ACP- L23, L24 Medical renal diseases Flashcards
The endothelial cells of the glomerulus are with fenestration. The Glomerular basement membrane (GBM) contains __________ with heparin sulfate producing ________charge. This serves as the main filtration barrier, blocking large MW molecules like albumin.
What is the possible pathology in GBM? (2)
Contains Type IV collagen;
Negative charge;
Pathology - Thickened in:
- Membranous nephropathy
- DM: increased type IV collagen synthesis
Visceral epithelial cells (VEC) produce GBM and they are podocytes (intracellular junctions) that serve as the final filtration barrier.
Possible pathology of VECs?
Minimal change disease: fusion of podocytes
Mesangial cells support glomerular capillaries.
Possible pathology?
IgA nephropathy:
IC deposition > release inflammatory mediators
Parietal epithelial cells are the lining of the Bowman capsule. Possible pathology?
Crescentic glomerulonephritis: proliferate and compress on glomerular tuft (blood vessels)
Which of the following about glomerular diseases are correct?
A. More than half is diffuse type
B. Less than half is focal type
C. Can be divided into segmental or global
D. Light microscope using H&E staining, PAS can be used for classifying the type of glomerular disease
E. Immunofluoresence can be used to identify protein deposition
All of the above
E:
IF - e.g. Anti-IgA Ab
Identify protein deposition, e.g.
1. Linear pattern in IF: anti-GBM disease, e.g. Goodpasture syndrome
2. Granular pattern in IF: Immune-complex type GN
______________ can be used to detect submicroscopic defects, such as podocytes fusion in nephrotic syndrome.
It can also be used to detect site of IC deposition, e.g. subendothelial, subepithelial and intramembranous
Electron microscope
In most nephritic syndrome, pathology is due to? (1)
explain (3)
Immune complex -
1. Type III HSR >
- IC circulate and deposit in glomeruli >
- activate C’ > C5a > neutrophil attracted > glomerular damage
What is the pathology of Goodpasture syndrome?(2)
Type II HSR - Antibodies against GMB antigens
Minimal change disease is due to _____ cell disorder, which produces cytokines.
This affects the GBM by affecting its ______, podocytes are damaged and fused.
T-cell disorder;
charge (lost negative charge)
(Visceral epithelial cell)
Clinical manifestation of glomerular disease is often chronic and will progress to?
There is no specific Tx, supportive Tx is given to slow disease progression.
End stage renal disease (ESRD)
Give 2 examples of primary glomerulonephritis
- Membranous nephropathy
- Minimal change nephropathy
- Cresenteric glomerulonephritis
- IgA nephropathy
Give 2 examples of secondary glomerulonephritis.
- Lupus nephritis
- Diabetic glomerulosclerosis
- Amyloidosis
- Post-streptococcal GN
Give 2 examples of heriditary glomerulonephritis.
- Alport’s sydrome (kidney disease, hearing loss, eye abnormalities)
- Thin membrane disease (hematuria)
- Fabry’s disease (deficiency of enzyme that builds up a type of fat in body)
What are difference in definition between nephritic syndrome and nephrotic syndrome?
Nephritic syndrome - Glomerular injury due to neutrophils
Nephrotic syndrome:
Glomerular injury due to cytokines but not neutrophils
Nephritic/ Nephrotic?
A. Hypertension is due to increase fluid retention in azotaemia (increased N-containing components in blood)
B. Hypertension is due to RAAS activation that reduced ECF
Nephritic - A
Nephrotic - B
