Renal Pathology - Nephritic Syndromes Flashcards
Nephritic syndrome pathogenesis (2):
- Inflammatory rupture of glomerular capillaries
- Bleeding into urinary space
Nephritic syndrome clinical findings (6):
- Hematuria
- Red cell casts in urine
- Oliguria
- Azotemia
- HTN
- Possible proteinuria and edema
Diseases primarily nephritic (3):
- Acute proliferative (poststreptococcal) glomerulonephritis
- Nonstreptococcal acute glomerulonephritis
- Rapidly progressive glomerulonephritis (RPGN)
Acute proliferative (poststreptococcal) glomerulonephritis - light microscopy (2):
- Proliferation: enlarged, hypercellular glomeruli
- Diffuse neutrophil and monocyte infiltration
Acute proliferative (poststreptococcal) glomerulonephritis - IF:
Granular deposits of IgG, IgM and C3 in mesangium and along GBM
Acute proliferative (poststreptococcal) glomerulonephritis - EM:
“Humps” of Ag-Ab deposits on epithelial side of basement membrane (subepithelial)
RPGN:
Ruptures in GBM
RPGN - crescents (3):
- Most common histologic finding
- Proliferation of parietal epithelial cells lining Bowman’s capsule
- Infiltration by monocytes and macrophages
Type I RPGN (2):
- Anti-GBM antibody
- Renal limited or Goodpasture syndrome
Type II RPGN:
Immune complex deposition
Type III RPGN (3):
- Pauci-Immune
- No anti-GBM or immune complexes
- Most have circulating ANCA
RPGN - light microscopy:
Crescents with fibrin strands
RPGN - IF (3):
- Type I (Goodpasture): linear GBM fluorescence for Ig and complement
- Type II: granular immune deposits
- Type III: little or no deposition
RPGN - EM:
All types: ruptures in GBM
RPGN clinical S/S (4):
- Hematuria and RBC casts
- Proteinuria, moderate
- HTN, edema
- Circulating Abs depending on underlying disease
