17.5 Pathology: Glomerular diseases

Question 1

What is the basement membrane in the glomerulus composed of?

Answer 1

Type IV Collagen

Negatively charged proteoglycans

Question 2

What types of cells does the glomerulus contain?

Answer 2

Endothelial (inner capillary surface)
Mesangial (stalk)
Epithelial (urinary surface of BM)

Question 3

What is the clinical presentation that occurs with nephrotic syndrome/severe proteinuria? (4)

Answer 3

Oedema (systemic)
Proteinuria (>4g/day)
Hypoalbinaemia
Hyperlipidaemia

Question 4

What is the defect in nephrotic syndrome?

Answer 4

Permeability of filter

Question 5

What are some common causes of proteinuria/nephrotic syndrome? (4)

Answer 5

1. Diabetes mellitus
2. Glomerulonephritis (minimal change disease, membranous glomerulonephritis, others)
3. Amyloid deposition
4. Genetic abnormalities in proteins between adjacent podocytes

Question 6

What does acute renal failure refer to? What would we see in an FBE?

Answer 6

Acute reduction in GFR (see increased serum urea/creatinine)

Question 7

What are the renal causes of acute renal failure? (4)

Answer 7

ATN (acute tubular necrosis)
Acute glomerulonephritis
Acute intersitial disease
Others e.g. vascular disease

Question 8

What is glomerulonephritis?

What is it associated with?

Answer 8

Acute injury to glomerulus

Associated with deposition of immune complexes in the tuft

Question 9

What is an example of an acute post infectious glomerulonephritis?

Answer 9

Post Streptococcal GN

Question 10

What is the most common form of glomerulonephritis in Australia (what does this lead to)?

Answer 10

IgA Nephropathy (leads to haematuria)

Question 11

What is a common form of glomerulonephritis that causes proteinuria?

Answer 11

Membranous nephropathy

Question 12

What do we see in the kidney in Systemic Lupus Erythematosis?

Answer 12

Glomerulonephritis (immune complexes depositing in wall, congealed pink protein complexes)

Question 13

Where do immune complex deposits lie in membranous glomerulonephritis?

Answer 13

Outside the BM

Question 14

What do we often see in a histological section of a glomerulus with severe acute injury?

Answer 14

Necrosis leading to a ‘cresent’ (non specific, consists of fibrin, monocytes and podocytes)

Question 15

What is the top cause of end stage renal failure in Aus?

Answer 15

Diabetic nephropathy (protein leakage and nephrotic syndrome)

Question 16

What would ye olde patient with vinegar in urine possibly have?

What could it have been due to?

Answer 16

Nephrotic syndrome (increased glomerular capillary wall permeability to proteins)

Immune complex mediated glomerulonephritis (membranous GN)

Question 17

What could someone presenting with oliguria and acute renal failure a few weeks after recovering from a bad throat infection have?

Answer 17

Acute post streptococcal GN (immune complex mediated)

Question 18

What will severe glomerular injury be associated with?

Answer 18

Cresents in the urinary space outside of the glomerular tuft