B5.039 Prework 2: Patterns of Glomerular Injury

Question 1

percentage of glomeruli involved in a disease pattern

Answer 1

focal (less than 50%)

diffuse (50% or more)

Question 2

extent of involvement of individual glomeruli

Answer 2

segmental (portions affected)

global (entire glomerulus affected)

Question 3

normal appearance of capillaries

Answer 3

patent lumina
smooth GBM contours
small endothelial cells
inconspicuous podocytes

Question 4

normal appearance of mesangium

Answer 4

1-3 cells per contiguous area

small amount of matrix

Question 5

overall normal glomerulus appearance

Answer 5

evenly distributed cellularity

Question 6

intrinsic hypercellularity

Answer 6

endocapillary- cells encroaching on capillary lumina

mesangial- clustering of cells, but patent capillary lumina

Question 7

extrinsic hypercellularity

Answer 7

crescents of cells around capillary tuft

Question 8

what is intrinsic hypercellularity often associated with

Answer 8

immune complex deposition

lupus, IgA

Question 9

what is extrinsic hypercellularity often associated with

Answer 9

GBM break/rupture

Goodpastures

Question 10

GBM double contours

Answer 10

extra layer of GBM in response to injury

Question 11

characterize GBM double contours

Answer 11

endothelial cells or podocytes make new BM in response to injury
can be accompanied by mesangial cell migration or immune cell infiltration
mesangial cell can make new ECM

Question 12

mesangial matrix expansion

Answer 12

can be nodular or more even

increased pink spaces,more than 1-3 nuclei thick

Question 13

causes of mesangial matrix expansion

Answer 13

chronic disease like DM or HTN

immunoglobulin or immune complex deposition

Question 14

immune complex deposition (detected by IF)

Answer 14

capillary pattern (granular)- IgG
mesangial pattern (granular)- IgA
linear pattern- anti-GBM

Question 15

immune complex deposition (detected by EM)

Answer 15

subepithelial (epimembranous)
subendothelial
mesangial
structure (fibrillar, tubular)
appear large, granular, electron dense

Question 16

glomerular thrombosis causes

Answer 16

thrombotic microangiopathy (TMA) or coagulopathy like DIC
TMA causes: SLE, HUS, TTP, scleroderma, HTN

Question 17

appearance of glomerular thrombosis

Answer 17

coarse, ropey material in capillary lumen

Question 18

glomerular tuft necrosis

Answer 18

fibrous material
nuclear fragmentation
cellular debris

Question 19

when do you see glomerular tuft necrosis

Answer 19

immune mediated glomerular injury

Question 20

scar/sclerosis of glomeruli

Answer 20

insudates (fluid passes through capillary layer and becomes trapped)
glassy, hyaline appearance