Nephrotic syndromes: Pathology review
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Nephrotic syndromes: Pathology review
Pathology
Renal and ureteral disorders
Renal agenesis
Horseshoe kidney
Potter sequence
Hyperphosphatemia
Hypophosphatemia
Hypernatremia
Hyponatremia
Hypermagnesemia
Hypomagnesemia
Hyperkalemia
Hypokalemia
Hypercalcemia
Hypocalcemia
Renal tubular acidosis
Minimal change disease
Diabetic nephropathy
Focal segmental glomerulosclerosis (NORD)
Amyloidosis
Membranous nephropathy
Lupus nephritis
Membranoproliferative glomerulonephritis
Poststreptococcal glomerulonephritis
Goodpasture syndrome
Rapidly progressive glomerulonephritis
IgA nephropathy (NORD)
Lupus nephritis
Alport syndrome
Kidney stones
Hydronephrosis
Acute pyelonephritis
Chronic pyelonephritis
Prerenal azotemia
Renal azotemia
Acute tubular necrosis
Postrenal azotemia
Renal papillary necrosis
Renal cortical necrosis
Chronic kidney disease
Polycystic kidney disease
Multicystic dysplastic kidney
Medullary cystic kidney disease
Medullary sponge kidney
Renal artery stenosis
Renal cell carcinoma
Angiomyolipoma
Nephroblastoma (Wilms tumor)
WAGR syndrome
Beckwith-Wiedemann syndrome
Bladder and urethral disorders
Posterior urethral valves
Hypospadias and epispadias
Vesicoureteral reflux
Bladder exstrophy
Urinary incontinence
Neurogenic bladder
Lower urinary tract infection
Transitional cell carcinoma
Non-urothelial bladder cancers
Renal system pathology review
Congenital renal disorders: Pathology review
Renal tubular defects: Pathology review
Renal tubular acidosis: Pathology review
Acid-base disturbances: Pathology review
Electrolyte disturbances: Pathology review
Renal failure: Pathology review
Nephrotic syndromes: Pathology review
Nephritic syndromes: Pathology review
Urinary incontinence: Pathology review
Urinary tract infections: Pathology review
Kidney stones: Pathology review
Renal and urinary tract masses: Pathology review
Assessments
Nephrotic syndromes: Pathology review
USMLE® Step 1 questions
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Questions
USMLE® Step 1 style questions USMLE
of complete
Reproduced from: Wikipedia
Which of the following is the most likely explanation for this patient’s condition?
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Transcript
Contributors
Kaia Chessen, MScBMC
Anca-Elena Stefan, MD
Kaylee Neff
Victoria Cumberbatch
On the Nephrology ward, two people came in with the same symptoms: peripheral and periorbital edema.
One of them is a 10 year old caucasian boy named Brian who had recently been stung by a bee, and the other one is a 55 year old Hispanic individual named Gregory.
Lab tests show that both of them have hypoalbuminemia, hyperlipidemia and urinalysis showed frothy urine with fatty casts.
A 24-hour protein collection was done which showed massive proteinuria with more than 3.5 grams of protein lost through urine per day.
Both Brian and Gregory have nephrotic syndrome, but Brian has minimal change disease, while Gregory has focal segmental glo-merulo-sclerosis.
Nephrotic syndrome happens when the glomeruli are damaged and they become more permeable, so they start letting plasma proteins pass from the blood to the nephron and then into the urine.
This leads to proteinuria, which is when more than 3.5 grams of protein is excreted through the urine per day.
One of the proteins lost through urine is albumin and this leads to hypoalbuminemia.
This causes peripheral and periorbital edema since there’s less oncotic pressure in the blood vessels and the fluid leaks out.
On your tests, a nephrotic patient could also present with a hypercoagulable state and you will need to understand the pathology.
The reason for this is that the person is also losing antithrombin III proteins which is the body’s anticoagulant.
This means that individuals with nephrotic syndrome are prone to thrombotic and thromboembolic complications.
Immunoglobulins are another type of proteins lost through urine, which means that there’s a higher risk for infection.
Now, apart from proteins, lipids are also lost through urine, which gives the urine a frothy or foamy appearance.
Summary
Nephrotic syndrome is a kidney disorder characterized by abnormal filtration in the glomeruli, because glomeruli are damaged and are unable to properly retain proteins in the blood. This can lead to protein in the urine, low protein levels in the blood, and swelling.
Nephrotic syndrome is characterized by proteinuria that exceeds 3.5 grams per 24 hours. Loss of such a large amount of proteins leads to swelling (edema) in the legs, ankles, and other parts of the body, as well as an increased risk of infections and blood clots. Nephrotic syndrome can be caused by various conditions, including kidney diseases, diabetes, and lupus. It is usually treated with medications to control the underlying cause.
Sources
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Comprehensive Clinical Nephrology E-Book" Elsevier Health Sciences (2018)
- "Minimal Change Disease" Clinical Journal of the American Society of Nephrology (2016)
- "Clinical and pathologic characteristics of focal segmental glomerulosclerosis pathologic variants" Kidney International (2006)
- "Prophylactic Anticoagulation in Nephrotic Syndrome: A Clinical Conundrum" Journal of the American Society of Nephrology (2007)
- "Pathogenesis of membranous nephropathy: recent advances and future challenges" Nature Reviews Nephrology (2012)
- "Clinical Manifestations of Kidney Disease Among US Adults With Diabetes, 1988-2014" JAMA (2016)
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