Glomerular Pathology Flashcards
What constitutes the glomerular membrane?
Endothelium Basal lamina (connective tissue) Podocyte foot processes
What cells support capillaries?
Mesangial cells
What is the difference between primary and secondary glomerulonephritis?
Primary - only affects the glomerulus
Secondary - affects other parts of the body e.g. SLE, Wegeners
What is the aetiology of glomerulonephritis?
Immunoglobulin deposition
Some diseases may have no Ig deposition e.g. Diabetic glomerular disease
What are the presentations of glomerulonephritis?
Haematuria
Heavy proteinuria
Slowly increasing proteinuria
Acute renal failure
What are the main causes of haematuria?
UTI
Urinary tract stone
Urinary tract tumour
Glomerulonephritis
What does biopsy show on IgA glomerulonephritis?
Deposition of IgA with prominent mesangial cells
IgA increase proliferation of mesangial cells
In IgA glomerulonephritis, does it present with IgA in the urine?
No, IgA isnt filtered it is stuck within the mesangium
What type of cells are present in the urine of someone with IgA glomerulonephroitis?
RBC
What is the prognosis of IgA nephropathy?
Usually self limiting
Small percentage go onto chronic renal failure via continued deposition of IgA in the matrix
If someone presents with low albumin, where is the pathology?
Glomerulus
What is the pathology of membranous glomerulonephritis?
Thickened glomerular basement membrane
(IgG deposits in the membrane between basal lamina and podocyte. This causes the basal lamina to spike in order to surround and move the deposit)
How does membranous glomerulonephritis result in low serum albumin ?
IgG is too big to be filtered into the urine
IgG activates complement (C3) cascade which punches holes into the filter = allows albumin to leak into the urine = nephrotic syndrome
What is the prognosis for membranous glomerulonephrosis?
1/4 in chronic renal failure by 10 years
What can sometimes be the underlying cause of membranous glomerulonephritis?
Malignancy
What can be the cause of albumin slowly increasing in the urine over years?
Poor glycaemic control in diabetes
What is the pathology of diabetic nephropathy?
Glycated molecules are deposited in the basal lamina underlying the endothelium = thickened but leaky basement membrane
Glycated molecules are also deposited oin the mesangial matrix which causes compresses capillaries
In what type of glomerulonephropathy is Kimmelsteil-wilson lesions found and what are they?
Gross excess of mesangial matrix forming nodules
Found in diabetic nephropathy
What is the prognosis for diabetic nephropathy?
Inevitable decline if poor glycaemic control and its well established
What is the pathology of crescentic glomerulonephritis?
Crushed glomerulus
Crescent of macrophages around glomerular tuft
What are 3 causes of a crescentic glomerulonephritis?
Granulomatosis with polyangiitis (Wegener’s granulomatosis)
Microscopic polyarteritis
Antiglomerular basement membrane disease
What is granulomatosis wut polyangiitis and what pattern of pathology does it cause?
also known as Wegener’s
Its a form of vasculitis (inflammation of the vessels) affecting the kidneys, nose and lungs
Shows a crescentic glomerulonephritis
What further tests can you carry out if you suspect Wegeners?
ANCA
Anti neutrophil cytoplasmic antibodies
What is the prognosis of Wegeners disease?
If left untreated = fatal
If treated = 75% remission
What is the treatment for wegeners glomerulonephritis?
Cyclophosphamide
what are the 4 main presentations of glomerular disease?
haematuria
heavy proteinuria
slowly progressing proteinuria
acute kidney injury
what glomuerular disease presents with proteinuria?
membranous glomuerlonephritis
what glomerular disease presents with haematuria?
IgA glomerulonephritis
what glomerular disease causes acute kidney injury?
crescentic glomerulonephritis
This pattern of glomerular injury is caused by many diseases such as;
- glomerulomatosis with polyangitis (Wegener’s disease)
- microscopic polyarteritis
- anti-glomerular basement membrane disease
what is the prognosis for Wegener’s disease (granulomatosis with polyangitis)?
6 months if untreated
75% remission if treated
5 yr survival 80%
what is the pathological cause of proteinuria?
podocyte damage in the glomerulus
podocytes surround capillaries and are a barrier for filtration
damage to the podocytes disrupts the barrier allowing large proteins such as albumin to be filtered
