SM_208a: Nephrosis Flashcards
_____ indicates nephrosis
> 3.5 g protein per 24 hours indicates nephrosis
_____ in the urine indicate nephritis
RBCs in the urine indicate nephritis
Juxtaglomerular apparatus senses _____
Juxtaglomerular apparatus senses flow
Fluorescent microscopy looks for ______
Fluorescent microscopy looks for IgG, IgM, IgA, and complement components C1q and C3
____ means involving some glomeruli, whereas ____ means involving all glomeruli
Focal means involving some glomeruli, whereas diffuse means involving all glomeruli
_____ means involving part of the glomerulus, whereas _____ means involving the entire glomerulus
Segmental means involving part of the glomerulus, whereas global means involving the entire glomerulus
This is a _____ glomerulus
This is a normal glomerulus
This is a _____ glomerulus
This is a crescent glomerulus
(glomerulus compressed to the side)
This is a _____ glomerulus
This is a hyaline glomerulus
(thick membrane)
This is a _____ glomerulus
This is a tram-track glomerulus
This is a _____ glomerulus
This is a wire-loop glomerulus
Describe the pathogenesis and mediators of glomerular diseases
Pathogenesis and mediators of glomerular diseases
- Circulating immune complexes
- Immune complex deposition in-situ: anti-GBM sntibodies, anti-other antibodies (anti-glomerular, planted)
- Mediators: cells (neutrophils, macrophages) and complement
- Epithelial injury
- Renal ablation
Renal ablation is when ______ and is _____ to reverse
Renal ablation is progressive attempts to compensate for kidney injury cause residual glomeruli to hypertrophy and reach a point where they are not functional anymore and is generally irreversible
Describe the characteristics of minimal change disease
Minimal change disease
- Very young kids after an upper respiratory tract infection
- Chief complaint by parents: kid is swollen (edema)
- LM: normal
- FM: negative
- EM: effacement of podocyte foot processes
- Treatment: corticosteroids w/ good prognosis
On EM, minimal change disease will manifest as _____
On EM, minimal change disease will manifest as effacement of podocyte foot processes
Treatment of minimal change disease involves _____
Treatment of minimal change disease involves corticosteroids
Minimal change disease occurs in ____ and is responsive to ____
Minimal change disease occurs in children and is responsive to corticosteroids
Describe focal segmental glomerulosclerosis
Focal segmental glomerulosclerosis
- Pattern of glomerular injury demonstrating partial scarring of some glomeruli
- Generally in adults
- May be primary, drug-induced, complicate other diseases (HIV + heroin), or rarely be inherited
- LM: sclerosis affecting some parts of some glomeruli
- FM: non-specific (IgG, IgM, complement) and depends on underlying disease (IgA in IgA-induced nephropathy, full house in lupus)
- EM: loss of foot processes and podocyte detachment
On LM, focal segmental glomerulosclerosis manifests as _____
On LM, focal segmental glomerulosclerosis manifests as sclerosis affecting some parts of some glomeruli
The ____ glomerulus is damaged, ____ glomerulus is partially damaged, and ____ glomerulus is normal
The left glomerulus is damaged, middle glomerulus is partially damaged, and right glomerulus is normal
Focal segmental glomerulosclerosis occurs in ____ and is _____ to steroids
Focal segmental glomerulosclerosis occurs in adults and is not responsive to steroids
____ and ____ are necessary to differentiate minimal change disease from focal segmental glomerulosclerosis
Clinical information and LM are necessary to differentiate minimal change disease from focal segmental glomerulosclerosis
Describe membranous nephropathy
Membranous nephropathy
- Adults w/ slowly progrssive renal failure due to circulating immune complexes and immune complex formation
- Occurs in many conditions: lupus, Hep B or C, heavy metal exposure, drugs, or primary
- LM: diffuse thickening of capillary wall (wire-loop)
- FM: variable - granular deposits of C3 and IgG, may be negative if primary, may have full house due to lupus
- EM: subepithelial deposits along GBM containing Ig imparting a spike and dome pattern
On LM, membranous nephropathy manifests as ____ of capillary walls
On LM, membranous nephropathy manifests as wire-loop appearance of capillary walls
On EM, membranous nephropathy manifests as ____
On EM, membranous nephropathy manifests as subepithelial deposits along GBM containing IG imparting a spike and dome pattern
(dark deposits are progressively surrounded by lighter basement membrane materials and eventually reabsorbed)
There are ____ types of membranoproliferative glomerulonephritis
There are 2 types of membranoproliferative glomerulonephritis
(histomorphic designation based on LM)
Describe MPGN type 1 / MPGN-IC
MPGN type 1 / MPGN-IC
- Occurs due to circulating immune complexes
- May complicate lupis, Hep B or C, chronic infections with chronic antigenemias, or be primaary
- Prognosis depends on underlying disease
LM: increased cellularity of glomerulus w/ pronounced lobulation, GBM may show tram-tracks on silver stain - FM: C3 + IgG
- EM: variable
Describe MPGN type 2 / C3 glomerulopathy
MPGN type 2 / C3 glomerulopathy
- Occurs due to C3 abnormality
- Pathogenesis involves dysregulation of the alternative complement pathway and depletion of complement
- May also present as nephritic syndrome
- Poor prognosis
- LM: increased cellulairty of glomerulus w/ pronounced lobulation, GBM may show tram-tracks on silver stain
- FM: C3
- EM: variable
MPGN-IC manifests as _____ on FM
MPGN-IC manifests as C3 + IgG on FM
C3 glomerulopathy manifests as _____ on FM
C3 glomerulopathy manifests as C3 on FM
Describe diabetic nephropathy
Diabetic nephropathy
- LM: diffuse thickening of GBM resulting in leakage of proteins into urine (proteinuria)
- Nodules form: nodular sclerosis with Kimmelstiel-Wilson nodules as the key feature
Key pathologic feature of diabetic nephropathy on LM is _______
Key pathologic feature of diabetic nephropathy on LM is Kimmelstiel-Wilson nodule
Describe chronic glomerulonephritis
Chronic glomerulonephritis
- End-stage of many kidney diseases
- May be the stage at which the patient presents: presents as chronic renal failure, cannot tell what the underlying disease was
- LM: diffuse sclerosis of most glomeruli, interstitial fibrosis, tubular atrophy
Describe tubulointerstitial nephritis
Tubulointerstitial nephritis
- Infectious (acute pyelonephritis, chronic pyelonephritis and reflux nephropathy), and non-infectious (drug-induced interstitial nephritis, ischemia, metabolic derangements, physical damage)
- Includes analgesic-induced nephropathy
Describe analgesic-induced nephropathy variant of tubulointerstitial nephritis
Analgesic-induced nephropathy variant of tubulointerstitial nephritis
- Patients who use long-term large-dose analgesics (acetaminophen/phenacetin derivatives, aspirin, caffeine, codeine) are at increased risk of tubule damage
- Pathogenesis: acetaminophen/phenacetin cause oxidative damage to tubules, and aspirin (prostaglandin synthesis inhibitor) results in vasoconstriction and edema
Acetaminophen/phenactin cause analgesic-induced nephropathy by ______
Acetaminophen/phenactin cause analgesic-induced nephropathy by causing oxidative damage to tubules
Aspirin causes analgesic-induced nephropathy by ______
Aspirin causes analgesic-induced nephropathy by inhibiting prostaglandins, which results in vasoconstriction and ischemia
