HISTO: Renal pathology Flashcards
What is the pressure at the glomerulus?
60mmHg
What is the volume of blood filtered by glomeruli per minute?
125ml/min
What is the inheritance pattern of adult PCKD?
AD
What is an iatrogenic cause of renal cysts?
Dialysis in ESRD
Which type of malignancy occurs due to renal cysts?
papillary cell
What is the UO criteria in stage 3 AKI?
<0.3ml/kg/hr for 24hrs or anuria for 12hrs
What happens to the brush border of epithelial cells in ATN?
Apoptosis and sloughing leading to obstruction
Compared to ATN, what is the mechanism in ATIN?
Acute tubulo-interstitial nephritis is usually caused by immune damage (but can also be drugs/infection). Interstitial inflammatory infiltrate of eosinophils and granulomas is seen.
What are two characteristic features of acute glomerulonephrotis?
Urine casts
Crescents
What are 3 types of crescenteric glomerulonephritis?
Immune complex-associated - SLE/IgA/post strep
Anti-GBM
Pauci-immune
Which crescenteric GN is ANCA positive?
Pauci-immune
What are Abs directed at in anti-GMB GN?
C terminal of collagen type IV
What is an extra renal complication of anti-GBM GN?
Lung injury - abs cross-react with alveolar BM
Which cells cause damage in Pauci-immune GN?
Neutrophils
What is the pattern of Ig deposits in anti-GBM vs Pauci immune?
Linear vs scanty
What can the causes of thrombotic microangiopathies affecting the kidney be divided into?
Diarrhoea assoc
Non-diarrhoea assoc
e.g. MAHA/HUS
What proteinuria levels are seen in nephrOtic syndrome?
> 3.5g/day
List the 6 main causes of nephrotic syndrome.
Systemic: DM, SLE, amyloidosis
Non-systemic:
MCD*
FSGS*
MGN - this one is immune complex mediated
*primary glomerular diseases
Compare MCD and FSGS tx.
FSGS is less likely to respond to steroids than MCD.
What is the most common cause of nephrOtic syndrome in adults?
MGN
Where do immune complexes deposit in MGN?
Subepithelium (outside BM) - IgG and C3
What is the Ab against in MGN?
PLA2R in primary disease
(phospholipase A2 M receptor)
Secondary disease may be due to malignancy/drugs/ infection/SLE
What is the progression in disease in diabetic nephropathy?
Microalbuminaemia –> proteinuria –> nephrotic syndrome
Which stage is Kimmelstiel-Wilson seen in diabetic glomerulosclerosis?
Stage III
Which stage is thichening BM seen in diabetic glomerulosclerosis?
Stage I
What are stages II and IV of diabetic glomerulosclerosis?
Stage I - thick BM
Stage II - more mesangial matrix
Stage III - nodular lesions
Stage IV - advanced glomerulosclerosis
What is AA amyloid derived from?
SAA - serum amyloid associated protein
Name 2 causes of microscopic haematuria.
Thin BM - hereditary defect in type IV collagen
IgA nephropathy
What is the thickness of BM in thin BM disease?
<250nm
What syndrome is linked to thin BM?
Alport’s - deafness, ocular disease, haematuria
What is the defect in Alport’s?
X linked dominant - mutation in alpha5 subunit
What is the most common form of glomerulonephritis? What is it associated with?
IgA nephropathy - associated with HSP
Where is IgA deposited in IgA nephropathy?
Mesangial deposition
What classification is used for IgA nephropathy?
Oxford (MEST-C)
List the top 5 causes of CKD requiring RRT from 1-5.
Diabetes Glomerulonephritis PCKD Pyelonephritis Hypertension
What is the appearance of kidneys in hypertensive nephropathy?
Shrunken with granular cortices + nephrosclerosis, hyalinosis, intimal thickening and ischaemic changes
Which classification is used for renal SLE?
ISN/RPS classification
Which class of SLE nephropathy shows subendothelial vs subepithelial deposits?
Subendothelial = Class 3 Subepithelial = Class 5
Which class of SLE nephropathy shows diffuse >50% disease?
Class 4
Which class of SLE nephropathy shows a mesangial vs membranous pattern ?
Mesangial - class 1 and 2 Membranous - class 5
List 4 renal SLE syndromes.
AKI
NephrOtic syndrome
CKD
Isolated urinary abnormality
