Lecture 10 Glomerulus Disease (Pathology)

Question 1

Name the structures found in the renal corpuscle

Answer 1

Afferent arteriole
Podycytes
Mesangial cells
Bowman's capsule
Efferent arteriole

Question 2

Define Glomerulonephritis

Answer 2

Disease of the glomerulus. Can be inflammatory or non-inflammatory

Question 3

What are the 4 common presentations in Glomerulonephritis

Answer 3

1. Haematuria (blood in urine)
2. Heavy proteinuria (nephrotic syndrome)
3. Slowly increasing proteinuria
4. Acute renal failure

Question 4

A 40 year old male has discoloured urine which tests positive for blood what investigations should be done

Answer 4

Urine culture
Ultrasound
Clotting
Renal biopsy (light microscopy and immunofluorescence)

Question 5

What are the main causes of haematuria

Answer 5

UTI
Urinary tract stone
Urinary tract tumour
Glomerulonephritis

Question 6

If a patient has IgA Glomerulonephritis what would you see in the renal biopsy with immunofluorescence

Answer 6

Immunoglobulin (of IgA type) and complement component C3 in mesangial area of all glomeruli. Causes increased proliferation of mesangial cells

Question 7

What is the prognosis of IGA Glomerulonephritis

Answer 7

• Usually self-limiting

* Small percentage go onto chronic renal failure (via continued deposition of matrix)

Question 8

50 year old male
• 3 weeks of feeling unwell and swollen legs
• Send of blood biochemistry and haematology tests  Serum albumin is low
• Dipstick proteinuria
Sliver stain shows spikes surrounds a deposit of Ig
What is the clinical diagnosis

Answer 8

Membranous glomerulonephritis

thickened glomerular basement membrane and deposits of IgG seen on electron microscopy

Question 9

In membranous glomerulonephritis where does the IgG deposit deposit itself

Answer 9

Between basal lamina and podocyte

Question 10

In membranous glomerulonephritis the IgG deposits lead to__

Answer 10

activation of C3 which punches holes in the filter. Leaky filter now allows albumin to be filtered into urine

Question 11

What is the prognosis for membranous glomerulonephritis

Answer 11

1/4 will have chronic renal failure in 10 years

Question 12

What is the underlying cause of of IgG Production and Accumulation in Membranous Glomerulonephritis

Answer 12

• In many patients antigen is phospholipase A2 receptor on podocytes

Question 13

• 31 year old woman
• Type 1 diabetes since 7 years of age
• Long periods of poor glycaemic control
• Developed retinopathy
• Albumin in urine slowly increasing over last few years. Now has heavy protein leakage into urine
• Check clotting screen then do renal biopsy
• Glycated molecules  Matrix deposition in basal lamina underlying endothelium and in mesangial matrix
No immune complex
What is the clinical diagnosis

Answer 13

Diabetic Nephropathy

Question 14

• Female, 50 years old
• Unwell for 3 weeks
• Cough
• Serum biochemistry – creatinine 500 (was 60 one year before)
• Rapidly rising creatinine = acute renal failure
• Ultrasound: no renal tract lesion
• Check clotting then renal biopsy: early endothelial damage with fibrin deposition and crescents with crushed glomerular tuft
what is the diagnosis

Answer 14

Crescentic Glomerulonephritis

Question 15

What are the causes of Crescentic Glomerulonephritis

Answer 15

1. Granulomatosis with polyangiitis (previously known as Wegener’s granulomatosis)
2. Microscopic polyarteritis (a disease very much like granulomatosis with polyangiitis)
3. Antiglomerular basement membrane disease
4. Other - Many other forms of glomerulonephritis

Question 16

What is 1. Granulomatosis with polyangiitis (previously known as Wegener’s granulomatosis)

Answer 16

• A form of vasculitis (= inflammation in vessels) which affects vessels in kidneys, nose and lungs

Question 17

What further tests can be done to confirm Granulomatosis with polyangiitis (previously known as Wegener’s granulomatosis)

Answer 17

Serum test shows presence of anti-neutrophil cytoplasmic antibodies (ANCA)

Question 18

What is the nature of anti-neutrophil cytoplasmic antibodies (ANCA) in1. Granulomatosis with polyangiitis

Answer 18

– Not deposited in kidney
– Antibodies directed against proteinase 3 and myeloperoxidase, 2 enzymes in primary granules of neutrophils
– Antibodies produce tissue damage via interactions with primed neutrophils and endothelial cells.
– Form of autoimmunit

Question 19

What is the prognosis for 1. Granulomatosis with polyangiitis

Answer 19

– Fatal (mean survival 6 months) if left untreated

– Cyclophosphamide – 75% complete remission- anti-cancer drug