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Nephrotic presentation Proteinuria (>3.5 g/day), hyperlipidemia, fatty casts, edema, associated with thromboembolism (loss of ATIII), increased risk of infection (loss of immunoglobulins), podocyte effacement Membranous glomerulonephritis diffuse capillary and GM thickening, most common cause of adult nephrotic syndrome, EM- "spike and dome appearance" - subepithelial Ig3 and C3 deposits on silver stain, caused by captopril, infection - Hep B, malaria, syphillis, cancer Minimal change disease (lipoid nephrosis) most common in children, after recent infection or immune stimulus, LM - normal glomeruli, EM - foot process effacement, selective loss of negative charge --> lose albumin not globbulins Amyloidosis seen with multiple myeloma, chronic conditions, TB, RA, LM - apple-green birefrigence Diabetic glomerulonephropathy nonenzymatic glycosylation of GM - increase permeability, thickening, efferent arterior hyalinization --> increased GFR, mesangial expansion, Kimmelstiel-Wilson lesion, nodular glomerulosclerosis Focal segment glomerulosclerosis HIV patients, LM - segmental sclerosis and hyalinosis, IV drug users Membrano-proliferative glomerulonephritis Type 1 - "tram-track" appearance from GBM splitting from mesangial ingrowth. subendothelial immune complex with granular immunoflouresence, in HCV, Type 2 - dense deposits, autoantibody C3 activation - low C3 levels