Glomerulonephritis and nephritic syndrome

Question 1

what do we see in GN and nephritic syndrome and what do they mean?

Answer 1

1. hematuria- blood in urine
2. oliguria- reduced GFR
3. azotemia- elevated BUN/creatinine
4. HTN

Question 2

Glomerular hematuria looks like

Answer 2

muddy brown blood- “coca-cola”

Question 3

urine analysis in GN can look like either _____ and ________

Answer 3

WBC/cellular casts and RBC casts/dysmorphic RBC

Question 4

pathogenesis of glomerulonephritis

Answer 4

1. glomerular injury
2. influx of inflammatory cells
3. glomerular inflammation

Question 5

immune mediated glomerular injury steps

Answer 5

1. immune complex deposition, ab, and activated neutrophils - with/without complement activation
2. influx of inflammatory cells and remodeling GBM
3. Glomerular injury/symptoms

Question 6

Glomerulonephritis can be caused by (5)

Answer 6

1. acute post-streptococcal/postinfectious
2. Membranoproliferative
3. Crescentic
4. IgA nephropathy/ Henoch-Schonlein purpura
5. SLE

Question 7

acute post-streptococcal/postinfectious

1. caused by
2. most commonly after
3. pathogenesis
4. Gn presents

Answer 7

1. caused by deposition of immune complexes
2. most common after- strptococcal pharyngitis (group A beta-hemolytic Strep)
3. pathogenesis: - subendothelial antigen (ag) depostion during infection anad antibody (ab) delivery during immune phase - subendothelial deposition of circulating Ag-Ab complexes
4. GN presents 1-3 weeks after infection

Question 8

acute post-streptococcal GN is a prototype for acute post-infectious GN:

1. other infections include
2. most frequent in
3. treatment?
4. recovery?

Answer 8

1. • impetigo - endocarditis - abscess -osteomyelitis
2. most frequent in children
3. no specific treatment
4. most children recover without complications within 3 months

Question 9

Membranoproliferative GN:

1. _____ glomerular inflammation
2. caused by
3. pt. presents with
4. results in
5. most cases are secondary to
6. Type I/ primary MPGN is
7. presents in ______ with a nephritic presentation with _____ complement

Answer 9

1. chronic glomerular inflammation
2. caused by deposition of immune complexes in subendothelium and in the GBM
3. pt. presents with chronic inflammatory or autoimmune disorders
4. results in GBM abnormalities and inflammatory changes
5. most cases are secondary to hepatitis
6. Type I/ primary MPGN is idiopathic
7. presents in young adults with a nephritic presentation with low complement

Question 10

Cresentic Gn:

1. what is the crescent signify
2. indicates
3. patient presents with

Answer 10

1. it is a finding not a diagnosis
2. indicate severe glomerular inflammation with destruction of glomerular capillary wall
3. clinically the patient presents with rapid loss of kidney function- RPGN

Question 11

Anti-GBM disease:

1. autoimmune disorder with
2. etiology
3. trigger
4. if ab against GBM cross reacts with alveolar GM in the lung it is

Answer 11

1. autoimmune disorder with circulating anti-GBM ab
2. etiology is ?
3. trigger viruses/toxins in susceptible individual
4. if ab against GBM cross reacts with alveolar GM in the lung it is goodpasture syndrome (pt. will present with hemoptysis)

Question 12

if negative pauci-immune

Answer 12

granulomatosis with polyangitis- Wegner’s

Question 13

Pauci-immune GN:

1. most common cause of
2. Ab to
3. ANCA activates _______ in the capillaries causing endothelial injury and vasculitis (inflammation of the blood vessel)

Answer 13

1. most common cause of crescentic GN
2. Ab to neutrophils cytoplasmic antigens (ANCA)
3. ANCA activates neutrophils in the capillaries causing endothelial injury and vasculitis (inflammation of the blood vessel)

Question 14

IgA Nephropathy and Henoch-Schonlein Purpura (HSP)

1. ____ deposition disease; when it is in the systemic capillaries and vessels it is ____ and when it is in the glomeruli only it is ________
2. most common
3. age
4. recurrent

Answer 14

1. IgA deposition disease; when it is in the systemic capillaries and vessels it is HSP and when it is in the glomeruli only it is IgA nephropathy- Berger disease
2. most common primary GN in the world: 10% in the USA and 40% in Asia
3. age: early childhood and adolescence
4. recurrent microscopic or gross hematuria

Question 15

Lupus Nephritis:

1. what is wrong
2. which organ is involved 50%
3. true or false: morphologic and clinical presentation is variable

Answer 15

1. immune complex deposition in glomeruli/vessels
2. Kidney is involved 50%
3. True

Question 16

Answer 16

pt with acute post-streptococcal-postinfectious GN notice the cellular glomerulous

Question 17

Answer 17

pt with acute post-streptococcal-postinfectious GN notice the inflamed glomerulous

Question 18

Answer 18

pt with acute post-streptococcal-postinfectious GN- IF shows granular deposits of IgG and complement C

Question 19

Answer 19

pt with acute post-streptococcal-postinfectious GN- EM notice that the subepithelial deposits are under the podocytes

Question 20

Answer 20

pathogenesis of acute post-streptococcal-postinfectious, MPGN and immune complex deposition related GN

Question 21

Answer 21

biopsy of a pt with membranoproliferative GN

Question 22

Answer 22

pt with membranoproliferative GN notice the thick wall of the capillary and the inflammatory cells

Question 23

Answer 23

pt with membranoproliferative GN notice the thick and double contours of rhe GBM

Question 24

Answer 24

pt with membranoproliferative GN- chronic depositions of IgG and complement C3

Question 25

Answer 25

pt with membranoproliferative GN notice the subendothelial electron dense deposits

Question 26

Answer 26

Crescentic GN

Question 27

Answer 27

## Footnote Ig linear-smoky or vapor like- seend in Anti- GBM disease or goodpasture syndrome

Question 28

Answer 28

IgG granular seen in immune complex deposition

Question 29

Answer 29

ANCA positive vasculitis- no immunoglobin

Question 30

Answer 30

against collagen iv causing inflammatory cells to enter

Question 31

Answer 31

immune complex deposition related Gn EM and also seen in Lupus Nephritis

Question 32

Answer 32

pathogenesis of pauciimmune GN notice the neutrophils that are granular and bilobar- granules cntain peroxidase and proteinases which when Ab attack activates them which causes destruction of capillaries and endothelium leading to injury

Question 33

Answer 33

HPS

Question 34

Answer 34

IgA nephropathy notice the increased mesengial matrix in response to the IgA deposition

Question 35

Answer 35

IgA nephropathy

Question 36

Answer 36

IgA nephropathy notice the electron dense deosits corresponding to IgA depositions

Question 37

Answer 37

Lupus nephritis

Question 38

Answer 38