Nephropathology Flashcards
What are the four categories that glomerular lesions are divided into?
Focal involves <50% of the glomeruli
Diffuse involves >50% of the glomeruli
Segmental involves <50% of an individual glomerulus
Global involves >50% of an individual glomerulus
How can glomerular problems present?
With acute or chronic renal failure, with proteinuria and/or haematouria
What is the usual pathogenesis of a primary glomerular disease?
It is usually autoimmune attack of the glomerulus or of something deposited in the glomerulus
What is goodpastures disease?
When antibodies form against the glomerular basement membrane
What are the histological features of primary glomerular disease?
Histological features include hyalinisation and sclerosis, thickening of the basement membrane with immune complexes and amyloid/fibrin, and hypercellularity due to proliferation and infiltration
What is a typical presentation of acute glomerulonephritis and how is this likely to have started?
Will present with haematuria, increased urea and creatinine, oliguria (less urine) and may be proteinuria
This will have likely been caused by Strep skin/throat infection that causes formation of antibodies that deposit in the kidney
What are the three main types of necrosing glomerulonephritis?
Anti-GBM (glomerular basement membrane) - rare
Immune complex mediated
Immune complex mediated
ANCA (anti neutrophil cytoplasmic antibodies) associated with vasculitis
What is nephrotic syndrome?
Collection of symptoms leading to kidney damage, the primary of which is massive proteinurea leading to oedema.
What are the three main causes of nephrotic syndrome?
Membranous nephropathy - most common cause in adults, diffuse basement membrane thickening and immune complex deposition
Minimal change disease most common in children, EM shows fusion of podocyte foot processes
Focal segmental glomerular sclerosis - depletion of podocytes, poor response to steroids
What is the main cause of secondary glomerular disease?
Diabetic nephropathy causes thickening of the basement membrane
What are primary and secondary amyloidosis?
Both are proteinaceous material deposited in the tissues, Primary is due to deposition of light chains in multiple myeloma and secondary is due to chronic diseases such as TB
How does SLE affect the glomerulus?
Deposition of immunoproteins causes membranous nephropathy
How can chronic pyelonephritis develop?
From repeated episodes of acute pyelonephritis cause tubuloinerstitial inflammation. This is common in people with obstruction.
What is tubular interstitial nephropathy usually related to?
Often related to drugs (NSAIDs) Leads to lymphocyte infiltration and damage. This can be treated with steroids
What does acute tubular necrosis commonly occur?
In hypotension
