Renal pathology II Flashcards
what is the defining feature of focal segmental glomerulosclerosis (FSGS)? what is the cardinal feature?
- defining feature: proteinuria
- cardinal feature: progressive glomerular scarring
what is the progresesion of focal segmental glomerulosclerosis (FSGS)?
- early: glomerulosclerosis is focal and segmental
- late: diffuse and global
what is the primary cause of focal segmental glomerulosclerosis (FSGS)? secondary?
- primary: idiopathic
- secondary: virus, drug-induced, genetic, adaptive
what viruses are associated withfocal segmental glomerulosclerosis (FSGS)?
- HIV
- CMV
- EBV
- parvovirus B19
what drugs are associated with focal segmental glomerulosclerosis (FSGS)?
- heroin
- anabolic steroids
is hematuria associated with focal segmental glomerulosclerosis (FSGS)?
yes, but microscopic
what are the LM, IF, and EM findings for focal segmental glomerulosclerosis (FSGS)?
- LM: SEGMENTAL sclerosis
- IF: mild IgM and C3, or negative
- EM: diffuse epithelial cell injury (foot process effacement)
mild IgM and C3 in sclerotic areas are seen in IF for what disease?
focal segmental glomerulosclerosis (FSGS)
what renal disease is associated with “waxing and waning” proteinuria?
membranous glomerulonephropathy
what is the pathogenesis of membranous glomerulonephropathy?
deposition of Ag-Ab complexes
what are the LM, IF, EM findings in membranous glomerulonephropathy?
- LM: thickened capillary walls, “SPIKES” on silver stain
- IF: GRANULAR IgG and C3 along GBM
- EM: subepithelial deposits
spikes on silver stain are associated with what renal disease?
membranous glomerulonephropathy
what stain is used for membranous glomerulonephropathy? what are you looking for?
- silver stain
- spikes
how is membranoproliferative glomerulonephritis described?
usually nephrotic syndrome with a nephritic component (hematuria)
are steroids and immunosuppressive agents effective against membranoproliferative glomerulonephritis?
no
what is the pathogenesis of mesangiocapillary glomerulonephritis?
mesangial hypercellularity (proliferative component) + capillary wall remodeling (with formation of double contours)
membranoproliferative glomerulonephritis can be divided into what two types? what characterizes each type?
- type I: subendothelial deposits
- type II: intramembranous deposits
“tram tracks” are seen in what renal disease? what is their cause?
- membranoproliferative glomerulonephritis type I
- reduplication (splitting) of the GBM
what are the LM, IF, and EM findings in membranoproliferative glomerulonephritis type I?
- LM: tram tracks
- IF: granular C3 and often IgG
- EM: subendothelial and mesangial deposits interpositioned between endothelial cells and GBM
low serum C3 is seen in what renal disease?
membranoproliferative glomerulonephritis type II
70% of membranoproliferative glomerulonephritis type II have what factor? what is its function?
- C3 nephritic factor
- autoantibody which stabilizes C3 convertase, protecting it from enzymatic degradation
what is the pathogenesis of membranoproliferative glomerulonephritis type II?
persistent C3 activation and consumption causes hypocomplementemia and LOW serum C3
what are the LM, IF, and EM findings in membranoproliferative glomerulonephritis type II?
- LM: tram tracks
- IF: ONLY C3
- EM: intramembrane deposits in lamina densa
what is a common patient complaint for nephritis syndrome?
dark colored urine
acute nephritic syndrome is caused by what two descriptive pathological changes?
- diffuse proliferative glomerulonephritis
- crescentic glomerulonephritis
diffuse proliferative GN is associated with what pathogen?
post-strep GN
crescenteric GN is caused by what 3 diseases?
- goodpasture’s disease
- lupus nephritis
- ANCA associated diseases
post infectious acute GN shows what symptoms?
- hematuria
- azotemia
- oliguria
does acute post infection GN infect children or adults?
children
what are the LM, IF, and EM findings in post infection GN?
- LM: diffuse proliferative GN with neutrophils
- IF: scattered granular (“starry sky”) IgG, IgM, and C3 along GBM AND in masangium
- EM: subepithelial “humps” (IgG, IgM, C3 along GBM focally)
enlarged, hypercellular glomeruli with endothelial and mesangial cell proliferation - diagnosis?
acute post infection GN
starry sky pattern on IF for renal disease - diagnosis?
post infection GN
in crescenteric GN, where are the crescents?
cellular crescenteric proliferation of cells lining Bowman’s space
the crescents in crescenteric GN contain what components?
- anti GBM Abs
- ICs
- anti-PMN Ab
what is the pathogenesis of crescenteric GN?
- plasma constituents into Bowman’s space (coag factors, inflammatory mediators)
- fibrin forms
- proliferation of epithelial cells from the parietal wall of Bowman’s capsule
- influx of monocytes / macrophages
what are the 3 types of crescenteric GN? which type is associated with goodpasture’s disease?
- type I: anti-GBM
- type II: immune complex
- type III: pauci-immune
type I is associated with goodpasture’s disease
what is goodpasture’s disease?
autoimmune disease characterized by abnormal production of antibodies directed against type IV collagen which constitutes the GBM
goodpasture disease results in what symptoms / signs?
- vasculitis in lung and kidney
- pulmonary-renal syndome
goodpasture disease causes what condition in the kidney/
crescenteric GN type I
what will be elevated in goodpasture disease?
serum anti-GBM antibody
how is goodpasture disease treated?
- high dose steroids
- cytotoxic agents
- plasmapheresis
what is pauci-immune crescenteric GN?
group of vasculitic disorders especially affecting small vessels
pauci-immune crescenteric GN is associated with what Ab?
ANCA (anti-neutrophil cytoplasmic antibody)
wegener’s granulomatosis is an example of what GN?
pauci-immune crescenteric GN
rapidly progressive GN is mostly associated with what type of GN?
cresenteric GN
