Nephropathies Flashcards
Amyloidosis is nephrotic or nephritic? what is it associated with?
Nephrotic. Associated with chronic conditions ex. multiple myeloma, TB, RA.
Cause of DPGN
Due to SLE or MPGN. Most common cause of death in SLE. SLE and MPGN can present as nephrotic syndrome and nephritic syndrome concurrently.
Minimal change disease is a nephrotic or nephritic syndrome?
nephrotic syndrome
Diabetic glomerulonephropathy
- Nonenzymatic glycosylation ( EG) of GBM leads to increased permeability, thickening.
- NEG of efferent arterioles causes increased GFR leading to mesangial expansion.
- LM-mesangial expansion, GBM thickening, eosinophilic nodular glomerulosclerosis (Kimmelstiel-Wilson lesion).
Bergers disease is a nephritic or nephrotic syndrome?
Nephritic syndrome
This gets filtrated and is found in urine in minimal change disease
Selective loss of albumin, not globulins, caused by GBM polyanion loss.
Most frequent patient population to see post-strept glomerulonephritis and presentation?
Most frequently seen in children. Peripheral and periorbital edema, dark urine, and hypertension. Resolves spontaneously.
Is Acute poststreptococcal glomerulonephritis a nephrotic or nephritic syndrome?
Nephritic syndrome.
Rapidly progressive (crescentic) glomerulonephritis (RPGN)
- LM and IF-crescent-moon shape.
- Crescents consist of fibrin and plasma proteins (e.g., C3b) with glomerular parietal cells, monocytes, and macrophages.
What is MPGN Type I associated with?
Is associated with HBV, HCV
Is Diabetic glomerulo-nephropathy a nephrotic or nephritic syndrome?
Nephrotic syndrome
Nephritic syndrome presentation and associated with?
An inflammatory process. When it involves glomeruli, it leads to hematuria and RBC casts in urine. Associated with azotemia, oliguria, hypertension (due to salt retention), and proteinuria (
Pathological process causing damage in glomerulo-nephropathy
*Nonenzymatic glycosylation (NEG) of GBM –>increased permeability, thickening *NEG of efferent arterioles –>increases GFR –>mesangial expansion
Nephrotic syndrome presentation and associated with?
*Presents with massive proteinuria (>3.5g/day, frothy urine), hyperlipidemia, fatty casts, edema. *Associated with thromboembolism (hypercoagulable state due to AT III loss in urine) and increased risk of infection (loss of immunoglobulins)
Berger’s disease (IgA nephropathy) is related to what clinical disorder?
Related to Henoch-Schonlein purpura
What is the pathological process of Alport syndrome
Mutation in type IV collagen –> split basement membrane. X-linked.
Berger’s disease (IgA nephropathy) often presents/flares with?
Often presents/flares with a URI or acute gastroenteritis.
Whats the prognosis on RPGN
Poor prognosis. Rapidly deteriorating renal function (days to weeks)
LM, EM, IM findings in Diffuse proliferative glomerulonephritis (DPGN)
**LM-“wire looping” of capillaries *EM-subendothelial and sometimes intramembranous IgG-based IC’s often with C3 deposition. *IF-granular
Is RPGN a nephrotic or nephritic syndrome?
Nephritic syndrome
Membrano proliferative glomerulonephritis (MPGN) type I findings
Subendothelial IC depositis with granular IF; “tram-track” appearance due to GBM splitting caused by mesangial ingrowth.
Rapidly progressive (crescentic) glomerulonephritis (RPGN) LM and IF findings
LM and IF-crescent-moon shape. Crescents consist of fibrin and plasma proteins (ex. C3b) with glomerular parietal cells, monocytes, and macrophages.
LM findings of Amyloidosis
LM-congo red stain shows apple green bifringence under polarized light
LM and EM findings in Minimal change disease (lipoid nephrosis)
LM-normal glomeruli EM-foot process effacement
What are some disease processes that can result in RPGN
*Good pastures syndrome-type II hypersensitivity; antibodies to GBM and aveolar basement membrane –>linear IF. Present with Hematuria/hemoptysis. *Granulomatosis with polyangiitis (c-ANCA) *Microscopic polyangiitis (p-ANCA)
Cause of Minimal change disease (lipoid nephrosis)
May be triggered by a recent infection or an immune stimulus.
Most common patient found with minimal change disease and what is the Treatment?
Is most common in children and it responds to corticosteroid Tx.
LM and EM findings in Focal segmental glomerulosclerosis
LM-segmental sclerosis and hyalinosis. EM-effacement of foot process similar to minimal change disease.
LM findings in Diabetic glomerulo-nephropathy
LM-mesangial expansion, GBM thickening, eosiniphilic nodular glomerulosclerosis, (Kimmelstiel-Wilson lesion)
Cause of Membranous nephropathy
Can be idiopathic or caused by drugs, infections, SLE, solid tumors.
Focal segmental glomerulosclerosis associations
Associated with HIV infection, heroin abuse, massive obesity, interferon treatment, and chronic kidney disease due to congenital absence or surgical removal.
Alport Syndrome presents with what?
Glomerulonephritis, deafness, and less commonly, eye problems
MPGN is nephrotic or nephritic?
It is nephrotic, but it can also present as nephritic syndrome.
- Minimal change disease (lipoid nephrosis)
- LM-normal glomeruli.
- EM-foot process effacement
Berger’s disease (IgA nephropathy) LM, EM, and IF findings
LM-mesangial proliferation EM-mesangial IC depositis IF-IgA-based IC depositis in mesangium
Acute poststreptococcal glomerulonephritis LM, EM, and IM findings
*LM-glomeruli enlarged and hypercellular, neutrophils, “lumpy-bumpy” appearance. *EM-subepithelial immune complex (IC) humps. *IF-granular appearance due to IgG, IgM, and C3 deposition along GBM and mesangium.
- Membranous nephropathy
- LM-diffuse capillary and GBM thickening.
- EM-“spike and dome” appearance with subepithelial deposits.
- IF -granular. SLE’s nephrotic presentation.
Focal segmental glomerulosclerosis is nephrotic or nephritic?
nephrotic
What is MPGN type II associated with?
Is associated with C3 nephritic factor
LM, EM, and IF findings in Membranous nephropathy
LM-diffuse capillary and GBM thickening EM-“spike and dome” appearance with subepithelial deposits IF-granular. SLE’s nephrotic presentation
2nd most common cause of primary nephrotic syndrome in adults?
Membranous nephropathy
Most common cause of nephrotic syndrome in adults
Focal segmental glomerulosclerosis
Membrano proliferative glomerulonephritis (MPGN) type II findings
Intramembranous IC depositis; “dense depositis.”
- Focal segmental glomerulosclerosis
- LM-segmental sclerosis and hyalinosis.
- EM-effacement of foot process similar to minimal change disease.
- Most common cause of nephrotic syndrome in adults.
Membranaproliferative glomerulonephritis
- Type 1-subendothelial IC deposits with granular IF; “tram-track” appearance clue to GBM splitting caused by mesangial ingrowth (in picture)
- Type I is associated with HBV, HCV.
- Type II-intramembranous IC deposits; “dense deposits.”
- Can also present as nephritic syndrome.
- Type II is associated with C3 nephritic factor.
