Histology Flashcards
Causes of Granular IgG on IF
Primary membranous, SLE
Causes of Linear IgG on IIF
Anti GBM disease, diabetes, monoclonal immunoglobulin deposition disease
Causes of mesangial IgG staining
Lupus, IgA
Features of membranous Nephropathy
Thickened BM, Spikes on silver stain, subepithelial deposits
IgG4 subclasses
Note - mesangial deposits more likely in secondary MN
Features of FSGS
> 70% foot process effacement
Causes of subendothelial deposits
Lupus (class3-4), MPGN, cryoglobulinaemia
Causes of intramembranous deposits
Dense deposit disease, C3 factor
Features of transplant glomerulopathy
Double contouring on silver stain
Features of Amyloid
Congo red, apple bifringe, PAS negative - look pale
Features associated with IgA
KM55 - positive on renal Bx
Glomerulosclerosis
Tubulointerstitial fibrosis
Mesangial hypercellularity
Endocapillary hypercellularity
Crescents
Features of post infection GN on renal Bx
Diffuse proliferative GN
Hypercellularity - monocytes and neutrophils
IIF - dominant C3 staining. some IgG
Starry sky pattern
Irregular mesangial and capillary wall pattern
SubEpitheilial humps / deposits
C3 Glomeulonephritis
C3 deposits in the mesangium and subendothelial space
Name 5 Lupus classes on histology
The standard classification divides these into five different patterns:
I - No disease
II - Mesangial proliferation
III - Focal proliferative
IV - Diffuse proliferative
V - Membranous.
VI = Sclerosis
Histological features of Membranoproliferative glomerulonephritis aka Mesangiocapillary GN
Double contour / splitting of GBM = Tram Tracks
mesangial and endothelial cell proliferation,
expansion of the mesangial matrix
thickening of the peripheral capillary walls.
Features seen with BK infection
Cd4 positive staining
SV -40 antigen seen in tubular epithelial cells.
Inclusion bodies
Features of Lupus
Proliferation of capillaries and obliteration of capillary loops - capillaries stain deep red =”wire loop” lesion
Full house immunology
increase in mesangial matrix volume
Subendothelial deposits
Mesangial fingerprinting
Features of Alports on renal Bx
Loss of podocytes
Thin GBM - look’s like ‘basket weave’
Splitting of lamina densa
Looks similar to FSGS
When do you see Kimmelstiel-Wilson lesions
Depict nodular glomerulosclerosis
Seen in diabetic related kidney disease.
When do you see inclusion body’s versus owls eyes
Owl’s eyes = CMV
Inclusion bodys = BK (seen with SV 40)
Features of Oxalate nephropathy on renal Bx
Calcium oxalate deposition within the tubular epithelial cells and lumen
Crystals appear translucent
Look like ‘fan-like’ / sheaf like / sunburst
Strongly birefringent under polarized light
Features of glomerular nephropathy as they occur
1) Tubular cell hypertrophy - causes hyperfiltration
2) Thickening of GBM
3) Thickening of tubular membrane
4) Kimmelsteil- wilson nodules
5) Glomerular microaneurysums
When do you see tubular reticulocyte inclusion bodies
SLE
HIV
interferon
Difference between hyaline casts and fractured casts
fractured casts - cells around the edge due to it being an inflammatory process. Hyaline cells - no cells around the edge
Differentials for increased inflammatory cells in transplant Bx
Tcell mediated rejection / cellular rejection
Viruses - BK
Features on Bx in Light chain cast nephropathy
Aka myeloma cast nephropathy
Kappa on IF
Fractured casts
Features of dense deposit disease
Intramembranous, sausage like deposits
Common cause is C3 nephritic factor- antibody which inhibits Factor H, allowing uncontrolled activation of the alternative pathway of complement. Causes very low levels of serum C3.
Causes of cresents on renal Bx
ANCA
IgA /HSP
Lupus
Anti GBM
Post infectious GN
Features of IgG4 on renal biopsy
IgG4 positive Plasma cell
lymphocytic infiltration in the tubulointerstitial compartment
Storiform fibrosis
Features of Class 2-3-4-5 lupus
Class 2 = Mesangial proliferation
Class 3 = <50% gloms affected
Class 4 = >50% gloms affected
Class 5 = Subepithelial deposits
Features of acute tubular necrosis on renal Bx
Flattening of tubular cells
Intratubular cast formation
History of muddy brown / granular casts
