Renal 5 Flashcards
What is seen in this photo?
“frog head”
Arrow is pointing to subepithelial side with a “hump”
- Immune complex (IgG complement/dead protein from strep)
- From head: Segmented nucleus, and lysosomes,(specific/non-specific neutrophils) jammed up against capillary loop
(to dx acute post strep GMN)
What type of stain is this?
- Millions of immune complexes on subepithelial side
- Allows RBC into uroniferous space
- IF-C3 Granular Staining (Lumpy-Bumpy)
- Nephritic!
Classic case of what?:
- young child w/ abrupt onset of malaise, fever, nausea, oliguria, hematuria, cola urine one to two weeks after recovering from sore throat
- Red cell casts in urine, mild proteinuria, periorbital edema, mild HTN
Acute Post-Strep GMN
(sxs of nephritic syndrome)
What are the 4 sxs of pt w/ nephritic syndrome / Post strep GMN?
- Cola colored urine
- Periorbital edema in the morning
- Edema
- Mild HTN
95% of children recover from Acute Post-Strep GMN / Nephritic Syndrome, and only 1 - 2 % will develop what?
Rapidly Progressive GMN
Patients who have Rapidly Progressive GMN will develop what?
Crescent Formation
Bowmans capsule compressing the tuft. Both kidneys will die within hours. Must get dialysis quickly or pt will die.
Crescent Formation of Acute Post Strep GMN / Rapidly Progressive GMN
Crescent Formation
Usually occurs after focal necrosis of the glomerular capillaries in diseases such as Goodpastures Syndrome
Rapidly Progressive (Cresentic) GMN
Which condition does NOT lead to crescent formation?
Minimal Change Disease (Nils)
How are crescents formed?
Inflammatory cells surround the compressed capillary loops in the form of a crescent moon
Crescentic Glomerulonephritis
- Autoimmune disease characterized by formation of antibodies to the body’s own basement membrane components (collagen type 4)
- Which 2 organs are affected?
- Goodpastures Syndrome
- Lungs & Kidneys
- Lungs injured –> intraalveolar hemorrhage
- In glomeruli, antibodies cause rupture of BM, so macrophages exit through holes of BM
- Macrophages accumulate in urinary space (forming crescents that compress capillary loops)
Goodpastures Syndrome
Goodpastures Syndrome w/ intra-alveolar hemorrhage
(brown macrophages in the lungs bc/ of iron)
“ribbon pattern”
- Goodpastures Syndrome w/ LINEAR deposits in Glomerulus
- (no immune complex here! that would be called “lumpy bumpy”)
W/ Goodpastures Syndrome, no blood is flowing through the compressed capillary loops, so what results?
Glomerular filtration ceases, causing anuria
- What is the prognosis of Goodpastures Syndrome?
- Treatment?
- Most patients never recover.
- Survival depends on continuous dialysis or transplantation
What 4 conditions lead to crescent formation?
- Wegeners
- PAN (Polyarteritis nodosa)
- Acute Post Strep GMN
- Goodpastures Syndrome
- Characterized clinically by: Nephrotic Syndrome
- Pathologically by: fusion of visceral epithelial foot processes (podocytes)
- Most common cause of nephrotic syndrome in kids (protein spilled in urine)
Minimal Change Disease (Nils)
- What is seen on Light Microscopy for Minimal Change Disease (Nils)?
- What is seen on IF?
- Light: Glomeruli show NO CHANGES, hence name for Nils
- IF: the glomeruli do not contain deposits of immunoglobulins
“Jigsaw Puzzle”
- Minimal Change Disease (Nils)
- Fusion of foot processes (podocytes)
- “Effacement”
“stained glass”
Minimal Change Disease (Nils)
Stained Glass
Minimal Change Disease
In which condition is the proteinuria generally more selective than other types of Nephrotic Syndrome?
Minimal Change Disease
Over 90% of children / slightly fewer adults who have Minimal Change Disease have complete remission of _______ within ___ weeks of initiation of ______ therapy.
- proteinuria
- 8 weeks
- corticosteroid
What is the #1 cause of Nephrotic Syndrome in adults? (Spilling of proteins)
Membranous Glomerulonephritis
Immune mediated glomerulopathy characterized by diffuse thickening of the glomerular basement membrane secondary to massive deposition of immune complexes
Membranous Glomerulonephritis
- No evidence of ANY inflammatory cells in glomeruli
- Urine is DEVOID of RBCs (like acute post strep GMN)
Membranous Glomerulonephritis
Thick strings w/ pepper
Membranous Glomerulonephritis
(shows capillary loops w/ thick walls)
Unlike Acute Post Strep GMN, Membranous GMN causes what?
Nephrotic Syndrome
Membranous GMN
- Etiology?
- Light Microscopy:
- EM:
- IF:
- 85% idiopathic
- Light: glomeruli w/ thickened BMs, but are normocellular
- EM: thickening of BM attributed to deposition of dense immune complexes = lumpy bumpy
- IF: granularity of deposits
Looks like brain
Membranous Glomerulonephritis
Avocado
Membranous GMN w/ deposits of immune complexes
Sandy Ribbons
Membranous Glomerulonephritis Granular Deposits of IgG = Lumpy Bumpy
- Typical signs/sxs of Nephrotic Syndrome
- When followed 20 yrs,
- 25% pts have _____
- 50% have _____ w/ stable renal function
- 25% develop ______
- Membranous GMN
- 25% have spontaneous remission
- 50% have persistent proteinuria
- 25% develop End Stage Renal Failure
Membranous GMN
- Treatment?
- Prognosis?
- Corticosteroids for those w/ progressive renal failure
- Prognosis better in children (higher rate of remission)
Which forms of Glomerular Disease can become chronic?
ALL 17
- Important cause of end-stage renal disease (presenting as chronic renal failure)
- Most, if not all immune mediated glomerulopathies can progress to this end-stage disease, terminating in uremia (ammonia circulating which can go to brain and cause ____.)
- Chronic Glomerulonephritis
- Can cause coma.
- Grossly, kidneys are symmetrically shrunken
- Surfaces are finely granular because of loss of ____.
- Chronic Glomerulonphritis
- Tubules
Chronic Glomerulonephritis
- Histologically, the glomeruli have undergone hyalinization and appear as solid globules of homogenized matrix
- Marked interstitial fibrosis, tubular atrophy, & thick walled arteries w/ narrowed lumina
- Pts aware bc of/ which 4 things?
Chronic Glomerulonephritis
- Proteinuria
- Azotemia (nitrogen in blood)
- HTN
Edema
“eye patch”
Chronic Glomerulonephritis
(sclerosed, hyalinized glomeruli)
- Dead glomerulus & live one (the pretty one with the white streaks is still alive)
Jelly beans
Chronic Glomerulonephritis
(atrophic dilated tubules)
