics of Acute postinfectious (Poststreptococcal) Glomerulonephritis?

<p>Hematuria, Oliguria with azotemia, Hypertension</p> Signup and view all the answers

What is the pathogenic hallmark of IgA nephropathy?

<p>Deposition of IgA in the mesangium</p> Signup and view all the answers

What are the clinical features of Crescentic Glomerulonephritis (CrGN)?

<ol> <li>Rapidly progressive loss of renal function. 2. Nephritic syndrome. 3. Severe oliguria. 4. Death from renal failure within weeks to months if untreated</li> </ol> Signup and view all the answers

What are the gross features of acute pyelonephritis?

<p>Discrete, yellowish, raised abscesses on the renal surface</p> Signup and view all the answers

How do bacteria reach the kidneys in acute pyelonephritis?

<p>Through the bloodstream or from the lower urinary tract (ascending infection)</p> Signup and view all the answers

What genetically determined properties influence bacterial adhesion to the urethral urothelium?

<p>Properties of both the urothelium and the offending bacteria</p> Signup and view all the answers

What is a key step in the evolution of acute pyelonephritis?

<p>Bacterial adhesion to the urethral urothelium and gaining access to the bladder</p> Signup and view all the answers

Why does UTI most commonly affect females?

<p>Due to factors facilitating entry of bacteria to the bladder such as short urethra and close proximity of the urethra to the rectum</p> Signup and view all the answers

What results from outflow obstruction in acute pyelonephritis?

<p>Incomplete bladder emptying and increased residual volume of urine</p> Signup and view all the answers

What is azotemia?

<p>Elevation of blood urea nitrogen and creatinine levels</p> Signup and view all the answers

How is azotemia divided based on its origin?

<ol> <li>Pre-renal azotemia, 2. Renal azotemia, 3. Post-renal azotemia</li> </ol> Signup and view all the answers

What does uremia signify?

<p>Azotemia associated with biochemical and systemic clinicopathological alterations</p> Signup and view all the answers

What characterizes nephrotic syndrome?

<p>Heavy proteinuria, hypo-albuminemia, severe edema, hyperlipidemia, lipiduria</p> Signup and view all the answers

What are the major clinical manifestations of acute nephritic syndrome?

<p>Acute onset of gross hematuria, mild to moderate proteinuria, azotemia, edema, hypertension</p> Signup and view all the answers

What is the significance of asymptomatic hematuria and proteinuria?

<p>Manifestation of mild glomerular abnormalities</p> Signup and view all the answers

What is acute renal failure characterized by?

<p>Recent onset of oliguria or anuria with azotemia</p> Signup and view all the answers

What does chronic renal failure refer to?

<p>Prolonged symptoms and signs of uremia</p> Signup and view all the answers

How can urinary tract infection (UTI) be characterized?

<p>Bacteriuria and pyuria</p> Signup and view all the answers

What is the complication of analgesic abuse related to transitional-cell carcinoma?

<p>Increased incidence of transitional-cell carcinoma of the renal pelvis or bladder</p> Signup and view all the answers

Define Acute Tubular Necrosis (ATN)?

<p>Acute renal failure due to necrosis of tubular epithelial cells</p> Signup and view all the answers

What are the types of cystic diseases of the kidney?

<p>Hereditary, Developmental but nonhereditary, Acquired disorders</p> Signup and view all the answers

What are the two forms of Drug-Induced Interstitial Nephritis (DIN)?

<p>Acute DIN and Analgesic Nephropathy</p> Signup and view all the answers

What is the characteristic feature of Autosomal Dominant Polycystic Kidney Disease (ADPKD)?

<p>Multiple expanding cysts of both kidneys that destroy the intervening parenchyma</p> Signup and view all the answers

What is the most important cause of calcium stones formation?

<p>Increased urine concentration of the stone's constituents (supersaturation)</p> Signup and view all the answers

What are the common constituents of renal stones?

<p>Calcium oxalate, Calcium oxalate mixed with calcium phosphate, Magnesium ammonium phosphate, Uric acid, Cystine</p> Signup and view all the answers

What is the classic presentation of acute poststreptococcal glomerulonephritis?

<p>Acute nephritic syndrome</p> Signup and view all the answers

What is characterized by heavy proteinuria, hypo-albuminemia, severe edema, hyperlipidemia, and lipiduria?

<p>Nephrotic syndrome</p> Signup and view all the answers

What refers to recent onset of oliguria or anuria, accompanied by azotemia?

<p>Acute renal failure</p> Signup and view all the answers

What does chronic renal failure refer to?

<p>Prolonged symptoms and signs of uremia</p> Signup and view all the answers

What is the characteristic feature of Autosomal Dominant Polycystic Kidney Disease (ADPKD)?

<p>Multiple cysts in both kidneys</p> Signup and view all the answers

What is the most common glomerular disease revealed by renal biopsies worldwide?

<p>Minimal-Change Disease (MCD)</p> Signup and view all the answers

What genetically determined properties influence bacterial adhesion to the urethral urothelium?

<p>P-fimbriae and type 1 fimbriae</p> Signup and view all the answers

What is the pathogenic hallmark of IgA nephropathy?

<p>Deposition of IgA immune complexes in the mesangium</p> Signup and view all the answers

What are the types of antigens involved in circulating immune complex-mediated glomerular diseases?

<ol> <li>Endogenous antigens (e.g., in SLE) 2. Exogenous antigens (e.g., bacterial, viral, parasitic infections) 3. Unknown antigens (e.g., membranous nephropathy)</li> </ol> Signup and view all the answers

What are the mediators of immune injury in Glomerulonephritis?

