Glomerular Disease 6

Question 1

A patient with abs against dsDNA and Sm antigen is diagnostic of what pathology?

Answer 1

SLE (systemic lupus erythematosus)

Question 2

What type of GN is CLASS I of lupus nephritis?

Answer 2

minimal or no detectable abnormalities

Question 3

What type of GN is Class II of lupus nephritis?

Answer 3

mesangial lupus glomerulonephritis

Question 4

What type of GN is Class III of lupus nephritis?

Answer 4

focal proliferative glomerulonephritis

Question 5

What type of GN is class IV of lupus nephritis?

Answer 5

diffuse proliferative glomerulonephritis

Question 6

What type of GN is class V of lupus nephritis?

Answer 6

Membranous GN

Question 7

What type of GN is Class VI of lupus nephritis?

Answer 7

Diffuse sclerosing

Question 8

Wire loop lesions extensive sub endothelial deposits are seen in what class of lupus nephritis?

Answer 8

Class III, IV & V lesions

Question 9

What do wire loop lesions indicate?

Answer 9

active disease

Question 10

Wire loop lesions are due to depositions of what?

Answer 10

Ig deposition

Question 11

Upon LM what is the appearance of the nephron suggestive of SLE?

Answer 11

thickened capillary loops

Question 12

Upon IF what can be seen in a person with SLE?

Answer 12

IF: IgG, IgA, IgM, C3 …. Full House

Question 13

Upon EM where would you see immune complex depositions in those with SLE?

Answer 13

sub epithelial
sub endothelial
mesangial immune complex deposits

Question 14

What is the key to avoid organ damage in diabetes?

Answer 14

control of blood sugar

Question 15

Is there increased GFR in early stages of diabetic GN?

Answer 15

yes

Question 16

What are some characteristic features on microscopy of one with Diabetic GN?

Answer 16

1. capillary basement membrane thickening
2. nodular glomerulosclerosis
3. Kimmelstiel Wilson disease
4. Fibrin Caps: prominent accumulation of hyaline material in capillary loops
5. Capsular Drops: hyaline material adherent to Bowman’s capsule

Question 17

Describe the Pathogenesis of Diabetic Nephropathy.

Answer 17

Hyperglycemia is responsible for Diabetic nephropathy

1. 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

2. 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.

Question 18

What condition is this lesion characteristic of and what is it?

Answer 18

Capsular drop lesion

Represents leakage of plasma proteins from the damaged capillaries

Question 19

How does the gross image of the kidney appear in one with amyloidosis?

Answer 19

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)

Question 20

Describe renal appearance under microscopy of renal amyloidosis.

Answer 20

homogenous amorphous pink deposits of amyloid found in glomerulus, filling the tubules. Often found in the arteries.

Question 21

Describe what is seen in this slide.

Answer 21

Congo red stain positivity (nephron)

Characteristic feature of renal amyloidosis

Question 22

Describe what is being seen in this slide.

Answer 22

Congo red stains and polarized microscopy - Apple green birefringence positivity

Question 23

Does senile systemic amyloidosis involve the kidney?

Answer 23

no

Question 24

Example of primary causes of renal amyloidosis.

Answer 24

multiple myeloma - AL (amyloid light chain amyloidosis)

Question 25

Example of secondary causes of renal amyloidosis.

Answer 25

chronic inflammatory disease - AA (amyloid A amyloidosis)
TB
rheumatic disease

Question 26

Associations of hereditary amyloidosis.

Answer 26

lysozyme, ApoAII