Renal histopathology Flashcards
Minimal change
LM: normal
Immuno: normal, possibly a bit of mesangial IGM
EM: effacement (flattening) podocyte foot processes
FSGS
LM: segmental solidification of the glomerular tuft, affected glomeruli capillaries are segmentally obliterated by accumulation of acellular matrix and hyaline deposits. Coarsely granular deposits of IgM and C3. No immune deposits or cellular proliferation in majority
EM: effacement foot processes (same as MCD)
collapsing variant FSGS associated with…
HIV
membranous GN
diffuse thickening GBM- subepithelial usually.
EM: stain C3 and IgG
MPGN= mesangiocapillary GN
mesangial hypercellularity
endocapillary proliferation
duplication of glomerular BM–> double contours
Ig + and C’ + on staining
Scleroderma renal crisis looks like
onion skin narrowing of arterioles
glomerular ischaemia
NO immune complex deposition
NO inflammatory changes
IgA nephropathy
MPGN with IgA dominant mesangial immune deposits
mesangial hypercellularity
Can see tram track appearance.
IF:
Immune complex mediated eg cryoglobulinaemia, SLE, HCV–>STAIN IgG and C1 (classical pathway)
Complement mediated: NO IgG but C3 (alternative pathway)
with hepatitis see subep and subend deposits
Post infectious
LM: inflammatory infiltrate and hypercellularity. Vessels ok. Big Gloms. A few crescents
Immuno: 1st 2 weeks IgG and C3 granular pattern of glomerular capillaries and mesangium. NOT IgA
EM: subepithelial immune deposits
Anti-GBM disease
This is type 1 RPGN:
Diffuse necrotising crescentic GN
Linear deposits of IgG (5-20%)
Lupus nephritis; focal proliferative, diffuse proliferative
subendothelial immune deposits/wire loops hypercellularity leukocyte infiltration fibrinoid necrosis full house of IF hyaline thrombi
Class 1 lupus nephritis
LM normal
IF immune complex deposits
EM electron dense deposits
Class 2 lupus
LM: mesangial hypercellularity
IF: mesangial immune complexes
Class 5 lupus nephritis
thick BM
subepithelial immune deposits
What should you do if crescentic GN without immune complexes or anti GBM Ab?
Think pauci immune crescentic GN due to GPA, MRA, Churg Strauss
5 key features of HIV associated nephropathy
normal to large kidneys massive proteinuria FSGS findings on renal biopsy normotension elevated urea and creatinine
