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Patho 3 Shea > Renal 5 > Flashcards

Renal 5 Flashcards

1
Q

What is seen in this photo?

“frog head”

A

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)

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2
Q

What type of stain is this?

  • Millions of immune complexes on subepithelial side
  • Allows RBC into uroniferous space
A
  • IF-C3 Granular Staining (Lumpy-Bumpy)
  • Nephritic!
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3
Q

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
A

Acute Post-Strep GMN

(sxs of nephritic syndrome)

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4
Q

What are the 4 sxs of pt w/ nephritic syndrome / Post strep GMN?

A
  • Cola colored urine
  • Periorbital edema in the morning
  • Edema
  • Mild HTN
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5
Q

95% of children recover from Acute Post-Strep GMN / Nephritic Syndrome, and only 1 - 2 % will develop what?

A

Rapidly Progressive GMN

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6
Q

Patients who have Rapidly Progressive GMN will develop what?

A

Crescent Formation

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7
Q

Bowmans capsule compressing the tuft. Both kidneys will die within hours. Must get dialysis quickly or pt will die.

A

Crescent Formation of Acute Post Strep GMN / Rapidly Progressive GMN

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8
Q
A

Crescent Formation

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9
Q

Usually occurs after focal necrosis of the glomerular capillaries in diseases such as Goodpastures Syndrome

A

Rapidly Progressive (Cresentic) GMN

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10
Q

Which condition does NOT lead to crescent formation?

A

Minimal Change Disease (Nils)

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11
Q

How are crescents formed?

A

Inflammatory cells surround the compressed capillary loops in the form of a crescent moon

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12
Q
A

Crescentic Glomerulonephritis

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13
Q
  • Autoimmune disease characterized by formation of antibodies to the body’s own basement membrane components (collagen type 4)
  • Which 2 organs are affected?
A
  • Goodpastures Syndrome
  • Lungs & Kidneys
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14
Q
  • 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)
A

Goodpastures Syndrome

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15
Q
A

Goodpastures Syndrome w/ intra-alveolar hemorrhage

(brown macrophages in the lungs bc/ of iron)

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16
Q
A

“ribbon pattern”

  • Goodpastures Syndrome w/ LINEAR deposits in Glomerulus
  • (no immune complex here! that would be called “lumpy bumpy”)
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17
Q

W/ Goodpastures Syndrome, no blood is flowing through the compressed capillary loops, so what results?

A

Glomerular filtration ceases, causing anuria

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18
Q
  • What is the prognosis of Goodpastures Syndrome?
  • Treatment?
A
  • Most patients never recover.
  • Survival depends on continuous dialysis or transplantation
19
Q

What 4 conditions lead to crescent formation?

A
  • Wegeners
  • PAN (Polyarteritis nodosa)
  • Acute Post Strep GMN
  • Goodpastures Syndrome
20
Q
  • 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)
A

Minimal Change Disease (Nils)

21
Q
  • What is seen on Light Microscopy for Minimal Change Disease (Nils)?
  • What is seen on IF?
A
  • Light: Glomeruli show NO CHANGES, hence name for Nils
  • IF: the glomeruli do not contain deposits of immunoglobulins
22
Q

“Jigsaw Puzzle”

A
  • Minimal Change Disease (Nils)
  • Fusion of foot processes (podocytes)
  • “Effacement”
23
Q

“stained glass”

A

Minimal Change Disease (Nils)

24
Q

Stained Glass

A

Minimal Change Disease

25
Q

In which condition is the proteinuria generally more selective than other types of Nephrotic Syndrome?

A

Minimal Change Disease

26
Q

Over 90% of children / slightly fewer adults who have Minimal Change Disease have complete remission of _______ within ___ weeks of initiation of ______ therapy.

A
  • proteinuria
  • 8 weeks
  • corticosteroid
27
Q

What is the #1 cause of Nephrotic Syndrome in adults? (Spilling of proteins)

A

Membranous Glomerulonephritis

28
Q

Immune mediated glomerulopathy characterized by diffuse thickening of the glomerular basement membrane secondary to massive deposition of immune complexes

A

Membranous Glomerulonephritis

29
Q
  • No evidence of ANY inflammatory cells in glomeruli
  • Urine is DEVOID of RBCs (like acute post strep GMN)
A

Membranous Glomerulonephritis

30
Q

Thick strings w/ pepper

A

Membranous Glomerulonephritis

(shows capillary loops w/ thick walls)

31
Q

Unlike Acute Post Strep GMN, Membranous GMN causes what?

A

Nephrotic Syndrome

32
Q

Membranous GMN

  • Etiology?
  • Light Microscopy:
  • EM:
  • IF:
A
  • 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
33
Q

Looks like brain

A

Membranous Glomerulonephritis

34
Q

Avocado

A

Membranous GMN w/ deposits of immune complexes

35
Q

Sandy Ribbons

A

Membranous Glomerulonephritis Granular Deposits of IgG = Lumpy Bumpy

36
Q
  • Typical signs/sxs of Nephrotic Syndrome
  • When followed 20 yrs,
    • 25% pts have _____
    • 50% have _____ w/ stable renal function
    • 25% develop ______
A
  • Membranous GMN
  • 25% have spontaneous remission
  • 50% have persistent proteinuria
  • 25% develop End Stage Renal Failure
37
Q

Membranous GMN

  • Treatment?
  • Prognosis?
A
  • Corticosteroids for those w/ progressive renal failure
  • Prognosis better in children (higher rate of remission)
38
Q

Which forms of Glomerular Disease can become chronic?

A

ALL 17

39
Q
  • 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 ____.)
A
  • Chronic Glomerulonephritis
  • Can cause coma.
40
Q
  • Grossly, kidneys are symmetrically shrunken
  • Surfaces are finely granular because of loss of ____.
A
  • Chronic Glomerulonphritis
  • Tubules
41
Q
A

Chronic Glomerulonephritis

42
Q
  • 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?
A

Chronic Glomerulonephritis

  • Proteinuria
  • Azotemia (nitrogen in blood)
  • HTN
    Edema
43
Q

“eye patch”

A

Chronic Glomerulonephritis

(sclerosed, hyalinized glomeruli)

  • Dead glomerulus & live one (the pretty one with the white streaks is still alive)
44
Q

Jelly beans

A

Chronic Glomerulonephritis

(atrophic dilated tubules)

Patho 3 Shea (19 decks)

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