Ren 7 - Nephrosis And Nephritis Flashcards
What would be the terminology for a kidney biopsy with less than half of the glomeruli are affected?
Focal.
What would be the terminology for a kidney biopsy with more than half of the glomeruli are affected?
Diffuse.
What would be the terminology for a kidney disease when the basement membrane is thickened in a biopsy?
Membranous.
What is the difference between primary glomerular disease and secondary glomerular disease?
Primary is only the kidneys and secondary is more of a systemic disease.
What is the difference between nephrosis versus nephritis?
Nephrosis: More than 3.5 grams of protein in urine during the day; heavy proteinuria.
-Nephritis: Less than 3.5 g of protein in urine per day.
What are the symptoms of nephritis?
- Light proteinuria.
- Hematuria.
- RBC casts.
- Azotemia.
- Hypertension.
- Decreased urine volume.
What type of reaction causes post-streptococcal glomerulonephritis?
Type III hypersensitivity: Immune complexes that are deposited in the glomerulus.
When does post-strep glomerulonephritis happen?
In 1 to 3 after Group A strep streptococcal infection.
What would we see in kidney biopsy in post-strep glomerulonephritis?
Hypercellular glomeruli and neutrophils.
What do we see in electron microscope in post-strep glomerulonephritis?
Subepithelial humps on the top of the basement membrane and inside the podocyte foot processes.
What happens to the complement C3 levels in post strep glomerulonephritis?
They decrease due to the activation of complements.
What does Anti-streptolysin O titer check for and what does it overlook? What must we test for what was overlooked?
The anti-streptolysin O titer checks if you did infact have a strep throat and/or pharyngitis. However, it may not be elevated in cases of strep impetigo, which can still cause strep glomerulonephritis.
-In cases of strep impetigo, we must use Anti-DNase B that is elevated in both strep impetigo and strep throat.
What substance is elevated in both strep throat and strep impetigo?
Anit-DNase B.
What is another name for IgA nephropathy?
Berger disease.
What type of vasculitis is IgA nephropathy associated with?
Henoch-Schonlein purpura.
What are the symptoms of Henoch-Schonlein purpura?
Classic triad:
- Purpura: usually on legs and buttocks.
- Arthritis.
- Abdominal pain.
What is the pathophysiology of IgA nephropathy?
There is an increase in IgA serum, and IgA immune complexes get deposited in the mesangium of the glomerulus. There is also a proliferation of mesangial cells.
What are the symptoms of IgA nephropathy?
- Hematuria.
- RBC casts.
- Flares up after URI.
What is the pathophysiology of Alport syndrome?
Defect in type IV collagen (basement membrane). On kidney basement membrane, they thin out and widen into two.
What are the symptoms of Alport syndrome?
[Can’t see, can’t pee, can’t hear a high C]
- Eye problems.
- Nephritis.
- Deafness.
What is another name for rapidly progressive glomerulonephritis?
Crescentic glomerulonephritis.
What is the pathophysiology of Goodpasture syndrome?
Type II hypersensitivity: Antibodies against the glomerular basement membrane. It attacks both the kidneys and the lungs.
What are the two disease that attack both the kidneys and the lungs?
- Goodpasture syndrome.
2. Granulomatosis with polyangiitis (GPA)
What lab finding is positive in Granulomatosis with polyangiitis (GPA)?
-Positive PR3-ANCA/c-ANCA.
What lab finding is positive in Microscopic polyangiitis?
-Positive p-ANCA/MPO-ANCA.
What are four disease that cause rapidly progressive glomerulonephritis?
- Goodpasture syndrome.
- Granulomatosis with polyangiitis (GPA).
- Microscopic polyangiitis.
- Lupus.
What is the most common, most severe form of lupus nephritis?
Diffuse Proliferative Glomerulonephritis.
What lab finding is associated with lupus nephritis?
Anti-dsDNA.
What is finding of lupus nephritis in light microscopy?
Anti-dsDNA antibodies lines the mesangium and subendothelially. These deposits line the basement membrane, making a wire-loop appearance in light microscopy.
