Flashcards in 17 - Renal Pathology III Deck (53)
What diseases cause asymptomatic isolated hematuria?
- IgA nephropathy(Berger Disease)
- Alport syndrome
- Thin GBM disease
Describe IgA nephropathy
- Most common type of primary glomerulonephritis worldwide
- Affects children and young adults
- Quite common in young adults, but NOT in African-Americans
- Causes recurrent hematuria
What will you see in a urinalysis of IgA nephropathy?
What will you see in an LM, IF and EM of IgA nephropathy?
NEED TO KNOW ****
- LM: Mesangial proliferation
- IF: Mesangial IgA
- EM: Mesangial deposits
Describe mesengial proliferation
Mesangial hypercellularity of more than 3 cells per mesangial region
Describe alport syndrome
- Alport syndrome is a defect of the glomerular basement membrane due to mutation in the gene encoding for the alpha-5 chain of collagen type IV
What are the clinical manifestations of alport syndrome?
- Sensorineural deafness
- X-linked dominant inheritance
- Affects males, females are carriers
- Presents with microscopic hematuria
- Progresses to renal failure
- Proteinuria is a sign of progression
What are the key lesions of alport syndrome?
- GBM thickening, splitting and lamination
- "Basket-weave" pattern
***KNOW BASKET WEAVE***
AB --> Alport = Basket
Describe thin GBM disease
- Benign familial (hereditary) hematuria
- About HALF of the GBM is as uniformly thin as it should be
What will you see on the LM, IF and EM or thin GBM disease?
LM = normal
IF = negative
EM = thin GBM
What are the secondary causes of glomerulonephropathies?
- SLE (lupus)
Describe lupus nephritis (SLE)
- Kidney is a major target of disease
- Granular immune complexes deposit in the glomerulus
What are the types of immune complexes that deposit in lupus nephritis?
Granular immune complex deposition of IgG, IgA, IgM, C3, C4
This is the ONLY glomerular disease with ALL immunoglobin deposition *****
What does diabetes cause in the kindey?
AKA diabetic nephropathy
How does diabetic nephropathy present?
Can present as proteinuria, nephrotic syndrome or chronic renal failure
Describe amyloidosis with kindney involvement
Amyloid gets "trapped" in:
- blood vessels
What does amyloid deposition cause?
- Usually the glomerular basement membrane becomes too "leaky" to proteins and the patient gets "nephrotic syndrome"
- Kidneys appear as a big pale "waxy" kidney
What will amyloidosis appear like under polarized light?
NEED TO KNOW *****
"Apple green birefringence"
Know this word by word ***
This apple green birefrigence appearance will be visible when stained with CONGO RED and seen under polarized light *****
Describe acute tubular necrosis (ANT)?
- Destruction of renal TUBULAR epithelium
- Loss of renal function
- 50% of ACUTE renal failure
This is NOT in the glomerulus, in the TUBULAR epithelium ***
What are the two types of acute tubular necrosis?
Either due to lack of blood flow or toxins
What types of nephrotoxic substances cause acute tubular necrosis (ANT)?
- Drugs (aminoglycosides, amphotericin B, gentamycin)
- Heavy metals (mercury)
- Organic solvents (carbon tetrachloride from dry cleaners)
- Radiocontrast dyes (contrast)
- Myoglobin (rhabdomyolysis in heat stroke)
What are the pathologic changes seen in acute tubular necrosis (ANT)?
- Dilated tubules with flattened epithelium
- Necrotic debris in tubules
Describe acute interstitial nephritis
A drug induced hypersensitivity reaction
What can cause acute interstitial nephritis?
- Synthetic penicillins
- Thiazide diuretics
What happens 2 weeks after taking the drug?
- Acute renal failure (oligouria + increased Cr)
What are the different types of pyelonephritis?
- Ascending = MOST COMMON*** (reflux or obstruction)
- Hematogenous is also possible (from blood)
Ascending means urethra --> bladder --> ureters --> kidney --> pelvis
What is the most common pathogen of pyelonephritis?
E coli ***
This is only for when it comes from ascending, not blood
What will you see in an acute case pylonephritis?
What will you see in chronic pyelonephritis?
Lymphocytes and scars (fibrosis)