Glomerular Diseases Flashcards
Systemic diseases that may lead on to glomerulonephritis…
Vascular – HTN, PAN
Metabolic – Diabetes
Hereditary – Alport, Fabry
Autoimmune – SLE
Five glormerular syndromes
Acute Nephritis Rapidly progressive glomerular nephritis Nephrotic Syndrome Chronic Renal Failure Asymptomatic Hematuria/Proteinuria
Four Potential hallmarks of glomerular injury
No Histological Alteration
Hypercellularity
Basement Membrane Thickening
Hyalinization and Sclerosis
Glomerular disease marked by no histological alteration
Minimal Change Disease – Visceral epithelial cells are injured with loss of foot processes leading to nephrotic syndrome
What happens in glomerular disease processes marked by hypercellularity
Could be immune infiltrates
Could be mesangial, endothelial, or epithelial prolif.
If rapidly progresing – form crecents
What happens in glomerular disease processes marked by basement membrane thickening
Thickening of Capillary Walls
Deposition of Material within BM
Amorphous Electron-Dense Material (precip. proteins)
IGs, complexes, fibrin, amyloid, cryo
What happens in glomerular disease processes marked by hyalinization and sclerosis
- Accumulation of homo., eosinoph. material precipitated from plasma proteins
- Increased BM, Mesangial Matrix
- Obliteration of Structural detail of Glom. tuft.
Important details for in situ immune complex fomation/deposition that damages the glomer.
- Ab directed against intrinsic fixed antigens that are components of the BM proper (ex. Goodpasture’s)
- Homogenous, Diffuse Linear Pattern by IF
Important details for glomerular damage associated with antibodies against planted antigens
- Non-glomerular antigens
- Assoc. w/ DNA, Bacterial Products, Large Aggregated Proteins, Drugs (Mostly cationic molecules)
- Granular/Heterogenous Pattern of Ig deposit
Important details for glomerular damage associated with circulating immune complex nephritis
- Immune complexes precipitate in glomeruli
- SLE, HEP B, HEP C, Tumor Antigens
- Leads to Leukocytic Infil. -> Endo./Mesangial Prolif
- IC in mesangium or btw BM and endo (Granular Deposits)
Important details for glomerular damage associated with antibodies to glomerular cells
Mesangial, endothelial cell antigens -> Injury + Thrombosis
Can cause proteinuria
Important details for glomerular damage associated with cell-mediated immunity
Sensitized nephrogenic T cells with activated mps + lympho
Experimentally assoc. w/ crecenteric GN
Acute proliferative glomerulonephritis results from..
acute deposition, as seen in post-streptococcal glomerulonephritis.
Effects of acute inflammatory rxns
Acute nephritis w/ hematuria + RBC Casts, azotemia, oliguria, mild HTN
Acute renal failure is associated with ______ GN
Rapidly Progressive (Crecentic)
Three types of glomerular disease associated with nephrotic syndrome
Membranous GN
Minimal Change Disease
Focal Segmental GN
Hallmark of persistent GN
Focal segmental glomerulosclerosis w/ proteinuria
Caused by compensatory hypertrophy of remaining glomeruli
How does glomerular sclerosis happen?
Endothelial and epithelial cell injury, Increased glom. permeability to proteins, accumulation of proteins in the mesangial matrix, fibrin deposition
Potential causes of GN –> tubulointerstitial damage
Chronic Ischemia, Immune Rxn to Shared Antigens, Phos. or Ammonia Retention, Proteinuria
Important details on Minimal Change Disease
No changes on light micro, loss of foot processes on e-
Lipid Accumulates in the tubule cels
No Immune Deposits
Massive Selective (Albumin) Proteinuria
Important details on membranous GN?
Chronic Ag-Ab mediated disease
Diffuse thickening of Glom. cap wall
Irregularly dense deposits btw BM and Epithelial Cells
Markedly thickened membrane
Important details on focal segmental glomerulonephritis
- Collapse of BM, increase in Matrix. Deposition of Hyaline masses. Lipid Droplets + Foam cells. Hyaline thickening of afferents.
- Non-involved glomeruli either appear normal or show increased mesangial matrix.
Disease marked as mixed nephritic and nephrotic syndrome
Menbranoproliferative GN
What happens in Membranoproliferative GN
- Proliferation of glom cells and leukocytic infiltration
- Large, Hypercelllar glomeruli, prolif mesangial matrix
- Two Types
- Can progress rapidly to progressive GN with crescents
