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Glomerular Dx Flashcards

1
Q

Do we know a lot about the etiologic factors involved in primary glomerulonephritis

A

No

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2
Q

What are the different forms of antibody mediated glomerular injury

A

In situ immune complex deposition in the glomerulus

Circulating immune complex deposition

Antibody to glomerular cells

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3
Q

Two forms of antibody mediated glomerular injury

A

Antibody reaction with intrinsic glomerular antigens

Antibody reaction with extrinsic antigens in the glomerulus from the circulation

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4
Q

Two forms of antibody reaction with intrinsic glomerular antigens

A

Masugi/ nephrotoxic nephritis

Heymann nephritis

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5
Q

What is masugi nephritis

A

Antibody reaction against intrinsic fixed normal glomerular basement membrane antigen

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6
Q

In which condition do you see anti-glomerular basement membrane glomerulonephritis which is human counterpart of masugi nephritis

A

Goodpasture syndrome

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7
Q

What is heymann nephritis

A

Antibody reaction against antigen complex (megalin) located on basal surface of visceral epithelial cell

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8
Q

What human condition resembles heymnn nephritis

A

Human membranous glomerulonephritis with an antigen that is the homologue of Megalin called m-type phospholipase A2 receptor

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9
Q

What is antibody reaction with extrinsic antigens in the glomerulus from the circulation

A

Antibodies reacts with previously planted non-glomerular antigens which interact with various intrinsic component of the glomerulus

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10
Q

What type of planted antigens can you find in antibody reaction with extrinsic antigens in the glomerulus from circulation

A 
Bacteria
virus
 parasites products 
drugs 
large aggregate proteins like immunoglobulins ,DNA,  
 immune complexes
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11
Q

What do you see in immunofluorescence microscopy of antibody reaction with planted antigens in the glomerulus

A

Granular or heterogeneous pattern of immunoglobin deposition on mesangium, capillary wall or both

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12
Q

How is there disease in circulating immune complex deposition in glomerulus

A

Trapping of circulating antigens antibodies complexes in glomeruli due to physical chemical properties of complexes and hemodynamics

leads to complement activation leading to injury

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13
Q

 in circulating immune complex deposition What do you see in the immunofluorescence microscopy

A

Granular deposits along the glomerular basal membrane , the mesangium , rarely in subepithelium

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14
Q

How do antibodies to glomerular sells cause injury to glomerulus

A

Antibodies to mesangeal cells leads to cytolysis with mesangeal cell proliferation

Antibodies to endothelial cells cause damage and capillary thrombosis

Antibodies to epithelial cell glycoproteins result in polyanion loss and proteinuria

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15
Q

What immune cell is involved in cell mediated glomerular injury

A

T cells

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16
Q

Is it possible to have alternative complement activation in certain types of human glomerulonephritis

A

Yes

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17
Q

How can glomerular Cells participate in their injury

A

Stimulate some cytokines like TGF beta , FGF , which stimulates production of extracellular matrix leading to development of glomerulosclerosis

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18
Q

C What are the factors affecting glomerular localization

A

Molecular charge
molecular size shape and deformability
glomerular hemodynamics
Mesangeal function

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19
Q

What makes the outer membrane and glomerular basement membrane negatively charged

A

Heparan sulfate

Sialoglycoprotein podocalyxin

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20
Q

How does the negative charge play a role in glomerulus localisation

A

Attracts cations macromolecules
Repel negative onions
Neutral charge molecule stay in mesangium

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21
Q

How are large complex cleared by the glomerulus

A

Through the mononuclear phagocyte system

22
Q

What mediates size dependent filtration

A

Type 4 collagen in the basement basement membrane and slits pores between podocytes

23
Q

Where do intermediate size molecules go in glomerulus

A

Sub endothelial

24
Q

Where do small size molecules go in glomerular

A

Intramembranous

Sub epithelium

25
Function of mesangeal sells
Phagocytosis in basement membrane
26
What system mediators can cause damage to the basement membrane of the glomerulus
``` Complement activation Activation of coagulation system Leucocytic infiltration reactive oxygen species nephritic factors ```
27
How does complement activation codes glomer basement membrane injury
Cell lysis stimulation of mesangeal cell to produce oxidants, proteases, cytokines, Eicosanoids, nitric oxide and growth factors
28
How does activation of coagulation system cause injury of basement membrane in glomerulus
Fibrin deposition in lumen in capillary walls which escape into Bowman space promoting proliferation of parietal epithelial cells which entraps platelets that degranulate them leading to free vasoactive peptide
29
Are all the mediator of injury involved in every case
No
30
When can you say that there is progression to chronic renal failure
When there’s destruction of enough functioning nephrons which reduces glomerular filtration rate to 50% or less than normal
31
How do glomeruli survive renal failure at first
Compensatory hypertrophy Increased single nephron GFR and GBF Capillary hypertension
32
What are the consequences of endothelial damage occurring in renal failure
Increased capillary permeability to proteins Protein and fibrin deposition -> glomerular sclerosis Less functioning nephrons Viscous cycle of glomerulosclerosis
33
Why is there tubule interstitial damage in renal failure
Sclerotic glomeruli -> ischemia of tubules downstream Acute and chronic inflammation in interstitum Damage / loss of peritubular capillary blood supply Direct injury to tubularccells Activation of tubular cells -> release of adhesion molecules , pro inflammatory cytokines , chemokines , GF
34
What are the different histologic patterns seen in glomerular injur y
Hypercellularity Thickening of GBM Hyalinization and sclerosis
35
Causes of hypercellularity in glomerular injury
Mesangeal cell proliferation Leucocyte infiltration (neutrophils , mononuclear cells ) Parietal epithelial cells lining bowman’s space proliferation ->crescent shape mass of cells in urinary space which compresses glomerular tuft
36
How do you see on light microscopy thickening of GBM
By seeing thickening of capillary walls
37
How do you see thickening of GBM under electron microscope
Large hump shaped deficits under visceral epithelium Smaller deposits on the basement membrane, Subendothelial or in the mesangi Thickening of the basement membrane proper Swelling of damaged endothelial or epithelial cells Mesengeal interposition
38
What is Hyalinization and sclerosis
Accumulation of homogeneous , eosinophilia material in glomerulus with obliteration of glomerular structural detail
39
What do you under electron microscopy in case of Hyalinization and sclerosis
Extracellular material deposit made up of plasma protein and GBM material , mesangeal matrix
40
Diffuse lesion in glomerulus
Involves all glomeruli
41
Focal lesion of glomerulus
Some glomuleri affected
42
Global injury to glomerulus
Whole glomerulus affected
43
Segmental injury
Parts of glomerulus affected
44
Mesangeal injury
Mainly mesangeal portion of glomerulus
45
Proliferative changes in the glomerulus
Hyper cellularity of glomerulus with proliferation of indigenous cells and recruitment of leukocytes following complement activation
46
What is membranous change in glomerulus
Thickening of peripheral capillary loops due to basement membrane expansion
47
What are membranous proliferative changes in the glomerulus
Combination of hyper cellularity and basement membrane thickening
48
What are crescentic changes in glomerulus
Florid proliferation of Pareto cells lining the Bowmans capsule and macrophages which can compress the glomerulus
49
Manifestation of glomerular disease
``` Asymptomatic proteinuria nephrotic syndrome hematuria nephritic syndrome rapidly progressive glomerulonephritis chronic renal failure ```
50
Why is there a proteinuria in glomerular injury
Increased permeability to protein in glomerulus

Renal (16 decks)

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