<p>Activation of complement, recruitment of neutrophils and monocytes, release of proteases, oxygen-derived free radicals, and arachidonic acid metabolites.</p> Signup and view all the answers

What is the best-characterized disease in nephritis caused by in situ immune complexes?

<p>Anti-GBM antibody GN (Goodpasture syndrome)</p> Signup and view all the answers

What is the clinical complex referred to as The Nephrotic Syndrome characterized by?

<p>Massive proteinuria, hypoalbuminemia, generalized edema, hyperlipidemia, and lipiduria.</p> Signup and view all the answers

What is the manifestation of renal stones?

<p>Renal colic, hematuria, recurrent stone formation.</p> Signup and view all the answers

What characterizes Podocyte injury in glomerular diseases?

<p>Effacement of podocyte foot processes associated with proteinuria.</p> Signup and view all the answers

What is the significance of Nephron Loss in renal diseases?

<p>Reduction in GFR, progression to end-stage renal failure, development of proteinuria, and glomerulosclerosis.</p> Signup and view all the answers

What are the key features of Glomerular Diseases based on the primarily affected component of the kidney?

<p>Glomerular, Tubular, Interstitial, Vascular.</p> Signup and view all the answers

Describe the pathogenesis of Minimal-Change Disease (MCD) in children.

<p>Due to a T-cell derived factor that causes podocyte damage.</p> Signup and view all the answers

What is the most common primary glomerular lesion leading to the nephrotic syndrome in children?

<p>Minimal-Change Disease (MCD).</p> Signup and view all the answers

Explain the pathogenesis of Focal and Segmental Glomerulosclerosis (FSGS).

<p>Types include primary (idiopathic) FSGS and secondary FSGS seen with various conditions.</p> Signup and view all the answers

What are the systemic causes of Membranous Nephropathy?

<p>Infections, malignancy, autoimmune diseases, exposure to inorganic salts, and certain drugs.</p> Signup and view all the answers

Describe the histological manifestations of Membranoproliferative Glomerulonephritis (MPGN).

<p>GBM thickening and proliferation of glomerular cells.</p> Signup and view all the answers

What characterizes the nephritic syndrome?

<p>Clinical complex with acute onset, hematuria, oliguria with azotemia, and hypertension.</p> Signup and view all the answers

Explain the pathogenesis of Acute postinfectious (Poststreptococcal) Glomerulonephritis.

<p>Associated with streptococcal infection, immune complex deposition, and low serum complement levels.</p> Signup and view all the answers

What is the pathogenic hallmark of IgA nephropathy?

<p>Deposition of IgA in the mesangium activating the alternative complement pathway.</p> Signup and view all the answers

What is the mechanism by which bacteria ascend along the ureters to infect the renal pelvis and parenchyma?

<p>Vesicoureteral reflux (VUR)</p> Signup and view all the answers

What is the most likely mechanism of action for drugs leading to Acute Drug-Induced Interstitial Nephritis (DIN)?

<p>Drugs act as haptens that bind to a cytoplasmic or extracellular component of the secreting tubular cells and become immunogenic.</p> Signup and view all the answers

What is the difference between Acute DIN and Analgesic Nephropathy in terms of nephritis development?

<p>Acute DIN is due to drugs acting as haptens causing immunogenicity, while Analgesic Nephropathy is due to the intake of large quantities of analgesics.</p> Signup and view all the answers

Why are changes affecting renal blood vessels considered both frequent and important?

<p>The renal vasculature is secondarily involved in almost all kidney diseases, various forms of systemic arteritis involve renal vessels, and the kidney plays a role in hypertension pathogenesis.</p> Signup and view all the answers

What characterizes Autosomal Dominant (Adult) Polycystic Kidney Disease (ADPKD)?

<p>ADPKD is characterized by multiple expanding cysts of both kidneys that ultimately destroy the intervening parenchyma.</p> Signup and view all the answers

What is the most common composition of renal stones?

<p>The majority of renal stones (80%) are composed of either Calcium oxalate or Calcium oxalate mixed with calcium phosphate.</p> Signup and view all the answers

What is the key cause of calcium stones formation?

<p>Increased urine concentration of the stone's constituents (supersaturation) is the most important cause of calcium stones formation.</p> Signup and view all the answers

What is the most important implication of cystic diseases of the kidney?

<p>Cystic kidney diseases are important as they are common, often present diagnostic challenges, and can be a major cause of chronic renal failure.</p> Signup and view all the answers

Explain the pathogenesis of IgA nephropathy.

<p>Deposition of IgA in the mesangium</p> Signup and view all the answers

What characterizes Henoch-Schönlein purpura?

<p>Purpuric rash, abdominal pain, arthritis</p> Signup and view all the answers

What are the clinical characteristics of Rapidly Progressive Glomerulonephritis (RPGN)?

<p>Rapidly progressive loss of renal function, nephritic syndrome, severe oliguria, death from renal failure if untreated</p> Signup and view all the answers

Describe the gross features of Chronic Glomerulonephritis.

<p>Symmetrically contracted kidneys with red-brown surface</p> Signup and view all the answers

What is Tubulointerstitial Nephritis (TIN) primarily associated with?

<p>Inflammatory diseases involving the interstitium and tubules</p> Signup and view all the answers

Explain the pathogenesis of Acute Pyelonephritis.

<p>Bacteria reach the kidneys through the bloodstream or ascending infection, leading to inflammation.</p> Signup and view all the answers

Why does UTI most commonly affect females?

<p>Due to factors facilitating bacterial entry to the bladder, such as short urethra and proximity to rectum.</p> Signup and view all the answers

What are the steps involved in the evolution of acute pyelonephritis?

<p>Bacterial adhesion to urothelium and access to bladder, followed by outflow obstruction and urine stasis.</p> Signup and view all the answers

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