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Questions and Answers

What is the main structural unit of the kidney?

Glomerulus

Bowman's capsule

Nephron (correct)

Renal corpuscle

Which condition is characterized by inflammation in the kidneys and includes symptoms like hematuria and hypertension?

Glomerulonephritis

Nephrotic syndrome

Chronic kidney disease

Nephritic syndrome (correct)

What primarily causes nephritic syndrome?

Decreased urine output

Infection of the renal epithelium

Obstruction of renal blood flow

Deposition of immune complexes (correct)

Which of the following is NOT a symptom associated with nephritic syndrome?

Severe proteinuria Signup and view all the answers

What structure within the nephron is responsible for filtering blood?

Glomerulus Signup and view all the answers

What type of microscopy reveals subepithelial electron dense deposits in nephritic syndrome?

Transmission electron microscopy Signup and view all the answers

What is a common finding in adults with nephritic syndrome?

Sudden hypertension and edema Signup and view all the answers

What is the prognosis for children experiencing nephritic syndrome after a streptococcal infection?

95% recover with conservative therapy Signup and view all the answers

Which of the following is NOT a characteristic of nephrotic syndrome?

Neutrophil infiltration Signup and view all the answers

What causes the effacement of foot processes in nephrotic syndrome?

Injury to podocytes Signup and view all the answers

What is a significant symptom of nephrotic syndrome indicated by urine appearance?

Foamy urine Signup and view all the answers

Which laboratory finding is characteristic of nephrotic syndrome?

Hypoalbuminemia Signup and view all the answers

Which group has a higher likelihood of developing rapidly progressive glomerulonephritis in nephritic syndrome?

Adults Signup and view all the answers

Which symptom is NOT typically associated with nephrotic syndrome?

Acute diffuse proliferative glomerulonephritis Signup and view all the answers

What is the primary cause of hyperlipidemia in nephrotic syndrome?

Increased hepatic lipogenesis due to hypoalbuminemia Signup and view all the answers

Which of the following is a characteristic gross picture of nephrotic syndrome?

Yellowish color due to lipid presence Signup and view all the answers

Which of the following conditions can lead to nephrotic syndrome?

Systemic lupus erythematosus (SLE) Signup and view all the answers

What is the most common type of glomerulonephritis in children associated with Type III hypersensitivity?

Acute diffuse proliferative glomerulonephritis Signup and view all the answers

Study Notes

The Nephron

Microscopic structural and functional unit of the kidney
Composed of the renal corpuscle and the renal tubule
- Renal Corpuscle: Glomerulus (tuft of capillaries) inside Bowman's capsule
- Renal Tubule: Extends from Bowman's capsule

Glomerulus

Network of capillaries called a tuft, located inside Bowman's capsule
Supported by the mesangium: supporting background of blood vessels made up of intraglomerular mesangial cells

Nephritic Syndrome

Inflammation of the kidney
Signs & symptoms:
- Hematuria: Blood in the urine
- Oliguria: Reduced urine output
- Hypertension
- Elevated blood urea & creatinine (BUN) (normal BUN < 3.5)
- Azotemia: Elevated nitrogen-rich waste compounds in the blood
- Edema: Swelling, usually in the face or legs
- Mild to moderate proteinuria: Protein in the urine
Causes:
- Deposition of immune complexes
- Acute diffuse proliferative glomerulonephritis (post streptococcal or acute glomerulonephritis) (most frequent in children)
Gross Picture: Kidneys may be slightly enlarged and pale due to edema

Nephrotic Syndrome

Kidney disorder causing excessive protein loss in urine due to glomeruli damage
Signs & symptoms:
- Heavy proteinuria (Albuminuria): Large amount of protein in the urine
- Hypo-proteinemia: Low protein levels in the blood
- Severe generalized edema: Widespread swelling
- Hyperlipidemia: High levels of lipids in the blood
Causes:
- Glomerulonephritis: membranous, membranoproliferative and minimal change glomerulonephritis
- Systemic lupus erythematosus (SLE)
- Diabetes
- Amyloidosis: Deposition of abnormal misfolded protein
- Infections: malaria, viral B and C hepatitis
- Nonsteroidal anti-inflammatory Drugs (NSAIDs)
Gross Picture: Enlarged & pale kidneys due to edema, yellowish color due to lipid resorption

Microscopic Picture

Nephritic Syndrome:
- Enlarged and hypercellular glomeruli: Due to proliferation of endothelial and mesangial cells and infiltration by neutrophils & monocytes
- Swelling of endothelial cells and presence of inflammatory cells obstructing capillary lumen
- Tubules contain red cell casts
- Interstitium: Slight leucocyte infiltrate and edema
- Immunofluorescence: Granular fluorescence deposited at glomerular capillary walls & mesangium for IgG-IgM & C3
- Electron Microscopy: Subepithelial (between epithelial cells of Bowman's capsule, & basement membrane) electron dense deposits known as subepithelial humps: finely granular, dome-shaped, representing immune complex deposits
Nephrotic Syndrome:
- Fusion of podocyte foot processes by electron microscopy
- Tubules:
  - Hyaline degeneration of the epithelium: due to protein resorption
  - Vacuolar degeneration of the epithelium: due to lipid resorption
  - Protein casts within the tubular lumen
- Interstitium: Variable edema

Pathophysiology of Nephrotic Syndrome

Injury to podocytes
Podocyte foot process effacement & detachment
Protein leaks into ultrafiltrate (urine)

Sings/Symptoms of Nephrotic Syndrome

High proteinuria: > 3.5 g/day
Hypoalbuminemia: Low albumin levels in the blood
Water & Na+ retention
Edema: Swelling
Hyperlipidemia/lipiduria: High lipids in blood/urine
Loss of Immunoglobulins & anticoagulants in urine: Can lead to infections and thrombotic complications
Foamy urine is a sign of proteinuria
"Pitting" edema: A type of edema that leaves an indentation after pressure is applied

Prognosis

Children:
- 95% recover with conservative therapy
- 1-2% develop rapidly progressive glomerulonephritis
- 2-3% develop chronic glomerulonephritis
Adults:
- 60% recover
- 40% develop rapidly progressive glomerulonephritis