Histopathology: Renal Disease

Question 1

2 main manifestations of glomerular disease?

Answer 1

• Failure to filter blood
• Causing increased waste products in blood.
• Failure to maintain barrier function
• Leading to loss of protein or blood cells in urin

Question 2

Glomerular crescents: Causes?

Answer 2

Immune complexes

Anti-GBM disease

ANCA (antineutrophil cytoplasmic antibody )

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Glomerular crescents are an accumilation of cells in the Bowman’s space

Question 3

What are Glomerular crescents?

Answer 3

Glomerular crescents are an accumilation of cells in the Bowman’s space.

Looks like a dark ring within the glomerulus where there should be space

Question 4

Causes of acute kidney injury?

Answer 4

Pre-renal

-Failure of perfusion (eg renal artery stenosis)

Renal

• Acute tubular injury
• Acute glomerularnephritis (GN)

Post-renal

-Obstruction to urine outflow

Question 5

Oliguria, red cells in urine. CXR shows infiltrates in lower zones.

On kidney biopsy, there are glomerular crescents.

Most likely diagnosis?

Answer 5

Anti-GBM disease

(aka goodpasture’s syndrome)

Question 6

Nephritic Syndrome, signs, symptoms and findings?

Answer 6

A manifestation of glomerular inflammation (i.e. glomerulonephritis (GN)) Syndrome characterised by: PHAROH

• Proteinuria (less than nephrotic syndrome)
• Haematuria (coke-coloured urine)
• Azootemia – high urea and creatinine
• Red Cell Casts (in urine)
• Oliguria
• Hypertension

Question 7

Proteinuria, >3g/24h, low serum albumin, Peripheral swelling, hyperlipidaemia. Kidney biopsy reveals no changes. Most likely diagnosis?

Answer 7

Minimal change disease

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“Proteinuria, >3g/24h, low serum albumin, Peripheral swelling, hyperlipidaemia” indicates nephrotic syndrome

Minimal Change Disease (MCD for short) is a kidney disease in which large amounts of protein is lost in the urine.

ie subclinical loss of filtration of protein by the kidney

Question 8

Proteinuria, >3g/24h, low serum albumin, Peripheral swelling, hyperlipidaemia. No history of diabetes. Kidney biopsy reveals diffuse glomerular basement membrane thickening. Most likely diagnosis?

Answer 8

Membranous glomerulopathy

(aka Membranous glomerular disease)

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“Proteinuria, >3g/24h, low serum albumin, Peripheral swelling, hyperlipidaemia.” indicates nephrotic syndrome.

“Diffuse glomerular basement membrane thickening” makes you think either membranous glomerulopathy or diabetic nephropathy. Diabetes is ruled out in the question.

Membranous glomerulopathy is glomerulopathy caused by sub epithelial immune complex deposition.

Question 9

A glomerulopathy caused by diffuse global subepithelial immune deposits within glomeruli. What is this called?

Answer 9

Membranous glomerulopathy

Question 10

Immune complexes within the glomerulus disrupt the normal filtration barrier, causing heavy proteinuria. What disease is this?

Answer 10

Membranous glomerulopathy

Question 11

In membranous glomerulopathy, if deposits of IgA, IgM, and C1q are also present, then what secondary cause of membranous glomerulopathy be considered?

Answer 11

SLE

Question 12

Proteinuria, >3g/24h, low serum albumin, Peripheral swelling, hyperlipidaemia. Kidney biopsy reveals glomerular consolidation and scarring (Hyalinosis). Most likely diagnosis?

Answer 12

Focal Segmental glomerulosclerosis

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Question 13

Proteinuria, >3g/24h, low serum albumin, Peripheral swelling, hyperlipidaemia. Kidney biopsy reveals diffuse glomerular basement membrane thickening with Kimmelstiel Wilson Nodules. Most likely diagnosis?

Answer 13

Diabetic nephropathy

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Kimmelstiel Wilson Nodules is a buzzword

Question 15

Proteinuria, >3g/24h, low serum albumin, Peripheral swelling, hyperlipidaemia. Kidney biopsy reveals apple green birefringence with Congo red stain. Most likely diagnosis?

Answer 15

Amyloidosis

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Signs of nephrotic syndrome

A protein called amyloid building up in your tissues and organs

Question 16

A primary glomerulopathy characterized histologically by sclerosis involving some, but not all, glomeruli and affecting only a portion of the glomerular tuft.

Answer 16

Focal segmental glomerulosclerosis

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Focal; some glomeruli

Segmental: A portin of the glomerulus affected.

Question 17

Haematuria (microscopic or macroscopic) and proteinuria. Kidney biopsy shows mild mesangial expansion of glomeruli. Dominant staining with IgA in the mesangial region of the glomeruli.

Most likely diagnosis?

Answer 17

IgA nephropathy

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Mesengial cells are cells within the glomerulus between the capillaries, that are not the endothelial cells of the capillary or the podocytes.

Question 18

A patient presents with the following.

Nausea. Decreased urine output. Increased serum creatinine. Increased Urea.

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Kidney biopsy shows glomeruli with a segmental, necrotizing glomerulonephritis, with breaches in the glomerular basement membrane and the formation of crescents in the Bowman’s space. Other segments of the glomeruli appear normal. A lymphoplasmacytic inflammatory cell infiltrate is present in the interstitium surrounding affected glomeruli.

Immunflourescence is performed. There is a strong linear staining of IgG and C3 is seen in the glomerular basement membrane.

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Most likely diagnosis?

Answer 18

Anti-glomerular basement membrane disease