102914 glomerular disease

Question 1

mechanisms of glomerular disease

Answer 1

immunocomplex deposition-ciruculate then deposit in glomerulus(like lupus). activates complement resulting in neutrophil chemotaxis

antibodies against GBM or glomerular antigens

cytokine production by inflam cells

Question 2

glomerular disease that is diffuse is

Answer 2

affecting all glomeruli

Question 3

focal

Answer 3

affects a few glomeruli

Question 4

global

Answer 4

affects the entire glomerulus

Question 5

segmental

Answer 5

affects a portion of the glomerulus

Question 6

how does glomerular disease present?

Answer 6

loss of GFR
hematuria
proteinuria

Question 7

nephrotic syndrome

Answer 7

proteinuria greater than 3.5 g/day
hypoalbuminemia
edema
hyperlipidemia

lipiduria
hypercoagulability

Question 8

nephritis

Answer 8

mild proteinuria
HEMATURIA (RBCs, RBC casts, dysmoprhic RBCs)
HTN
edema

Question 9

nephrotic glomerular diseases

Answer 9

minimal change disease
focal segmental glomerulosclerosis
membranous nephropathy
IgA neprhopathy

Question 10

nephritic glomerular diseases

Answer 10

membranoproliferative GN
acute post infec GN
crescentic (ANCA) GN
IgA nephropathy

Question 11

acute glomerulonephritis causes

Answer 11

IgA nephropathy
post infec GN
anti GBM disease/Goodpasture's
small vessel vasculitis
lupus nephritis
membranoproliferative GN

Question 12

what is the most common GN?

Answer 12

IgA nephropathy

Question 13

in what disease does hematuria frequently occur with an URI? (synpharyngitic hematuria)

Answer 13

IgA nephropathy

Question 14

what is a histologic feature of IgA nephropathy?

Answer 14

IF: mesangial IgA deposition

Question 15

HSP

Answer 15

systemic disorder with IgA deposition in multiple organs (skin, joints, GI, kidney)

Question 16

oliguria

Answer 16

low urine output

Question 17

histology findings for post Strep GN

Answer 17

EM: mesangial and large subepithelial hump-like deposits of immune complexes

Question 18

rapidly progressive GN

Answer 18

nephritic syndrome with rapid progression (in days to weeks) to renal failure

Question 19

causes of rapidly progressive GN

Answer 19

anti-GBM/Goodpasture’s
immune complex GN
ANCA associated GN (pauci immune)

Question 20

how do you diagnose anti GBM/Goodpasture’s?

Answer 20

anti GBM Ig in blood

LINEAR IgG and C3 on kidney biopsy IF

Question 21

pauci immune GN

Answer 21

crescenteric GN with little deposition of immune reactants (as opposed to anti-GBM disease, IgA nephropathy, lupus nephritis)

idiopathic or associated with ANCA vasculitis

Question 22

what do RPGNs look like under light microscopy?

Answer 22

crescenteric GN

Question 23

IF microscopy of immune complex mediated RPGN?

Answer 23

variable deposition of immune complex and complement

Question 24

IF microscopy of pauci immune RPGN?

Answer 24

negative

Question 25

nephrotic syndrome from primary renal disease ex

Answer 25

membranous nephropathy focal segmental glomerulosclerosis minimal change disease in children, 80% have minimal change disease

Question 26

secondary causes of nephrotic syndrome include

Answer 26

systemic diseases-diabetes mellitus, SLE, amyloidosis infections drugs-NSAIDs

Question 27

what is the most common cause of nephrotic syndrome in children

Answer 27

minimal change disease

Question 28

minimal change disease in adults can be caused by

Answer 28

idiopathic or drugs-NSAIDs neoplasms-Hodgkin's lymphoma infections

Question 29

minimal change disease histology

Answer 29

LM: glomeruli, interstitium and tubules look NORMAL EM: podocyte foot process effacement (fusion)

Question 30

membranous nephropathy-what secondary causes are responsible for it?

Answer 30

infections-HBV connecive tissue diseases-SLE neoplasms-carcinoma of lung, colon, stomach, breast. Non-Hodgkin's lymphoma drugs

Question 31

membranous nephropathy histology

Answer 31

LM: diffuse thickening of GBM. GBM spikes on silver stain

Question 32

membranous nephropathy

Answer 32

immune deposits form on subepithelial aspect of glomerular basement membrane

Question 33

forms of focal segmental glomerulosclerosis

Answer 33

primary (acute onset nephrotic syndrome) secondary hereditary

Question 34

causes of secondary FSGS

Answer 34

drugs-NSAIDs infections-HIV etc

Question 35

FSGS histology

Answer 35

LM: focal and segmental glomerular sclerosis with capillary collapse

Question 36

in terms of glomerular diseases, SLE can cause

Answer 36

a number of different ones