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BLOCK D - RENAL > Pathology of Glomerular Diseases > Flashcards

Pathology of Glomerular Diseases Flashcards

1
Q

4 clinical manifestations suggesting an underlying glomerular disease

A
  1. Proteinuria
  2. Hematuria
  3. Mixed pattern (proteinuria & hematuria)
  4. Acute kidney injury
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2
Q

Nephrotic syndrome signs (6)

A
  • Heavy proteinuria
  • Hypoalbuminemia
  • Edema
  • Hyperlipidemia
  • Lipiduria
  • Urine sediment: protein casts, fatty casts, liid droplets (maltese cross), oval fat bodies

RBCs can be seen but no RBC casts!

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3
Q

Nephrotic syndrome:
Primary disease is most prevalent in…
Secondary disease is most prevalent in…

A

Primary: mostly children
Secondary: mostly adults

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4
Q

Primary diseases that cause nephrotic syndrome (3)

A
  1. Minimal change disease
  2. Focal segmental glomerulosclerosis (FSGS)
  3. Membranous glomerulopathy

Mostly children

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5
Q

Secondary diseases that cause nephrotic syndrome (3)

A
  1. Diabetes mellitus
  2. Amyloidosis
  3. Pregnancy

Mostly adults

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6
Q

Proteinuria during pregnancy is usually a sign of …

A

maternal hypertension-pre-eclampsia

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7
Q

Signs of minimal change disease

A

Nephrotic syndrome!

  • Selective proteinuria (albumin only)
  • Preserved renal function

EM: diffuse effacement of foot processes
LM: Normal glomeruli
IF: negative

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8
Q

Typical presentation of minimal change disease

A

Abrupt onset of nephrotic syndrome in an otherwise healthy child.
Responds to short course of steroids
Great prognosis

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9
Q

One of the most common causes of nephrotic syndrome in adults

A

Focal segmental glomerulosclerosis (FSGS)

more common in african descent

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10
Q

Clinical manifestation of FSGS

A
  • Nonselective proteinuria
  • Mild or moderate hematuria

NO RBC CASTS! Nephrotic syndrome :)

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11
Q

What is the probable initiating event in primary FSGS?

A

Injury to podocytes

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12
Q

FSGS biopsy findings

A
  • segmental and focal sclerosis of glomeruli
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13
Q

Collapsing variant of FSGS is associated with..

A

bad prognosis (HIV, severe manifestations)

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14
Q

FSGS response to steroids

A

poor - 50% develop ESRD within 10 years

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15
Q

Pathogenesis of membranous nephropathy

A

Basement membrane is attacked by antibodies (PLA2R)

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16
Q

Prognosis of membranous nephropathy

A

Not the worst - only 40% progress to renal failure over 2-20 years

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17
Q

Most common cancerous cause of membranous nephropathy

A

Hepatitis

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18
Q

Membranous nephropathy biopsy

A
  • Diffuse thickening of glomerular capillary walls
  • Spike formation

IM: IgG and C3 granular pattern
EM: sub-epithelial deposits, spikes

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19
Q

Frequent cause of secondary nephrotic syndrome in adults

A

Diabetes mellitus

20
Q

Biopsy findings of secondary nephrotic syndrome due to diabetes mellitus

A

Kimmelstiel-Wilson lesions
Diffuse or nodular diabetic glomerulosclerosis
Arteriosclerosis of blood vessels

21
Q

Proteinuria during pregnancy is usually a sign of…

A

maternal pre-eclampsia (hypertension and proteinuria due to endothelial dysfunction).

BIOPSY NOT REQUIRED

22
Q

3 causes of primary glomerulonephritis (nephritic syndrome)

A
  • Acute post-infectious GN
  • IgA nephropathy
  • Membrano-proliferative GN
23
Q

Acute post-infectious glomerulonephritis (nephritic syndrome) often presents in children (and sometimes adults) some weeks after…

A

beta-hemolytic group A streptococcal infection of upper respiratory tract or skin

24
Q

Common infections (esp. in adults) that lead to acute post-infectious glomerulonephritis

A

Staphylococcus, pneumococcus, viruses, pneumonia, endocarditis, skin infections

25
Characteristic signs of acute post-infectious glomerulonephritis (6)
Rusty urine (tea-coloured, coca-cola) Edema Hypertension RBC casts Mild to moderate proteinuria Hypercellularity (neutrophils)
26
Crescents in post-infectious glomerulonephritis indicate...
worse prognosis
27
Acute post-streptococcal GN (nephritic) presents with.. on immunosfluorescence
Large coarse granular deposits or C3 and IgG (humps)
28
Prognosis for acute post-infectious GN
Usually good prognosis unless necrosis and crescents Very rare ESRD
29
Most common biopsy features of IgA nephropathy (nephritic syndrome)
Mesangial cell proliferation (histology) Mesangial deposits of IgA (IF)
30
What is henoch-schonlein purpura?
A systemic form of IgA nephropathy with vasculitis (nephritic syndrome)
31
Presentation of henoch-schonlein purpura
Gross hematuria, GI symptoms (tummy aches, vomiting, diarrhea) and rashes on lower extremities
32
Rapidly progressive glomerulonephritis (nephritic syndrome)
RPGN results in rapid loss of renal function in a few days or weeks, typically in the setting of nephritic syndrome
33
Characteristic histologic finding associated with RPGN
Presence of crescents
34
Is RPGN dangerous?
Yes! It is a medical emergency!If untreated, leads to death from renal failure
35
Difference between acute and chronic crescentic GN
Acute: cellular crescent Chronic: fibrous crescent
36
Most common glomerular disease in the world
IgA nephropathy
37
Acute pyelonephritis
Acute suppurative inflammation of the kidney and renal pelvis caused by bacterial infection (E coli). Characterized by fever, chills, pain, dysuria, urgency.
38
2 types of acute pyelonephritis (how the bacteria reach the kidney)
Ascending: From lower UTI Hematogenous: sepsis, infective endocardidtis
39
Acute pyelonephritis is usually.. a) unilateral b) bilateral
a) unilateral
40
How are glomeruli affected in acute pyelonephritis?
Glomeruli are NOT affected!!!
41
Papillary necrosis
Special and severe form of pyelonephritis (ischemic necrosis of pyramids and papilla, most often seen in the context of diabetes, obstruction or analgesic abuse)
42
Acute Tubulointerstitial Nephritis
Adverse drug reaction to antibiotics and analgesics (penicillin, diuretics, NSAIDs). Abnormal immune reaction (hypersensitivity).
43
Main indicator of ATN
Red granules (eosinophils)
44
Most common cause of acute kidney injury
Acute tubular injury (i.e. acute tubular necrosis)
45
Cause of acute tubular injury/necrosis
Ischemic or toxic injury to tubules
46
Chronic kidney injury is a broad term that describes the final common pathway of...
progressive nephron loss from any type of kidney disease

BLOCK D - RENAL (17 decks)

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