SM 205a/208a/209a/212a - Renal Syndromes, Nephrosis, Nephritis Flashcards
What conditions might FSGS be secondary to?
HIV + Heroine use
Reduced renal mass
Hyperfiltration injury
Obesity
What pathologic findings are present?
Focal segmental glomerulosclerosis
Not all glomeruli show sclerosis (focal)
Only parts of the affected glomeruli are affected (segmental)
Which renal syndrome will show linear IgG deposits on FM?
Anti-GBM disease
(aka RPGN Type I)
A nephritic syndrome
Why is important to identify and treat membranous nephropathy quickly?
To avoid potential complications
- Renal vein thrombosis
- Pulmonary embolism due to hypercoagulability
What renal syndrome shows this pattern on immunofluorescence?
What would you expect from the patient’s history?
- IgA Neprhopathy (nephritic)
- Deposits in the mesangium instead of the basement membane
- We would expect them to be IgA
- History
- Recurrent hematuria (tea/cola colored urine) associated with URI or pharyngitis
- Synpharyngitic - occurs during or very soon after infection
Which renal syndromes are associated with a history of Hep B and Hep C?
- Nephrotic
- Membranous nephropathy
- Nephriti
- MPGN
What are the major nephritic syndromes?
- RPGN
- Type I = anti-GBM disease
- Type II
- Type III = Pauci-Immune disease
- Post-Infectious Glomerulonephritis
- Lupus Nephritis
- IgA Nephropathy
- MPGN
What are the 3 major primary nephrotic syndromes?
Minimal Change Diseae
Focal Segmental Glomerular Sclerosis
Membranous Nephropathy
Which renal syndrome is associated with APOL1 mutation?
FSGS
(FSGS is a pattern of injury, not a renal syndrome, I just didn’t know how else to phrase the question)
What are the characteristics of Membranous Nepropathy on..
LM:
FM:
EM:
Membranous nephropathy = nephrotic
- LM
- Thickened capillary wall (Wire-Loop)
- Thickened GBM
- Spikes and holes on silver stain
- FM
- Granular IgG and C3 deposits in the basement membrane
- EM
- Sub-epithelial immune deposits
- Spike and dome pattern
What is this pattern of fluorescence called?
Which renal syndrome is it associated with?
What would you expect from the patient’s history?
- Starry-sky pattern
- Characteristic of post-infectious glomerulonephritis - These would be IgG and C’ deposits
- Urine would be Cola-colored
- History
- Cola-colored urine
- Strep infection (skin or pharyngitis) 7-14 days ago (ish)
What are the characteristics of Type II RPGN on…
LM
FM
EM
Nephritic
- LM
- Diffuse, crescenteric glomerulonephritis
- FM
- Granular C3 deposits with IgG or IgA
- EM
- Lumpy bumpy appearance
Describe the key differences betwee Class IV Lupus Nephritis and Class V Lupus Nephritis
- Class IV
- Nephritic
- Low serum complement
- Cell proliferation, wire loops
- Class V
- Nephrotic (Yes, very confusing)
- Normal serum complement
- Thickened GBM, spike and dome pattern
- Like membranous nephropathy
Class V Lupus Nephritis presents like which renal syndrome?
Membranous nephropathy (nephrotic)
- LM
- Thickened GBM
- Spike and hole pattern on silver stain
- FM
- Full House
- EM
- Sub-epithelial immune deposits
- Spike and dome pattern
- Normal serum complement
Describe the characteristics of MPGN on…
LM
FM
EM
MPGN = Nephritic
- LM
- Lobular glomerulus (shown in picture)
- Hypercellular
- Tram-Tracking on silver stain
- FM
- Granular C3 deposits (+/- IgG) in the Basement Membrane
- EM
- Variable
Which renal syndrome is characterized by a “spike and dome” pattern on EM?
Membranous nephropathy (nephrotic syndrome)
What are the characteristics of Post-Infectious Glomerulonephritis on…
LM
FM
EM
PIGN = Nephritic syndrome
- LM
- Hypercellularity - Neutrophils, lymphocytes
- FM
- Starry-sky appearance
- IgG and complement
- EM
- Sub-epithelial humps