What are symptoms of nephrotic syndrome?
- Proteinuria greater than 3.5 gram a day.
- Hypoalbuminemia.
- Edema.
- Increased risk of infection.
- Increased risk of thrombosis
- Hyperlipidemia.
What type of kidney disease is minimal change disease?
Nephrotic syndrome.
What is the most common cause of nephrotic syndrome in children?
Minimal change disease.
What are the causes of minimal change disease?
- Most common cause of nephrotic syndrome in children.
- Triggered by infections or immunizations.
- There is abnormal podocyte foot processes.
What is the treatment for minimal change disease?
Corticosteroids.
What is the most common cause of nephrosis in adults?
Focal segmental glomerulosclerosis.
-More prevalent in blacks and latinos.
What would be the most common type of nephrotic syndrome in HIV patients?
Focal segmental glomerulosclerosis.
What does membranous nephropathy cause to the basement membranes?
- Thickening of the basement membranes.
- Domes caused by subepithelial immune complex deposits.
- Causes “spike and dome” appearance: Thickened basement pushing between the domes.
What histological difference do we see between membranoproliferative GN, post strep GN, and membranous nephropathy?
- Membranoproliferative GN: Subendothelial humps.
- Post strep GN: Subepithelial humps.
- Membranous nephropathy: Subepithelial domes.
What histological changes do we see in membranoproliferative glomerulonephritis?
- IgG immune complexes that cause subendothelial humps.
- Tram track (double glomerular basement membrane).
- Anormal foot processes.
What are some pathologies that can cause membranoproliferative glomerulonephritis?
- Hepatitis C.
- Hepatitis B.
- Lupus.
- Subacute bacterial endocarditis.
How does diabetes affect the kidneys?
Causes non-enzymatic glysycolation of basement membrane, making it thick and disfunctional (in form of Kimmelstiel-Wilson nodules) and arterioles, causing the mesangium to proliferate.
- Causes progressive proteinuria.
- Causes
Which part of the kidney does the amyloid deposit in amyloidosis?
At the mesangium.
What stain do we use for amyloidosis?
Congo red stain.
What disease causes linear pattern of IgG deposition on Immunoflourescence?
Goodpastrue syndrome.
What disease causes lumpy-bumpy deposits of IgG, IgM, and C3 in the mesangium in kidneys?
Poststreptococcal glomerulonephritis.
What disease causes deposits of IgA in the mesangium?
IgA nephropathy.
What disease causes anti-GBM antibodies, hematuria, and hemoptysis?
Goodpasture syndrome.
What disease causes nephritis, deafness and cataracts?
Alport syndrome.
What disease cause crescent formation in the glomeruli?
Rapidly progressive glomerulonephritis.
What disease causes wire-loop apperance on light microscopy?
Lupus nephritis which causes diffuse Proliferative glomerulonephritis.
What disease causes Kimmelstiel-Wilson lesions (nodular glomerulosclerosis)?
Diabetic nephropathy.
What disease causes effacement of epithelial foot processes on electron microscopy?
Minimal change disease.
What disease is a nephrotic syndrome associated with hepatitis B?
Membranoproliferative glomerulonephritis.
What nephrotic syndrome is associated with HIV?
Focal segmental glomerulosclerosis.
What disease has subendothelial humps and tram-track appearance on EM (electron microscopy)?
Membranoproliferative glomerulonephritis.
What disease is associated with segmental sclerosis and hyalinosis on LM (light microscopy)?
Focal segmental glomerulosclerosis.
What disease is associated with purpura on back of arms and legs, abdominal pain, IgA nephropathy?
Henoch-Schonlein purpura.
What disease causes apple-green birefringence with Congo red stain under polarized light?
Amyloidosis.
What disease causes spiking of the GBM due to subepithelial deposits on EM?
Membranous nephropathy.
RFF: Nodular hyaline deposits in the glomeruli.
Kimmelstiel-Wilson nodules (diabetic nephropathy).
RFF: Glomerulonephritis plus pulmonary vasculitis.
- Granulomatosis w/ polyangiitis.
2. Goodpasture syndrome.
