glomerular nephritis + nephrosis

Question 1

group A strep infection (pharyngitis, impetigo) 1-3 wks before glomerulonephritis
children
brown urine “coca-cola”: heme pigment from hematuria
↓ C3 (activated and destroys BM)
↑ anti-streptolysin O (prove recent strep pharyngitis)
↑anti-DNase B (prove recent pharyngitis + impetigo)

Answer 1

poststreptococcal glomerulonephritis

Question 2

type III hypersensitivity reaction: circulating antibodies bind to streptococcal antigens → immune complexes deposit in glomerulus

Answer 2

poststreptococcal glomerulonephritis

Question 3

pros/cons of antibiotics for group A strep infection

Answer 3

DON’t prevent: glomerulonephritis

prevent: rheumatic fever + rheumatic heart disease

Question 4

renal bx of poststreptococcal glomerulonephritis

Answer 4

LM: hypercellular glomeruli, neutrophils
IF: “lumpy-bumpy” deposits of IgG/IgM IC, C3 deposited along GBM and mesangium
EM: “subepithelial humps”

Question 5

associated with Henoch-Schonlein purpura (vasculitis)
triad:
palpable purpua on butt + legs
arthralagia
ab pain - intestinal hemorrhage
renal disease

Answer 5

IgA nephropathy (berger disease) - not beurger disease = vasculitis (young, male smoker)

Question 6

renal bx of IgA nephropathy

Answer 6

↑ serum IgA: IgA IC deposited in mesangium

proliferation of mesangial cells

Question 7

“lumpy-bumpy” deposits of IgG/IgM IC

“subepithelial humps”

Answer 7

poststreptococcal glomerulonephritis

Question 8

↑ serum IgA
hematuria
RBC casts
flares after infection (URI) - also occurs in Henoch-Schonlein purpura

Answer 8

IgA nephropathy

Question 9

defect in type 4 collagen (in BM)

Answer 9

alport syndrome

Question 10

renal bx of alport syndrome

Answer 10

splitting of BM

Question 11

triad:
can’t see: cataracts
can’t pee: nephritis
can’t hear high C: deafness (high frequency hearing loss)

Answer 11

alport syndrome

Question 12

differential diagnosis for rapidly progressive glomerulonephritis (crescentic glomerulonephritis):
crescent shaped deposits in glomeruli (fibrin, complement)

Answer 12

goodpasture syndrome
granulomatosis with polyangiitis
microscopic polyangiitis
lupus

Question 13

type II HSR (ab against GBM)

Answer 13

goodpasture syndrome

Question 14

linear IgG on IF (abs against GBM)

Answer 14

goodpasture syndrome

Question 15

kidney + lung disease

Answer 15

goodpasture syndrome: hematuria + hemoptysis

granulomatosis with polyangiitis (GPA): hematuria + lungs + upper airway (sinus, hard palate), +c-ANCA (PR3-ANCA)

Question 16

c-ANCA (PR3-ANCA) + crescent shaped deposits in glomeruli (fibrin, complement)

Answer 16

granulomatosis with polyangiitis

Question 17

p-ANCA (MPO-ANCA) + crescent shaped deposits in glomeruli (fibrin, complement)

Answer 17

microscopic polyangiitis

Question 18

most severe form of lupus nephritis

Answer 18

diffuse proliferative glomerulonephritis

Question 19

anti-dsDNA in mesangium + subendothelial associated with

Answer 19

lupus nephritis

Question 20

renal bx of diffuse proliferative glomerulonephritis (lupus nephritis)

Answer 20

LM:dense, pronounced GBM (due to anti-dsDNA) “wire-looping”

Question 21

wire-lupus

Answer 21

“wire-looping” in lupus nephritis

Question 22

diffuse proliferative glomerulonephritis may present as

Answer 22

nephrotic syndrome (heavy proteinuria >3.5 g/day)

Question 23

renal bx:
flattening or effacement of podocyte foot processes → more permeable to albumin
but relatively NORMAL

Answer 23

minimal change disease

Question 24

most common cause of nephrotic syndrome in children

Answer 24

minimal change disease

Question 25

children
triggered by infections or immunization
hypoalbuminemia
edema
tx: CS (give empirically w/o biopsy if fit clincial picture)

Answer 25

minimal change disease

Question 26

most common cause of nephrotic syndrome in adults

Answer 26

focal segmental glomerulosclerosis

Question 27

nephrotic syndrome in: african americans, latinos adults
HIV patients
becoming most common in US

Answer 27

focal segmental glomerulosclerosis

Question 28

renal bx:

focal (

Answer 28

focal segmental glomerulosclerosis

Question 29

most common nephrotic syndrome cause in:

caucasian adults

Answer 29

membranous nephropathy

Question 30

renal bx:
thickening of BM +
“subepithelial” immune deposits along BM → creates “BM spike + subepithelial dome” appearance

Answer 30

membranous nephropathy

Question 31

nephrotic syndrome caused by lupus

Answer 31

membranous nephropathy

membranoproliferative glomerulonephritis

Question 32

hematuria (nephritic sx)
heavy proteinuria (nephrotic sx)

Answer 32

membranoproliferative glomerulonephritis

Question 33

nephritic syndrome caused by lupus

Answer 33

diffuse proliferative glomerulonephritis

Question 34

renal bx:
membrane proliferates “tram-track” GBM
“subendothelial humps” (vs subepithelial humps poststreptococcal GN
mesangial cell growth: can grow between tracks

Answer 34

membranoproliferative glomerulonephritis

Question 35

causes of membranoproliferative glomerulonephritis

Answer 35

hep B/C
lupus
subacute bacterial endocarditis

Question 36

↑ blood glucose → nonenzymatic glycosylation:

glucose binds to Hb, blood vessels, glomerular BM (thick), arterioles (mesangium prolferates)

Answer 36

diabetic nephropathy

Question 37

microscopic albuminuria

can progress to nephrotic syndrome

Answer 37

diabetic nephropathy

Question 38

renal bx:
thick GBM
expansion of mesangium
kimmelstiel-wilson nodule (round, pink acellular nodule in glomeruli)

Answer 38

diabetic nephropathy

Question 39

abnormal amyloid proteins deposited
kidney most commonly involved in systemic amyloidosis
associated with multiple myeloma

Answer 39

amyloidosis

Question 40

renal bx:

expansion of mesangium + amyloid deposits

Answer 40

amyloidosis

Question 41

congo red stain: amyloid protein bright green under polarized light (apple green birefringence)

Answer 41

amyloidosis