Goljan renal

Question 1

Lupus

Answer 1

antibody = anti-dsDNA
antigen = DNA 

deposit in glomerular capillaries

Question 2

If immune complex too big,

Answer 2

then stuck underneath endothelial cell nucleus and can’t get thru basement membrane to podocyte

Question 3

post strep GN

bacterial antigen + antibody

Answer 3

small antibodies can go thru basement membrane and deposit on epithelial side = subepithelial deposit

Question 4

how to visualize immune complex

Answer 4

electron microscopy

Question 5

Goodpasture’s on EM

Answer 5

linear pattern due to anti-GBM antibodies

type 2

Question 6

granular pattern on EM means…

Answer 6

immune complex disease type 3

1) lupus
2) post-strep GN

Question 7

only glomerulonephritis truly diagnose with immunofluorescence

Answer 7

IgA glomerulonephritis

no IgG

Question 8

2 types of glomerulonephritis

Answer 8

1) nephritic

2) nephrotic

Question 9

definition of nephritic glomerulonephritis

Answer 9

1) red cell casts

2) inflamm of glomerulus = spill

Question 10

definition of nephrotic syndrome

Answer 10

1) fatty casts
2) > 3.5 g/24 hr urine
3) edema

Question 11

too many glomeruli > 100

Answer 11

proliferative glomerulonephritis

Question 12

patient had scarlet fever 2 weeks ago

now with hematuria, RBC casts, mild-mod proteinuria, HTN, periorbital edema

Answer 12

post-strep glomerulonephritis

Question 13

35 y/o woman with + ANA with rim pattern = anti-dsDNA

type of GN

Answer 13

diffuse proliferative GN

Question 14

lupus on EM

Answer 14

endocapillary wire loops
diffuse prolif GN
subendotheial immune deposits

Question 15

prolif parietal epith cells not in glomerulus with crescent around

Answer 15

crescentic GN

Question 16

worst GN

Answer 16

crescentic GN go into ARF within 3 months without dialysis

Question 17

most common crescentic GN disease

Answer 17

goodpasture’s
still nephritic

polyarteritis nodosa
Wegener’s

Question 18

maltese crosses

pathopneumonic for

Answer 18

cholesterol in urine

nephrotic syndrome

Question 19

children with nephrotic at risk for

risky organisms as child vs. adult

Answer 19

peritonitis

child = strep pneumoniae
adult = e coli

Question 20

8 y/o boy with URI 1 week ago
now weight gain
diffuse pitting edema/anasarca
normotensive

normal light microscopy
normal immunofluorescence

on EM, podocyte fusion

Answer 20

lipoid necrosis due to cholesterol in urine

minimal change disease

Question 21

when albumin goes down, liver ..

Answer 21

makes more cholesterol

cholesterol can’t get into urine –> fatty casts into urine = maltese c

Question 22

lost negative charge in basement membrane so albumin gets through

Answer 22

minimal change

Question 23

how to treat minimal change

Answer 23

corticosteroids

Question 24

most common nephrotic syndrome in kids

Answer 24

minimal change

Question 25

``` HIV+ patient with pitting edema UA shows > 3.5 g/day fatty casts in urine HTN ``` most common GN in aids patient, IVDA

Answer 25

focal segmental glomerulosclerosis

Question 26

2nd worst GN you can get

Answer 26

FSGS

Question 27

adult with pitting edema fatty casts in urine UA > 3.5 g protein per day not proliferative GBM thickened most common GN in adults

Answer 27

diffuse membranous glomeruonephritis

Question 28

diffuse membranous glomeruonephritis on EM on silver stain

Answer 28

on EM, subepithelial deposits on silver stain, epimembranous spikes = immune complexes

Question 29

most common causes of diffuse membranous nephropathy

Answer 29

1) idiopathic 2) NSAIDS 3) hep B 4) captopril 5) malaria, syphilis 6) carcinoma

Question 30

type 1 and type 2 MPGN immune complex because end in -itis type 1 found in what patients

Answer 30

HCV

Question 31

membranous glomerulopathy in ___ type 1 MPGN in ____ HCV found in HBV found in

Answer 31

HBV HCV MPGN and cryoglobulinemia polyarteritis nodosa and membranous glomerulopathy

Question 32

type 1 MPGN has a

Answer 32

subendothelial deposit | nephrotic syndrome

Question 33

type 2 MPGN

Answer 33

autoantibody against C3 nephritic factor causes C3 convertase overactive breaking complement down

Question 34

lowest complement levels in any glomerulonephritis found in

Answer 34

type 2 MPGN

Question 35

type 2 MPGN also known as

Answer 35

dense deposit disease

Question 36

tram tracking means

Answer 36

mesangial cell extended btwn basement membrane and endothelial cell MPGN

Question 37

big balls on electron microscopy

Answer 37

diabetic glomerulosclerosis

Question 38

diabetic glomerulosclerosis 1st vessel hyalinized = efferent arteriole

Answer 38

hyaline arteriolosclerosis = small vessel disease in diabetes and HTN type 4 collagen in mesangium = big balls excess red

Question 39

if lumen narrow in efferent arteriole

Answer 39

incr GFR, incr creatinine clearance efferent arteriole hyalinized and obstructing hyperfiltration damage

Question 40

when glucose attach to amino acid and protein

Answer 40

non enzymatic glycosylation of GBM

Question 41

diabetic patient with glomerulosclerosis

Answer 41

makes GBM permeable to protein microalbuminuria

Question 42

treatment for diabetic glomerulosclerosis and microalbuminuria

Answer 42

ACE inhibitor afferent arteriole controlled by PGE2 efferent arteriole controlled by angiotensin II if decr angiotensin II, vasodilates efferent arteriole decr GFR but still glycemic control because ACEI won't stop non enzymatic glycosylation

Question 43

kimmelsteil wilson disease

Answer 43

nodular glomerulosclerosis diabetic glomerulosclerosis

Question 44

amyloid deposits | when stain under polarized light

Answer 44

apple green birefringence

Question 45

associations ``` children IVDA, aids adults HCV autoantibody against C3, lowest complemetn ``` diabetes apple green

Answer 45

``` lipoid necrosis FSGS membranous glomerulopathy type 1 type 2 ``` diabetic glomerulosclerosis amyloids

Question 46

IgA glomerulonephritis anti-IgA

Answer 46

bergers disease | henoch-schonlein purpura

Question 47

``` palpable purpura polyarthritis slight GI bleed hematuria RBC casts ``` mesangial IgA deposits ``` kids = episode hematuria relapsing adults = episodic microscopic hematuria ```

Answer 47

henoch-schonlein purpura