Glomerular Disease 6 Flashcards
A patient with abs against dsDNA and Sm antigen is diagnostic of what pathology?
SLE (systemic lupus erythematosus)
What type of GN is CLASS I of lupus nephritis?
minimal or no detectable abnormalities
What type of GN is Class II of lupus nephritis?
mesangial lupus glomerulonephritis
What type of GN is Class III of lupus nephritis?
focal proliferative glomerulonephritis
What type of GN is class IV of lupus nephritis?
diffuse proliferative glomerulonephritis
What type of GN is class V of lupus nephritis?
Membranous GN
What type of GN is Class VI of lupus nephritis?
Diffuse sclerosing
Wire loop lesions extensive sub endothelial deposits are seen in what class of lupus nephritis?
Class III, IV & V lesions
What do wire loop lesions indicate?
active disease
Wire loop lesions are due to depositions of what?
Ig deposition
Upon LM what is the appearance of the nephron suggestive of SLE?
thickened capillary loops
Upon IF what can be seen in a person with SLE?
IF: IgG, IgA, IgM, C3 …. Full House
Upon EM where would you see immune complex depositions in those with SLE?
sub epithelial
sub endothelial
mesangial immune complex deposits
What is the key to avoid organ damage in diabetes?
control of blood sugar
Is there increased GFR in early stages of diabetic GN?
yes
What are some characteristic features on microscopy of one with Diabetic GN?
- capillary basement membrane thickening
- nodular glomerulosclerosis
- Kimmelstiel Wilson disease
- Fibrin Caps: prominent accumulation of hyaline material in capillary loops
- Capsular Drops: hyaline material adherent to Bowman’s capsule
Describe the Pathogenesis of Diabetic Nephropathy.
Hyperglycemia is responsible for Diabetic nephropathy
- Mechanism for glomerular damage:
- Hyperglycemia – Increased protein kinase c activity in the endothelial cells - Production of profibrogenic molecules like transforming growth factor B (TGF-B) - leading to increased synthesis of type 4 collagen by endothelial cells - Basement membrane thickening and luminal narrowing – Ischemic necrosis and scarring in the glomeruli - Diabetic glomerulopathy
- Mechanism for vascular changes – Hyaline arteriolosclerosis
AGE (advanced glycation end products) products - bind to vessel wall and BM collagen - interfering with glomerular barrier function Hemodynamic effects - associated with glomerular hypertrophy - contributes to the development of glomerulosclerosis.
What condition is this lesion characteristic of and what is it?
Capsular drop lesion
Represents leakage of plasma proteins from the damaged capillaries
How does the gross image of the kidney appear in one with amyloidosis?
kidney generally enlarged: cortex is thickened by yellow-white deposits of amyloid white arrows and the blurry appearance of the medulla is also caused by amyloid infiltration (green arrows)
Describe renal appearance under microscopy of renal amyloidosis.
homogenous amorphous pink deposits of amyloid found in glomerulus, filling the tubules. Often found in the arteries.
Describe what is seen in this slide.
Congo red stain positivity (nephron)
Characteristic feature of renal amyloidosis
Describe what is being seen in this slide.
Congo red stains and polarized microscopy - Apple green birefringence positivity
Does senile systemic amyloidosis involve the kidney?
no
Example of primary causes of renal amyloidosis.
multiple myeloma - AL (amyloid light chain amyloidosis)
Example of secondary causes of renal amyloidosis.
chronic inflammatory disease - AA (amyloid A amyloidosis)
TB
rheumatic disease
Associations of hereditary amyloidosis.
lysozyme, ApoAII
