3.7.3 Path: Nephritic Syndrome

Question 1

Acute renal failure

Answer 1

Pre-renal: Shock or HF caused by MI
Renal: Glomerular destruction, Glomerulonephritis
Post renal: Sudden obstruction to urine outflow

Question 2

EM findings of Acute Post-Infectious Glomerulonephritis

Answer 2

Subepithelial dense deposits that are shaped like humps on the epithelial side of the BM that are deposits of immune complexes

Question 3

IF findings of Acute post infectious glomerulonephritis

Answer 3

Granular or “Lumpy-bumpy”deposits are both IgG and complement along the BM

Question 4

Rapidly Progressive (Crescentic) GMN

Answer 4

Severe glomerular injury accompanied by formation of epithelial crescents in urinary space.

Inflammatory cells surround the compressed capillary loops in the form of crescent moon

Happens after focal necrosis of the glomerular capillaries in diseases such as goodpastures syndrome

Question 5

Goodpasture syndrome

Answer 5

AI disease. Antibodies formed against collagen type 4.

Question 6

Hallmark of Goodpasture syndrome

Answer 6

Diffuse linear staining of GBM for IgG–>Autoantibodies bound to BM

Question 7

Goodpasture AKA

Answer 7

Antiglomerular basement membrane disease or anti-GBM disease

Question 8

Renal characteristics associated with goodpasture

Answer 8

Involves glomeruli
Explosive acceleration of disease–>Rapidly progressive glomerulonephritis or crescentic glomerulonephritis
Urine output declines with hematuria and fluid retention with edema. Build up of urea and other wastes in blood

Question 9

What is the most common glomerulonephritis?

Answer 9

IgA nephropathy (Berger diseasE)

Question 10

Pathogenesis of IgA nephropathy?

Answer 10

Mucosal exposure to viral or bacterial antigens. Stimulates nephritogenic IgA dominant immune complexes within the glomeruli and mesangium which activate complement

Question 11

IF dx for IgA nephropathy?

Answer 11

Essential for dx. Mesangial staining for IgA and C3 needed for dx. Severe–>staining of glomerular capillar wall suggests less favorable prognosis

Question 12

EM of IgA nephropathy

Answer 12

Mesangial electron dense deposits under GBM, severe cases, deposits in capillary walls

Question 13

Alport syndrome

Answer 13

X-linked; Abnormal Type IV collagen;

Question 14

EM of alport syndrome

Answer 14

Most diagnostic
Irregularly thickened glomerular BM with splitting of lamina densa into interlacing string like lamina that surround electron lucent areas

Question 15

Sx of alport

Answer 15

Hematuria, proteinuria, progressif renal failure and HTN

Hearing impariement, defect to lens

Question 16

Thin glomerular BM disease

Answer 16

Hematuira due to thinning and rupure of the GBM
Dx: Biopsy and EM not Light micro
AD inheritance

Question 17

Type I Membranoproliferative Glomerulonephritis AKA

Answer 17

Mesangiocapillary glomerulonephritis

Question 18

Secondary causes of Type I Membranoproliferative Glomerulonephritis

Answer 18

Subacute bacterial endocarditis
Osteomylitis
Hep B virus infection
Neoplasia

Question 19

Silver stain of Type I Membranoproliferative Glomerulonephritis

Answer 19

Doubling or tram track replication of GBMs from thickened capillary walls

Question 20

AKA for Type II Membranoproliferative Glomerulonephritis

Answer 20

Dense deposit disease

Question 21

IF of Type II Membranoproliferative Glomerulonephritis

Answer 21

Linear staining of capillary walls and mesangial nodules for Complement C3 little or no staining for immunoglobulins

Question 22

Lupus nephritis

Answer 22

AI and immune complexes deposited in glomerular capillary loops–>complement–>Tissue injury

Question 23

Histo classification of Lupus nephritis- most severe

Answer 23

IV diffuse proliferative: Most serious; mesangial and subendothelial deposits; Moderate nephritis

Question 24

Class I and Class I Lupus nephritis on EM

Answer 24

Mesangial deposits

Question 25

Class V Lupus nephritis on EM

Answer 25

Several subepithelial dense deposits

Question 26

IF of Lupus nephritis

Answer 26

Subepithelial and subendothelial complexes are granular

Question 27

Lab findings of Lupus nephritis

Answer 27

Elevated BUN/Creatinine
Ua proteinuria 
Leukocytes and casts 
Autoab: AntidsDNA and Anti smith 
Serum complement decreased-->Active renal disease