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Renal Cram Deck > SM 205a/208a/209a/212a - Renal Syndromes, Nephrosis, Nephritis > Flashcards

SM 205a/208a/209a/212a - Renal Syndromes, Nephrosis, Nephritis Flashcards

1
Q

What conditions might FSGS be secondary to?

A

HIV + Heroine use

Reduced renal mass

Hyperfiltration injury

Obesity

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2
Q

What pathologic findings are present?

A

Focal segmental glomerulosclerosis

Not all glomeruli show sclerosis (focal)

Only parts of the affected glomeruli are affected (segmental)

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3
Q

Which renal syndrome will show linear IgG deposits on FM?

A

Anti-GBM disease

(aka RPGN Type I)

A nephritic syndrome

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4
Q

Why is important to identify and treat membranous nephropathy quickly?

A

To avoid potential complications

  • Renal vein thrombosis
  • Pulmonary embolism due to hypercoagulability
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5
Q

What renal syndrome shows this pattern on immunofluorescence?

What would you expect from the patient’s history?

A
  • 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
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6
Q

Which renal syndromes are associated with a history of Hep B and Hep C?

A
  • Nephrotic
    • Membranous nephropathy
  • Nephriti
    • MPGN
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7
Q

What are the major nephritic syndromes?

A
  • RPGN
    • Type I = anti-GBM disease
    • Type II
    • Type III = Pauci-Immune disease
  • Post-Infectious Glomerulonephritis
  • Lupus Nephritis
  • IgA Nephropathy
  • MPGN
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8
Q

What are the 3 major primary nephrotic syndromes?

A

Minimal Change Diseae

Focal Segmental Glomerular Sclerosis

Membranous Nephropathy

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9
Q

Which renal syndrome is associated with APOL1 mutation?

A

FSGS

(FSGS is a pattern of injury, not a renal syndrome, I just didn’t know how else to phrase the question)

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10
Q

What are the characteristics of Membranous Nepropathy on..

LM:

FM:

EM:

A

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
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11
Q

What is this pattern of fluorescence called?

Which renal syndrome is it associated with?

What would you expect from the patient’s history?

A
  • 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)
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12
Q

What are the characteristics of Type II RPGN on…

LM

FM

EM

A

Nephritic

  • LM
    • Diffuse, crescenteric glomerulonephritis
  • FM
    • Granular C3 deposits with IgG or IgA
  • EM
    • Lumpy bumpy appearance
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13
Q

Describe the key differences betwee Class IV Lupus Nephritis and Class V Lupus Nephritis

A
  • 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
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14
Q

Class V Lupus Nephritis presents like which renal syndrome?

A

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
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15
Q

Describe the characteristics of MPGN on…

LM

FM

EM

A

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
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16
Q

What are the characteristics fo Pauci-Immune disease on…

LM

FM

EM

A

Pauci-Immune disease = RPGN Type III - Nephritic

ANCA will show up on labs

  • LM
    • Fibrinoid necrosis (necrotizing vasculidities)
    • Diffuse, crescenteric glomerulonephritis affecting >50% of glomeruli
  • FM
    • No depositis
  • EM
    • No deposits
17
Q

Which renal syndrome is characterized by a “spike and dome” pattern on EM?

A

Membranous nephropathy (nephrotic syndrome)

18
Q

What are the characteristics of Post-Infectious Glomerulonephritis on…

LM

FM

EM

A

PIGN = Nephritic syndrome

  • LM
    • Hypercellularity - Neutrophils, lymphocytes
  • FM
    • Starry-sky appearance
    • IgG and complement
  • EM
    • Sub-epithelial humps
19
Q

Characteristic of nephritis or nephrosis?

Decreased GFR

A

Nephritis

20
Q

Characteristic of nephritic or nephrotic syndrome?

RBCs, RBC casts

A

Nephritic

21
Q

What is the treatment for Anti-GBM disease?

A

Aggressive treatment!

Steroids + Cyclophosphamide + Plasmapheresis

Renal Cram Deck (24 decks)

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