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NEPHROTIC SYNDROME - Coggle Diagram

- - - - Principal
        Findings
        
        Normal glomeruli on H&E stain; lipid in proximal tubule cells.
        
        Effacement of foot processes on electron microscopy.
        
        No immune complex deposits; negative immunofluorescence.
        
        Selective proteinuria (loss of albumin, not immunoglobulin).
        
        Excellent response to steroids (damage is mediated by
        cytokines from T cells)
        
        Light glomerular basement membrane on H&E
  - - - Effacement of foot processes on EM
        
        No immune complex deposits; negative IF
        
        Poor response to steroids→ chronic renal failure
      - Dense pink deposition of collagen
        within the glomerulus
        
        Focal (some glomeruli)
        
        Segmental sclerosis on H&E stain
        (partes con esclerosis otras normales en 1 glomérulo)
        
        Light glomerular basement membrane on H&E
  - - - Findings:
        
        Thick glomerular basement membrane on H&E
        
        Immune complex deposition → subepithelial deposits
        with 'spike and dome' appearance on EM (granular immunofluorescence)
        
        Poor response to steroids→chronic renal failure
  - - - 2 types based on
        location of deposits
        
        Type I - subendothelial → associated HBV and HCV
        
        Type II intramembranous (dense deposit disease) → associated C3 nephritic factor: autoantibody stabilizes C3 convertase→overactivation of complement, inflammation, and low levels of circulating C3.
  - - - Glomerular efferent arteriole more
        affected than the afferent arteriole
        →high glomerular filtration pressure
        
        Progresses to
        nephrotic syndrome
        
        Sclerosis of the mesangium + formation
        of Kimmelstiel-Wilson nodules
      - Hyperfiltration injury →microalbuminuria
  - - - Apple-green birefringence under
        polarized light after Congo red stain