SM 208 Nephrosis Flashcards
What is urinalysis?
A basic tool for evaluation of renal function
What does urinalysis evaluate for?
Protein, cells, electrolytes
What characterizes a nephritic syndrome?
RBC’s in the urine
Is blood in the urine during a nephritic syndrome macroscopic or microscopic?
Both!
What does fluorescent microscopy identify?
IgG, IgM, IgA and Complement components that deposit on the Glomerulus
What supports a capillary loop?
Mesangial cells
What does electron microscopy identify?
Exact location of deposition of various inciting agents and other subtle alterations of other components
Is kidney disease diagnosed with clinical pictures or biopsy evaluation?
Both; combine imaging with clinical picture
What is the difference between focal and diffuse?
Focal involves some glomeruli, while diffuse involves all glomeruli
What is the difference between segmental and global?
Segmental involves part of the glomeruli while global involves the entire glomeruli
How can PCT and DCT cells be differentiated on slides?
PCT cells form larger tubules and had thick cells due to lots of mitochondria to power active transport DCT cells are thinner and form smaller tubules
What causes a “crescent” on slides?
“Crescent” forms due to parietal epithelial cells abnormally proliferate
How does a “crescent” effect the Glomeruli?
“Crescent” compresses the Glomeruli and causes a loss of function
What is this?
A crescent compressing a glomeruli
What is this?
“Hyaline” glomeruli, since it’s so thick and pink
What is this?
Tram-Track staining where the Base Membrane has thickened and appears as two layers
What is this?
Wire-loop staining because of even thickening of all basement membrane around the capillary loops
What 5 things can cause glomerular disease?
Circulating IC’s
IC deposition in-situ
Cell-mediated and Complement mediated
Epithelial injury
Renal Ablation
What do anti-GBM antibodies target?
Anti-GBM antibodies target Type IV Collagen
What can cause Immune Complex deposition other than anti-GBM antibodies?
Planted Haptens which induce an immunogenic response against the Glomerulus
Why is Renal Ablation a death spiral?
Renal Ablation refers to the loss of one glomerulus causing another one to hypertrophy and compensate
However, the pressure and volume in the surviving nephron increases while the wall remains thin, leading to failure
This causes other nephrons to try and copmensate
What does Minimal Change Disease cause?
Nephrotic syndrome in young children after an URI, causing edema and effacement of podocyte foot processes
Treat with corticosteroids
A young child presents with an URI and swollen limbs, as well as heavy proteinuria. What disease does he have?
Minimal Change Disease
What causes nephrotic syndrome after an URI?
Minimal Change Disease
How is Minimal Change Disease treated?
Corticosteroids
Is FSGS a disease?
No, it’s a pattern of injury
How does FSGS present on slides?
Partial scarring of only some glomeruli
Is FSGS primary or acquired?
May be primary or drug-induced, especially after HIV + Heroin
HIV + Heroin predisposes which disease?
FSGS
What is FSGS?
A pattern of injury that causes partial scarring of some glomeruli that tends to follow HIV + Heroin use
How does FSGS appear on light microscopy?
Sclerosis affect some parts of some glomeruli
Is FSGS specific or non-specific on fluorsecent microscopy?
FM is non-specific and depends on the underlying diagnosis
How does FSGS appear on electron microscopy?
Loss of foot processes and podocyte detachment
Compare and contrast FSGS and Minimal Change Disease?
FSGS and MCD both present with the loss of foot processes, but MCD is mostly in kids and steroid responsive while FSGS is mostly in adults and non-responsive
Mostly effects kids and steroid responsive: FSGS or MCD?
Minimal Change Disease
Mostly effects adults, steroid non-responsive?
FSGS
What disease is this?
FSGS, since only some glomeruli and only parts of glomeruli are effected
How do you distinguish MCD and FSGS on electron microscopy?
You can’t; need to know the clinical picture with respect to age (kids = MCD, adults = FSGS) and steroid responsiveness (MCD = steroid responsive, FSGS = steroid unresponsive)
What is Membranous Nephropathy?
A disease in adults with slowly progressive renal failure due to circulating immunocomplexes and in-situ immune complex formation
Primary or drug induced
Is Membranous Nephropathy a primary or acquired disease?
Both; tends to follow Lupus
What causes wire-loop appearance in the glomerular capillaries?
Membranous Nephropathy
What causes a spike-and-dome pattern on electron microscopy?
Membranous Nephropathy
What is MPGN?
A histomorphologic designation dependent on light microscopy with 2 subtypes
What is Type I Membranoproliferative Glomerulonephritis?
A form of MPGN that occurs due to circulating immune complexes
Visualized on fluorescent microscopy as C3 + IgG
Prognosis depends on underlying disease
Which type of MPGN complicates chronic infections?
Type I MPGN
What is Type II Membranoproliferative Glomerulonephritis?
A form of MPGN that occurs due to C3 abnormality
Shows only C3 on Fluorescent Microscopy
Poor prognosis
How are Type I and Type II MPGN differentiated on fluorescent microscopy?
Type I = C3 + IgG
Type II = C3 only
Which type of MPGN involves dysregulation of the complement pathway?
Type II MPGN
Which disease causes a tram-track pattern on silver stain?
MPGN
What proliferates in MPGN?
The GBM proliferates
What are Kimmelstiel Wilson nodules pathopneumonic for?
Diabetic Nephropathy
What is the end stage of many kidney diseases?
Chronic Glomerulonephritis
How does Chronic Glomerulonephritis present on light microscopy?
Since Chronic Glomerulonephritis is the end-stage of kidney diseases, it presents with diffuse sclerosis of most glomeruli
What is this?
Chronic Glomerulonephritis; due to the completely destroyed Glomeruli
Is Tubulointerstitail Nephritis infectious or non-infectious?
Both
What causes infectious tublulointerstitial nephritis?
Pyelonephritis
What are non-infectious causes of tubulointerstitlal nephritis?
Drugs, ischemia
What drugs can cause tubulointerstitial nephritis?
AACC
Acetaminophen
Aspirin (NSAIDS)
Caffeine
Codeine
Long-term large doses
How does Acetaminophen cause tubulointerstital nephritis?
Oxidative damage to the tubules
How does aspirin cause tubulointerstitial nephritis?
Asprin inhibits Prostaglandin synthesis causing vasoconstriction and ischemia
