63.primary glomerulopathy/nephritis

Question 1

definition of primary glomerulopathies

Answer 1

renal inflammatory diseases due to primary damage of glomeruli by immune-mediated mechanisms

Question 2

how are the morphological changes in the kidneys described as?

Answer 2

identical in both

Question 3

changes in renal tissue/urine in primary glomerulopathies

Answer 3

1.renal tissue and urine are sterile
2.inflammatory process never purulent

Question 4

definition of secondary glomerulopathies

Answer 4

glomeruli are affected during the course of other systemic or hereditary diseases e.g lupus, alports syndrome

Question 5

classification of primary glomerulonephritis

Answer 5

1. Acute GN
   a) Post-streptococcal
   b) Non-streptococcal
2. Rapidly progressive GN
3. Minimal change disease
4. Membranous GN
5. Membrano-proliferative GN
6. Focal and diffuse proliferative GN
7. Focal segmental glomerulosclerosis (FSGS) . 8.IgAnephropathy
8. Chronic glomerulonephritis

Question 6

classification of secondary systemic glomerular diseases

Answer 6

1. Lupus nephritis (SLE)
2. Diabetic nephropathy
3. Amyloidosis
4. Polyarteritis nodosa
5. Wegener’s granulomatosis
6. Goodpasture’s syndrome
7. Henoch-Sch6nlein purpura
8. Systemic infectious diseases (bacterial endocarditis, syphilis, leprosy; viral e.g. HBV,
   HCV, HIV;parasitic e.g. falciparum malaria,filariasis)
9. Idiopathic mixed cryoglobulinaemia

Question 7

classification of hereditary nephritis

Answer 7

1.alports syndrome
2.fabrys disease
3.nail-patella syndrome

Question 8

how do we describe the extent of glomerular injury?

Answer 8

(a) Diffuse - more than 80% are affected
(b) Focal - some glomeruli are affected (<80%)
(c) Segmental - part of one glomerulus is affected
(d) Global- the entirety of one glomerulusis affected

Question 9

which is the more frequent glomerulonephritis?

Answer 9

diffuse and global

Question 10

describe the nephritic syndrome

Answer 10

characterized by:
1* hematuria with red blood cell (RBC)casts,
2* oliguria,
3* azotemia,
4* varying degreesofarterial hypertension
5*glomerular pathology by inflammation and proliferation

Question 11

describe the nephrotic syndrome

Answer 11

characterized by:
1* heavy proteinuria(i.e., > 3.5 g/day),
2* hypoalbuminemia,
3* hyperlipidemia,
4* edema.

Question 12

which glomerulonephritides show nephritic syndrome

Answer 12

1. Acute postinfectious glomerulonephritis;
2. Rapidly progressive glomerulonephritis;
3. Goodpasture’s syndrome and
4. Glomerulonephritis with vasculitis

Question 13

which glomerulonephritides show nephrotic syndrome

Answer 13

1. Minimal change nephrotic syndrome
2. Focal segmental glomerulosclerosis
3. Membranous glomerulonephritis
4. Membranoproliferative GN
5. IgA nephritis
6. Focal proliferative glomerulonephritis
7. Diffuse sclerosing glomerulonephritis

Question 14

which are the mechnisms of immune glomerular injury

Answer 14

1.immune complex-associated injury
2.injury associated with antibody to GBM

Question 15

factors responsible for the deposition of immune complexes within the glomerular basement membrane:

Answer 15

1.The glomeruli are vulnerable because they filter large volumes of blood
2. Small complexes pass through to the subepithelial side of the basement membrane in contrast to larger complexes which accumulate
subendothelially and in the mesangium.

Question 16

which are the phases of glomerular injury

Answer 16

1.exudative
2.proliferative
3.sclerotic

Question 17

describe the glomerular injury due to immune complexes

Answer 17

1. characterized by the presenceof antigen-antibody agegregates, which usually are precipitated in the glomerulus.
2. Immune complexes may exist preformed in the circulation aor they may arise insitu.
3. In situ formation occurs when antibodies are directed against endogenous glomerular antigens
   e.g SLE - the antigen is DNA, which has a strong affinity for collagen molecules, and binds to the basement membrane.

Question 18

describe the glomerular injury associated with antibody to GBM

Answer 18

1. caused by antibody directed against components (antigens) that are distributed in a continuous fashion in the basement membrane.
2. Antibody reacts with this antigen, activating the mediators of inflammation, which cause glomerular injury.
3. It occurs in Goodpaster’s syndrome, in which the glomerulonephritis is associated with pulmonary hemorrhages

Question 19

which are the mediators of glomerular damage

Answer 19

1.complement
2.polymorphonuclear leucocytes
3.clotting factors

Question 20

in normal conditions there are no more than …A. nuclei in one glomerulus and
no more than …B. mesangial cells in one mesangial zone

Answer 20

a-150
b-2

Question 21

for diagnosis of GN we use

Answer 21

1.renal biopsy
2.light microscopy
3.immunofluorescence
4.electron microscopy

Question 22

what is glomerular hypercellularity

Answer 22

mesangial cell proliferation and leucocytic infiltration of mesangium

Question 23

what is hyalinosis

Answer 23

accumulation of homogenous, eosinophilic material that represents precipitated plasma protein
—usually associated with inreased mesangial matrix