Glomerular Pathology

Question 1

What two things can the glomerulus leak?

Answer 1

Protein - proteinurea

Blood - haematuria

Question 2

What is nephrotic syndrome?

Answer 2

Nephrotic syndrome is a collection of symptoms due to kidney damage.`

It is classified by the triad of: proteinuria, oedema and hypoalbuminaemia

Question 3

What is nephritic syndrome?

Answer 3

Nephritic syndrome is also a collection fo symptoms due to kidney damage.

However, it is classified by haematuria, reduced GFR and hypertension

Question 4

What different parts of the kidney are effected in nephrotic/ nephritic syndrome?

Answer 4

Nephrotic = podocytes or basement membrane

Nephritic = wrong with vessel or endothelium as blood not get through.

If it affects the mesangium, then it could be a picture of nephrotic and nephritic syndrome.

Question 5

What are some common primary causes of nephrotic syndrome?

Answer 5

• Minimal Change Glomerulonephritis
• Focal segmental Glomerulosclerosis (FSGS)
• Membranous Glomerulonephritis

Question 6

What are some common secondary causes of nephrotic syndrome?

Answer 6

Diabetes
Amyloidosis
SLE

Question 7

What is minimal change glomerulonephritis?

Answer 7

Common in children / adolescence

Incidence reduces with increasing age

Heavy proteinuria or nephrotic syndrome

Responds to steroids

May reoccur

Usually no progression to renal failure.

Question 8

What causes minimal change GN?

Answer 8

Damage to podocytes - so no foot processes on the podocytes so they cannot absorb protein properly.

But, don’’t know what circulates in the blood to cause the podocytes to change.

Question 9

What is FSGS?

Answer 9

Nephrotic

Adults

Glomerulus starts to scar - glomerulosclerosis

Less responsive to steroids

Circulating factor damaging podocytes - know from transplant (different kidney will also leak protein)

Progressive to renal failure.

Don’t know if it is a separate condition to minimal change or if it is just different reaction as older?

Question 10

What is membranous glomerulonephritis?

Answer 10

Commonest cause of nephrotic syndrome in adults

Rule of 1/3 (1/3 better, 1/3 same, 1/3 worse)

Immune complex deposits

Autoimmune condition
May be secondary (associated with other pathologies e.g. lymphoma)

Question 11

What causes membranous glomerulonephritis?

Answer 11

It is caused by immune complexes binding to the podocytes and preventing filtration from occurring effectively.

The anti-PLA2R antibody is the most common cause.

Question 12

How can diabetes cause renal failure?

Answer 12

Causes progressive proteinuria - occurs early on.
This then progresses to renal failure,
It affects the small blood vessels, causes mesangial sclerosis and thickening of the basement membrane.

Question 13

What conditions can produce haematuria?

Answer 13

IgA Nephropathy

Thin glomerular basement membrane disease / Hereditary Nephropathy

Question 14

What conditions can cause nephritic syndrome?

Answer 14

Goodpasture syndrome (Anti-GBM disease)

Vasculitis

Question 15

What is IgA Nephropathy?

Answer 15

Commonest GN
Any age
Classically present eith visible / invisible haematuria
Relationship with mucosal (upper respiratory tract) infections
Variable histological features and course
+/- proteinurea
Significant proportion progress to renal failure
No effective treatment.

Question 16

What causes IgA nephropathy?

Answer 16

Too many cells or too much cytoplasm in mesangium.

Immune complex deposition

Question 17

What is thin GBM Nephropathy?

Answer 17

Hereditary 
Benign familial Nephropathy 
Isolated haematuria 
Thin GBM
Benign course

Question 18

What is Alport’s disease?

Answer 18

Hereditary 
X-linked 
Abnormal collagen IV
Associated with deafness
Abnormal appearing GBM
Progress to renal failure.

Question 19

What is goodpasture syndrome?

Answer 19

Anti-GBM disease

Relatively uncommon though clinically important

Rapidly progressive

Acute onset of severe nephritic syndrome - very unwell at presentation

Classically described association with pulmonary haemorrhage (smokers)

Autoantibody to collagen IV in basement membrane

Treatable by immunosuppressive and plasmapheresis if caught early.

Will probably need renal transplant

Question 20

What is vasculitis?

Answer 20

Group of systemic diseases - inflammation of blood vessels.

No immune complex / antibody deposition

Association with anti neutrophil cytoplasmic antibody (ANCA)

Nephritic presentation (RPGN)

Treatable if caught early.

Urgent biopsy service

Blindness, stoke symptoms, renal failure