Glomerulus Pathology

Question 1

What pathology can occur at the kidney?

Answer 1

1. Blockage: Renal failure and decreased GFR.
2. Leak: proteinuria/haematuria (one or both).
3. Nephrotic Syndrome.
4. Nephritic Syndrome.

Question 2

What is the site of Glomerular injury in Nephrotic Syndrome (Proteinuria)?

Answer 2

Podocyte/subepithelial damage.

Question 3

What are the 3 primary causes of Nephrotic Syndrome?

Answer 3

1. Minimal Change Glomerulonephritis.
2. Focal Segmental Glomerulosclerosis.
3. Membranous Glomerulonephritis.

Question 4

What are 3 second causes of Nephrotic Syndrome?

Answer 4

1. Diabetes mellitus.
2. Amyloidoses.
3. Systemic Lupus Erythematous.

Question 5

What is Minimal Change Glomerulonephritis?

Answer 5

A primary cause of Nephrotic Syndrome occurring in childhood/adolescence. The patient will have heavy proteinuria as a result of a circulating factor destroying the podocytes of the glomerulus.
There is NO immune complex deposition.
The patient will respond well to steroids.
The MCG can reoccur.
There usually is no progression into renal failure.

Question 6

What is Focal Segmental Glomerulosclerosis?

Answer 6

A proteinuria producing glomerulonephritis that occurs in adults. It is the result of an unknown circulating factor in the blood damaging podocytes. There is subsequent scarring (Glomerulosclerosis) of the glomerulus and thus it is progressive to renal failure.
It does not respond as well to steroids as MCG does.

Question 7

What is Membranous Glomerulonephritis?

Answer 7

A primary cause of nephrotic syndrome and the most common in adults.
There is immune system deposits of IgG antibody. It is probably autoimmune and may be secondary to other associated pathologies like lymphoma.
There are subepithelial deposits.
Due to Phospholipase A2 receptor antigen.

Question 8

What occurs in diabetes mellitus (a secondary nephrotic disease)?

Answer 8

1. Progressive proteinuria.
2. Progressive renal failure.
3. Microvascular damage.
4. Mesangial sclerosis-> nodules.
5. Basement membrane thickening.

Question 9

What 3 conditions can cause Haematuria?

Answer 9

1. IgA Nephropathy.
2. Think Glomerular Basement Membrane Disease.
3. Alport’s.

Question 10

What 2 conditions can cause Nephritic Syndrome?

Answer 10

1. Anti-Glomerular Basement Membrane Disease.

2. Vasculitis.

Question 11

What is Nephrotic Syndrome a triad of?

Answer 11

1. Proteinuria.
2. Microalbuminuria.
3. Oedema.

Question 12

What is Nephritic Syndrome a triad of?

Answer 12

1. Haematuria.
2. High blood pressure.
3. Decreased GFR.

Question 13

What is IgA Nephropathy?

Answer 13

It is the commonest cause of glomerulonephritis and occurs at any age.
Patients usually present clinically with visible or invisible haematuria.
IgA from mucosal infections damages kidneys by depositing in mesangial cells that support the kidney. The IgA contain immune complexes.
There may be proteinuria too.
Lots of people progress to renal failure.
There is no effective treatment.

Question 14

Give 2 examples of hereditary Nephropathies.

Answer 14

1. Thin Glomerular Basement Membrane Nephropathy.

2. Alport.

Question 15

What is Thin Glomerular Basement Membrane Nephropathy?

Answer 15

A benign familial nephropathy with isolated haematuria as a result of thin GBM.

Question 16

What is Alport’s Syndrome?

Answer 16

An X-linked disorder causing abnormal collagen IV. It is associated with deafness and abnormal appearing GBM as collagen IV is important for Basement membranes. Is can progress to renal failure. The GBM is split and laminated.

Question 17

What is Anti-Glomerular Basement Membrane Nephropathy?

Answer 17

A common cause of nephritic syndrome that is relatively uncommon but very clinically important. It is rapidly progressive with presentation of severe nephritic syndrome. It is classically associated with (in smokers) pulmonary haemorrhage. It is the result of an autoantibody to collagen IV in Basement membranes. There is IgG deposition.
It is treated with immunosuppression and plasmapheresis.

Question 18

What is Vasculitis?

Answer 18

A common cause of nephritic syndrome. It is a group of systemic disorders but there is NO immune complex/antibody deposition.
It is associated with ANCA. It is treatable if caught early. Urgent biopsy service should be done.
It causes segmental crescent necrosis.
The ANCA binds to a neutrophil and effects the endothelium of the blood vessels.
Affects small arterioles in lungs and kidney-> pulmonary-renal Syndrome.
Symptoms of fatigue, arthralgia, myalgia, weight loss.

Question 19

What is a Focal Pathology?

Answer 19

Affect 50% of the glomerulus in light microscopy.

Question 20

What us Diffuse Pathology?

Answer 20

More than 50% of light microscopy is involved.

Question 21

What is Segmental Pathology?

Answer 21

Part of glomeruli tuft is involved.

Question 22

What is Global Pathology?

Answer 22

Involves the entire glomeruli tuft.

Question 23

What is Membranous pathology?

Answer 23

Thickening of the glomeruli capillary wall.

Question 24

What is a Proliferative pathology?

Answer 24

Increased number of cells in the glomerulus, either proliferating glomeruli cells of infiltrating circulating inflammatory cells.

Question 25

What is a Crescent pathology?

Answer 25

Accumulation of mononuclear cells within the Bowman’s capsule, compressing the capillary tuft. Associated with severe disease.

Question 26

What is a Glomerulosclerosis pathology?

Answer 26

Segmental/global capillary collapse, assuming no or little filtration across thee sclerotic area.

Question 27

What is glomerulonephritis pathology?

Answer 27

Any condition associated with inflammation of the glomerular tuft.