RENAL PATHOLOGY 4 Flashcards

1
Q

This strong negative charge prevents negatively charged proteins like (1) from being filtered into the urinary space

A
  1. albumin
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2
Q

Immunological damage to the glomeruli can either produce predominantly (1) (nephrotic symptoms and signs) or predominantly (2) (nephritic symptoms and signs).

A
  1. mainly protein loss

2. bleeding and more severe injury

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3
Q

Clinically, patients with heavy proteinuria have the (1) syndrome which consists of proteinuria (usually 3.5 grams of protein in a 24 hour urine collection), (2)

A
  1. nephrotic

2. hypoalbuminemia, edema, hyperliipidemia, and lipiduria

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4
Q

The proteinuria leads directly to the (1) because the kidney is excreting the protein from blood into urine.

A
  1. hypoalbuminemia or low serum albumin
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5
Q

The hypoalbuminemia causes (2) because of the decreased plasma oncotic pressure from decreased serum proteins.

A
  1. edema (fluid within tissues)
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6
Q

The hyperlipidemia occurs because the (1) produces more (2) in the generalized response to produce more (3).

A
  1. liver
  2. lipoproteins
  3. albumin
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7
Q

(1) happens because of the increased lipoproteins carrying lipid and because of loss of the filtration barrier.

A
  1. Lipiduria (lipid in urine)
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8
Q

There can be extensive (1) in patients without any histopathological changes that can be seen by light microscopy (MCD/lipoid nephrosis)

A
  1. selective proteinuria
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9
Q

However, ultra-structural changes can be seen by electron microscopy generally show (1) in nephrotic syndrome in Minimal Change disease (MCD).

A
  1. loss of the epithelial podocyte foot processes
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10
Q

Minimal change disease (biopsy (1) is the most common cause of nephrotic syndrome in children. Children who do not develop any complications have a completely normal life span without any later renal disease.

A
  1. H&E stains- no change in glomeruli; hyaline (protein and lipid) droplets in tubular cells
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11
Q

Although the cause of minimal change disease is unknown, it is thought to be the result of (1) occurring in glomeruli

A

lymphokines of the T cells

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12
Q

Membranous nephropathy can be either primary (Anti-phospholipase A2 receptor antibody) or secondary from a disease which is producing (2) within the kidney

A
  1. antigens or immune complexes
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13
Q

Some of the secondary causes of secondary membranous nephropathy include inflammation disorders like (1)

A
  1. SLE, infections (IE), drugs (gold, penicillamine), and adenocarcinomas, DM
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14
Q

An experimental animal model called Heymann nephritis suggest that (1) are more often present first in the (2) or surrounding cells before the (3) arrive to form immune complexes.

A
  1. antigens
  2. basement membrane
  3. antibodies
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15
Q

Light microscopy can show (1) in membranous nephropathy (silver stains show (2) material so they can show immune complexes as areas where the silver stain is lost)

A
  1. thickened basement membranes

2. basement membrane

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16
Q

Electron microscopy of membranous nephropathy shows antigen-antibody complexes present in the subepithelial region between the (1)

A
  1. basement membrane and the podocyte
17
Q

The course of membranous nephropathy is

A
  1. CRF to end stage renal disease
18
Q

Most common (adult) cause of nephrotic syndrome is (1)

A
  1. focal segmental glomerulosclerosis (FSGS)
19
Q

Immune microscopy in membranous nephropathy can show the presence of (1) antibody or (2) components including (3) and the components of the (4) which actually causes the injury

A
  1. IgG
  2. complement
  3. C3
  4. membrane attack complex (C5b, C6-C9)
20
Q

GBM predominantly of _____
2. Also laminin, fibronectin, and glycosaminoglycans.
Relative exclusion of negatively charged molecules such as albumin due to _____

A

type IV collagen;

polyanionic glycosaminoglycans, (heparan sulfate).

21
Q

IgA deposit location

A

Mesangium

22
Q

How is edema caused in nephrotic syndrome: 2 causes

Dec. _____ due to loss of albumin;

  1. fluid escapes into tissues causing edema;
  2. Dec. onc. pressure leads to dec. ____ –> dec. ____ –> INC. _____–> fluid retention–> edema
A

Dec. plasma oncotic pressure due to loss of albumin; 1. fluid escapes into tissues causing edema; 2. Dec. onc. pressure leads to dec. plasma volume –> dec. GFR –> INC. aldosterone–> fluid retention–> edema

23
Q

Min. change disease -Occasional association with ___
and with ____ has led to the
speculation that it is a T lymphocytes disorder

A

Hodgkin disease; atopic asthma etc

24
Q

Minimal change disease
Light microscopy:
EM:
Immunofluoresence for immunoglobulins (IF) and complement:

A

Light microscopy: Normal
Electron microscopy: diffuse obliteration of podocyte foot processes
IF–> negative

25
Q

In intermediate disease stages, silver stains (which demonstrate basement membrane
material) reveal multiple projections or “spikes” on the epithelial surface of BM

A

Membranous nephropathy

26
Q

M embranous Nepropathy

Immunofluorescence microscopy reveals ____ staining of capillary walls for IgG and C3. There is intense staining for terminal complement components, including
the _____, which induces glomerular injury

A

diffuse granular; membrane attack complex;

27
Q

Membranous glomerulopathy. Caused by the ____ accumulation of immune complexes and the accompanying changes in the ____.

A

subepithelial; basement membrane (BM)

28
Q

IF- linear deposit see in glomeruli in_______

A

Type II hypersensitivity, Anti-GBM disease-aka CrGN (type 1)

29
Q

FEATURES OF Glomerulus in DM

A

Nodular (PAS positive DEPOSIT) nephrosclerosis

30
Q

Risk factors- FSGS

A

HIV, OBESITY, ETC.

31
Q

C3 NEPHRITIC FACTOR POSTIVE SERUM- GLOMERULAR FINDINGS

A

DENSE DEPOSIT

32
Q

DEPOSIT OF IGG, IGM, AND C3 IN GLOMERULI, INFECTION BY____

A

INFECTION WITH GROUP A-STREPTOCOCCI

33
Q

RESP. INFECTION FOLLOWED BY HEMATURIA- POSSIBLE CONDITION

A

IGA NEPHROPATHY

34
Q

INFECTION, ATHEROSCLEROSIS, AND DVT- POSSIBLE COMPLICATIONS OF_______

A

NEPHROTIC SYNDROME

35
Q

NON SELECTIVE PROTENIRIA

A

FSGS

36
Q

HEMATURIA AND +4 PROTEINURIA

A

FSGS AND MGN