Glomerulonephropathies Flashcards
5 characteristics of nephrotic syndrome
- proteinuria > 3.5 g/day
- hypoalbuminemia
- hypogammaglobulinemia
- hypercoagulable state
- hyperlipidemia and hypercholesterolemia
Most common cause of nephrotic syndrome in children
Minimal change disease
Cancer associated with minimal change
Hodgkin lymphoma
Minimal change findings on H&E stain, EM, and IF
H&E: normal glomeruli
EM: effacement of foot processes due to production of cytokines
IF: negative
Symptoms of minimal change disease
Selective loss of albumin, periorbital edema following an upper respiratory tract infection or vaccination
Has an excellent response to steroids
Populations most likely to have focal segmental glomerulosclerosis
Hispanics and African Americans, also associated with HIV, heroin use and sickle cell disease
Focal segmental findings on H&E stain, EM, and IF
H&E: focal (some glomeruli) and segmental (involving only part of the glomerulus) sclerosis
EM: effacement of foot processes
IF: negative
Populations most likely to have membranous nephropathy
Caucasian adults, also associated with HBV and HCV, solid tumors (lung, breast, colon), SLE or drugs (NSAIDS and pencillamine, gold)
Membranous nephropathy findings on H&E stain, EM, and IF
H&E: thick glomerular basement membrane
EM: subepithelial deposits with spike and dome appearance
IF: immune complex deposition giving a granular appearance
Membranoproliferative, type I findings on H&E stain and IF
H&E: thick glomerular basement membrane often with tram track appearance due to basement membrane splitting by mesangial ingrowth
IF: immune complex deposition giving a granular appearance
Diseases associated with membranoproliferative, type I
HBV and HCV
Membranoproliferative, type II findings on IF
IF: intramembranous dense deposits
Association with membranoproliferative, type II
C3 nephritic factor: autoantibody that stabilizes C3 convertase, leading to over activation of complement, inflammation and low levels of circulation C3
Microscopic findings in diabetic glomerulonephropathy
Sclerosis of the mesangium with formation of Kimmelstiel-Wilson nodules
Microscopic findings in systemic amyloidosis affecting the kidney
Amyloid deposits in the mesangium, characterized by apple-green birefringence under polarized light after staining with Congo Red
4 characteristics of nephritic syndrome
- limited proteinuria < 3.5 g/day
- oliguria and azotemia
- periorbital edema and hypertension
- RBC casts and dysmorphic RBCs in urine
Acute poststreptococcal glomerulonephritis findings on H&E stain, EM, and IF
H&E: glomeruli enlarged and hypercellular
EM: subepithelial immune complex humps
IF: granular appearance due to IgG, IgM, and C3 deposition along GBM and mesangium
Symptoms of PSGN
Peripheral and periorbital edema, dark urine, and hypertension usually 2-3 weeks following infection
RPGN findings on EM, and IF
EM: crescents in Bowman’s space composed of fibrin and macrophages
IF: varies on disease
RPGN condition with linear IF pattern
Goodpasture syndrome: antibody against collagen in glomerular and alveolar basement membranes
RPGN conditions with granular IF pattern
PSGN or diffuse proliferative glomerulonephritis
RPGN conditions with negative IF pattern (pauci immune)
Wegener’s, microscopic polyangiitis, and Churg-Strauss
Differentiate between microscopic polyangiits and Churg-Strauss
Both are p-ANCA+
Granulomatous inflammation, eosinophilia, and asthma are only associated with Churg-Strauss
Berger’s disease findings on H&E stain, EM, and IF
H&E: mesangial proliferation
EM: mesangial IC deposits
IF: IgA-based IC deposits in mesangium
Symptoms of Berger’s disease
Usually presents in childhood with episodic gross or microscopic hematuria with RBC casts usually following mucosal infections
Mutation found in Alport syndrome and inheritance pattern
Inherited defect in type IV collagen, most commonly X-linked
Symptoms of Alport syndrome
Isolated hematuria, sensory hearing loss, and ocular disturbances
Diffuse proliferative glomerulonephritis findings on H&E stain, EM, and IF
H&E: “wire looping” of capillaries
EM: subendothelial and sometimes intramembranous IgG-based ICs often with C3 deposition
IF: granular appearance
