Renal pathology Flashcards
What is the difference between focal, diffuse, segmental and global glomerular lesions?
Focal=Less than 50% of all glomeruli involved
Diffuse=More than 50% of all glomeruli involved
Segmental= Less than 50% of each individual glom involved
Global= More than 50% of each individual glom involved
What are the common pathogeneses of primary glomerular disease?
Autoimmune conditions such as Good-Pasture syndrome directed against the glom itself.
Antibody against something has been deposited in the glomerulus.
Deposition of a circulating Ag-Ab immune complex
What are some common causes of secondary glomerular disease?
SLE HTN DM vasculitis sarcoidosis
What histological changes can occur within the glomerulus to indicate damage?
Hypercellularity- Proliferation of mesangial, endothelial and epithelial cells. Leukocyte infiltration. Formation of crescents indicating accumulation of cells in Bowman’s space.
Basement membrane thickening-accumulation of immune complexes
Hyalinisation and sclerosis
What are the signs and symptoms of glomerulonephritis?
Haematuria, increase creatinine, increase urea, oliguria
What are the two main types of acute glomerulonephritis?
Post-infectious and necrotising
What is the most common age age group and causative agent of post-infectious acute glomerulonephritis?
Children mostly.
Anti-strep antibodies
What are the 3 main types of necrotising acute glomerulonephritis?
1) anti-GBM
2) Immune complex mediated
3) ANCA associated
What is nephrotic syndrome?
Nephrotic syndrome is characterized by a massive renal loss of protein (> 3.5 g/day) resulting in edema, hypercoagulability (antithrombin III deficiency), and an increased risk of infection (loss of immunoglobulins). Typical laboratory findings of nephrotic syndrome include hyperlipidemia and fatty casts on urinalysis.
What are the 3 most common causes?
Membranous nephropathy
Minimal change disease
Focal segmental glomerular sclerosis
What is membranous nephropathy? Who does it affect? What are it’s causes? How doe sit present on microscopy? How is it managed?
The most common cause in white adults leading to diffuse thickening of the GBM.
Primary- anti-phospholipase a2 antibodies can lead to primary membranous nephropathy. Secondary can be due to SLE, hepatitis B and C and medications.
LM: glomerular capillary loops and basement membrane appear thickened
IM: subepithelial deposits
EM: subepithelial dense deposits (“spike and dome appearance”)
Corticosteroids
What is minimal change disease? Who does it affect? What are it’s causes? How does it present on microscopy? How is it managed?
Most common in children. Can be associated with Hodgkin lymphoma. LM: no changes EM: effacement of the foot processes Corticostroids
What is focal segmental glomerular sclerosis? Who does it affect? What are it’s causes? How does it present on microscopy? How is it managed?
Most common cause of nephrotic syndrome in black populations. Potentially due to high prevalence of APOL1 gene which protects from trypanosomiasis. Can be associated with heroin abuse, HIV infection, obesity, and sickle cell disease.
LM: segmental sclerosis
IM: IgM and C3 inside the sclerotic regions
EM: effacement of the foot processes
Poor response to corticosteroids
What is IgA nephropathy?
A condition in which mesangial IgA immune complex deposits lead to glomerulonephritis. Typically presents in patients in their 2nd to 3rd decade of life with microhematuria and episodic gross hematuria during/directly after upper respiratory tract/gastrointestinal infections or strenuous exercise.
What is Alport syndrome?
A genetic disorder that is characterized by glomerulonephritis, often in combination with sensorineural hearing loss and, in some cases, eye abnormalities. It is caused by a genetic defect of type IV collagen, which is usually inherited in an X-linked dominant pattern. The disorder, therefore, usually affects boys.
