Renal Pathology Flashcards
To master the USMLE First Aid Section on nephritic and nephrotic syndromes.
Nephritic/ nephrotic syndrome presents with massive proteinuria (>3.5g/day, frothy urine), hyperlipidemia, fatty casts, and edema. It is associated with thromboembolism (hypercoaguable state due to ________ loss in urine) and increased risk of infection due to loss of ________.
NephrOtic syndrome = massive prOteinuria. Thromboembolism = hypercoaguable state due to antithrombin III loss in urine. Increased risk of infection due to loss of immunoglobulins.
What is the most common cause of nephrotic syndrome in adults?
Focal Segmental Glomerulosclerosis
Based off the following light microscopy picture of a glomerulus, which nephrotic syndrome is being represented? On electron microscopy, this same process would show _________ of foot processes.
Focal segmental glomerulosclerosis is represented based of the focused areas of sclerosis visible in the glomerulus.
Effacement of foot processes
Remember it’s associations: HIV infection, heroin abuse, massive obesity, interferon treatment, chronic kidney disease due to congenital absence or surgical removal.
Image from Wikipedia - http://en.wikipedia.org/wiki/File:Focal_segmental_glomerulosclerosis_-_high_mag.jpg
What causes the following nephrotic syndrome represented in the picture? (Multiple answers)
__________________.
What is the characteristic description of the electron microscopy image of the same process?
_________________.
The picture represents membranous nephropathy. Causes include drugs, infection, SLE, and solid tumors.
“Spike and dome” on EM due to subepithelial deposits.
Image citation: http://dxline.info/diseases/membranous-glomerulonephritis
A 10 year old boy comes in with massive proteinuria. About one month ago he had a minor viral infection. The glomeurli appear normal on light microscopy, but there is foot process effacement on electron microscopy. What is the best treatment? ___________. Why is there selective loss of albumin and not globulins? ___________
This child is presenting with Minimal Change Disease or Lipoid nephrosis. The best treatment is corticosteroids.
The selective loss is due to glomerular basement membrane polyanion loss.
- Image Citation:*
http: //www.merckmanuals.com/professional/multimedia/v1054890.html?Ref=t&ItemId=v1054890&RefId=genitourinary_disorders/glomerular_disorders/minimal_change_disease&Speed=256&Plugin=WMP&Error=
What conditions are associated with this description of a glomerulus under light microscopy: Congo red stain shows apple-green birefringence under polarized light?
Nephrotic syndrome - Amyloidosis is represented.
Chronic conditions associated with this amyloidosis include multiple myeloma, TB, RA.
- Image Citation:*
http: //www.pathology.vcu.edu/education/PathLab/pages/renalpath/rpsr/images/amyloid_sr/
Membranous proliferative glomerulonephritis is a form of nephrotic syndrome that presents as two types.
Type I contains subendothelial IC deposits with granular IF. It has a “tram-track/ dense deposit” appearance due to GBM splitting caused by mesangial ingrowth and is associated with what two conditions?
Type II has a “tram-track/ dense deposits” appearance due to intramembranous IC deposits and is associated with __________?
Type I has a “tram-track” appearance and is associated with HBV and HCV.
Type II has a “dense deposit” appearance and is associated with C3 nephritic factor.
A 68 year old obese patient presents with a fasting blood glucose of 283 and extensive trauma and damage to his feet, as well as loss of sensation to the distal lower extremities on physical exam. If the same disease process has affected his kidneys, what might his glomeruli look like and why?
This patient is suffering from diabetes. The kidneys will have evidence of diabetic glomerulonephropathy. This causes nonenzymatic glycosylation of the GBM, which leads to increased permeability and thickening. The glycosylation of efferent arterioles leads to an increase in GFR, which leads to mesangial expansion.
The disease presents with Kimmelstiel-Wilson lesions on light microscopy due to mesangial expansion, GBM thickening, and eosinophilic nodular glomerulosclerosis
What is the general amount of proteinuria in the description for nephritic syndrome?
<, >, or = 3.5g/day
Nephritic syndrome is an inflammatory process. The answer is LESS THAN 3.5g/day. Remember nephrItic = Inflammatory. When involving glomeruli, there will be hematuria and RBC casts in urine. It is associated with azotemia, oliguria, and hypertension (due to salt retention).
An 8 year old boy comes in with edematous eyes and complaints of dark urine. He has history of recent cough, fever, and abdominal pain, but without sore throat. What is the most likely cause of this patient’s current symptoms?
On electron microscopy of the glomerulus, what causes the humpy appearance?
Acute poststreptococcal glomerulonephritis. Mostly seen in children, and also includes hypertension as a symptom.
This nephritic syndrome resolves spontaneously and CANNOT be prevented by treating Strep throat with antibiotics. Only Rheumatic fever is prevented by treatment of Strep throat with antibiotics.
On light microscopy the glomeruli appear enlarged and hypercellular with neutrophils and a “lumpy-bumpy” appearance.
Subepithelial immune comples humps cause the lumpy appearance on electron microscopy.
On immunofluorescence, granular appearance is due to IgG, IgM, and C3 deposition along GBM and mesangium.
This nephritic syndrome has a poor prognosis. The renal function deteriorates within days to weeks. What shape can be seen on light microscopy and immunofluorescence of the glomeruli?
These shapes consist of _______ and ________, with glomerular parietal cells, monocytes, and macrophages.
Rapidly progressive (crescentic) glomerulonephritis (RPGN).
The shapes seen are crescent-moon.
They consist of fibrin and plasma proteins (C3b).
- Image citation:*
http: //quizlet.com/2019303/glomerular-pictures-flash-cards/
True/False: Goodpasture’s syndrome, Granulomatosis with polyangitis (Wegener’s), and Microscopic polyangiitis are all disease processes that may result in Rapidly progressive glomerulonephritis.
True.
What type of hypersensitivity is Goodpasture’s syndrome?
What symptoms are common with this disease?
What do antibodies form against to create a linear appearance on immunfluorescence of the glomeruli?
Type II hypersensitivity with antibody formation.
Symptoms include hematuria and hemoptysis.
Antibodies form against Glomerular basement membrane and alveolar basement membrane.
Granulomatosis with polyangiitis or Wegener’s involves _________ (c-ANCA or p-ANCA).
Microscopic polyangiitis involves __________ (c-ANCA or p-ANCA).
Wegener’s = c-ANCA
Microscopic polyangiitis = p-ANCA
Determine the syndrome and fill in the blank accordingly.
This nephritic syndrome remains the most common cause of death in SLE.
On light microscopy, one can see “___________” of capillaries.
Diffuse proliferative glomerulonephritis (DPGN).
“wire-looping” of capillaries.
On electron microscopy, there is subendothelial and sometimes intramembranous IgG-based ICs often with C3 deposition.
