Lecture 13-Glomerular Pathology

Question 1

What are the symptoms of nephrotic syndrome?

Answer 1

• proteinuria > 3.5g a day
• oedema due to reduced oncotic pressure
• high cholesterol

Question 2

What are the symptoms of nephritic syndrome?

Answer 2

• haematuria
• hypertension
• acute renal failure

Question 3

Where is the likely site of injury in nephrotic syndrome?

Answer 3

Podocyte/subepithelium

Question 4

What are the common primary causes of nephrotic syndrome?

Answer 4

• minimal change glomerulonephritis
• focal segmental glomerulosclerosis (FSGS)
• membranous glomerulonephritis

Question 5

What are the common secondary causes of nephrotic syndrome?

Answer 5

• diabetes mellitus

- amyloidosis

Question 6

True or false: minimal change glomerulonephritis is common in childhood

Answer 6

TRUE

Question 7

What is the pathophysiology of minimal change disease?

Answer 7

Podocytes lose their processes and split diaphragm -> protein leakage

Question 8

What is the treatment for minimal change disease?

Answer 8

Steroids

Question 9

What is FSGS?

Answer 9

Same as minimal change but in adults, with scarring

Question 10

Why doesn’t FSGS respond to steroids?

Answer 10

Scarring is permanent

Question 11

True or false: FSGS can progress to renal failure

Answer 11

TRUE

Question 12

What is membranous glomerulonephritis?

Answer 12

• commonest cause of nephrotic syndrome in adults

- immune complex deposits on podocytes

Question 13

What is the antigen involved in membranous glomerulonephritis?

Answer 13

Phospholipase A2

Question 14

What is the commonest cause of haematuria?

Answer 14

IgA nephropathy

Question 15

What is the site of injury in nephritic syndrome?

Answer 15

Endothelium around capillary loops

Question 16

Why can’t patients with IgA nephropathy fight infection?

Answer 16

Normally, IgA is secreted on mucosal membranes to stop bacteria entering so infection leads to more IgA production. In this condition, all the IgA is deposited in the nephron instead

Question 17

What is the treatment for IgA nephropathy?

Answer 17

No effective treatment but ACEI can be used to slow progression

Question 18

How can thin glomerular basement membrane nephropathy cause haematuria?

Answer 18

GBM is weak and can break -> bleeding

Question 19

What is Alport syndrome?

Answer 19

X linked condition with abnormal collagen IV (used in basement membranes) -> haematuria and can lead to renal failure

Question 20

What is Goodpasture syndrome?

Answer 20

• acute onset of severe nephritic syndrome
• associated with pulmonary haemorrhage (collagen IV in alveoli too)
• autoantibody to collagen IV

Question 21

How can Goodpasture syndrome be treated?

Answer 21

Immunosuppression and plasmaphoresis

Question 22

What is vasculitis?

Answer 22

Anti-neutrophil cytoplasmic antibody (ANCA) which activates neutrophils against blood vessels -> holes are punched through GBM