Path 2 Glomerular Disease Flashcards
Normal glomerular measurement
BM and podocytes are same width
Inside v outside lining gaps
- Fenestrae inside between Endothelial cells
- Filtration slits outside between Epithelial cells (podocytes)
Nephrotic syndrome
Increased BM permeability
- Proteinuria, hypoalbuminemia
- Generalized edema
- Hyperlipidemia and hypercholesterolemia
Minimal change disease
Lipoid nephrosis (nephrotic syndrome)
- Age 2-6
- No immune complex deposition
- Tx with steroids
Minimal change disease gross appearance
Lipid laden cortices
Minimal change disease histology (3)
- Normal glomeruli
- Lipid accumulation in proximal convoluted tubules
- Fusing of foot processes (epithelial)
Focal segmental glomerulosclerosis
Sporadic partial glomerular scarring
- Same clinical as MCD
- Older patients, can’t Tx with steroids
- IgM and C3 immune complex deposition
Focal segmental glomerulosclerosis
- Primary
- Secondary (HIV, heroin, IgA nephropathy)
Membranous GN
Nephrotic syndrome in teenagers and young adults
- IgG, C3 immune complex deposition
- Doesn’t respond to steroids
Membranous GN stain
PAS
Minimal Change Disease stain
Fat stain
Membranous GN histology (3)
- Thickened capillary loops
- Spike and dome appearance
- Granular immunofluorescence
Membranous GN EM
Thickened BM with immune complex nodules
Membranous GN etiology
- Idiopathic
- SLE, infections, drugs, malignancy
Diabetic nephropathy
Nephrotic syndrome
Diabetic nephropathy glomerulus histology (4)
Kimmelstiel-Wilson nodules
- Fibrin caps
- Increase in mesangial matrix
- Diffuse glmerulosclerosis
Diabetic nephropathy extra-glomerulus histology (2)
- Sclerosed afferent & efferent arterioles
- Armanni-Ebstein lesions (glycogen in tubules) in chronic hyperglycemia
Diabetic nephropathy EM (2)
- Markedly thickened BM
- Mesangial matrix accumulation
Amyloidosis
Nephrotic syndrome
-Subendothelial and mesangial deposits
Amyloidosis EM
Criss-cross fibrillary pattern
Amyloidosis histology (2)
- Congo Red stain
- Birefringence under polarized light
Lupus Nephropathy Class I
No observable renal involvement
Lupus Nephropathy Class II
Mesangial glomerulonephritis
Lupus Nephropathy Class III
Focal proliferative glomerulonephritis
-Less than half of glomeruli involved, but individual damage can be extensive
Lupus Nephropathy Class IV
Diffuse proliferative glomerulonephritis
Lupus Nephropathy Class V
Membranous glomerulonephritis
-Intra and extramembranous immune complex deposition
Lupus Nephropathy histology (5)
- Extensive inflammatory glomerular scarring
- Subendothelial and mesangial immune complex deposition
- Wire loop lesions
- Tubular reticular structures
- Fingerprint patterns pathognomonic
Nephritic syndrome
Inflammatory rupture of glomerular capillaries
- oliguria
- hematuria (w/RBC casts)
- azotemia
- HTN
Acute Proliferative Poststreptococcal GN
Prototypical nephritis
- IgG/C3 Immune complexes between epithelial foot processes -> PMN attack -> hemorrhage
- Complete recovery in all children, 60% adults
- Analogous to rabbit “serum sickness”
PSGN gross appearance
Petechial hemorrhages covering surface of kidney
PSGN histology
- Glomeruli enlarged, hypercellular (mesangial, endothelial, PMN), “bloodless”
- Granular immunofluorescence
PSGN EM
Subepithelial immune complexes
PSGN lab levels
- Decreased serum C3
- Increased ASO titer
Rapidly Progressive GN
-mechanism, cause, prognosis
Cresentic GN
- Proliferation of parietal epithelial cells of bowmans capsure
- Can be complication of PSGN
- Renal failure over weeks to months
Crescentic GN (RPGN) types
- ANCA positive
- ANCA negative
- Anti-GBM (Goodpasture)
- Immune complex (ASO, SLE, IgA)
Goodpasture syndrome
Antiglomerular BM antibodies
- attacks glomeruli and alveoli
- linear immunofluorescence for IgG
Alport syndrome - cause, histology, clinical
Type IV collagen mutation (alpha-5 chain)
- Rarefaction and splitting of BM lamina densa
- Hereditary nephritis, nerve deafness, ocular disorders (cataracts, lens dislocation)
Berger disease
IgA nephropathy
- IgA deposits in mesangium
- Recurrent hematuria in youth, often benign
IgA nephropathy as a component
Henoch-Schonlein purpura
- Skin purpura
- GI pain & bleeding
- Joint arthritis
- Kidney IgA nephropathy
Membranous GN v Membranoproliferative GN
BM v BM and Mesangium
Membranoproliferative GN histology (4)
- Tram-track BM (doubled)
- Lobular pattern
- Mesangial proliferation (hypercellular)
- Collapse of capillaries
Type 1 Membranoproliferative GN
Immune complex nephritis
- unknown antigen
- striking tram-track
Type 2 Membranoproliferative GN
Dense Deposit Disease
- C3 nephritic factor
- Serum C3 markedly reduced
Chronic GN
End-stage kidney
- Marked renal failure
- HTN
- Small pale kidneys
- Hyaline arteriolosclerosis
- Interstitial fibrosis