S8) Pathology of the Glomerulus Flashcards

1
Q

In terms of the pathology of the glomerulus, what does the term focal mean?

A

Focal – involving less than 50% of the glomeruli on light microscopy

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2
Q

In terms of the pathology of the glomerulus, what does the term diffuse mean?

A

Diffuse – involving more than 50% of the glomeruli on light microscopy

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3
Q

In terms of the pathology of the glomerulus, what does the term segmental mean?

A

Segmental – involving part of the glomerular tuft

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4
Q

In terms of the pathology of the glomerulus, what does the term global mean?

A

Global – involving the entire glomerular tuft

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5
Q

In terms of the pathology of the glomerulus, what does the term membranous mean?

A

Membranous – thickening of the glomerular capillary wall

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6
Q

In terms of the pathology of the glomerulus, what does the term proliferative mean?

A

Proliferative – an increased number of cells in the glomerulus (proliferating glomerular cells / infiltrating circulating inflammatory cell)

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7
Q

In terms of the pathology of the glomerulus, what does the term crescent mean?

A

Crescent – an accumulation of cells within the Bowman’s space; often compress the capillary tuft

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8
Q

In terms of the pathology of the glomerulus, what does the term glomerulosclerosis mean?

A

Glomerulosclerosis – segmental or global capillary collapse (presumed that there is little/no filtration across sclerotic area)

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9
Q

In terms of the pathology of the glomerulus, what does the term glomerulonephritis mean?

A

Glomerulonephritis – any condition associated with inflammation in the glomerular tuft

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10
Q

Identify the 4 different renal cortical compartments

A
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11
Q

Describe two different problems that can occur with the glomerulus

A
  • Glomerulus can block (renal failure, decreased eGFR)
  • Glomerulus can leak (proteinuria, haematuria)
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12
Q

What is Nephrotic Syndrome?

A

- Nephrotic syndrome is a condition that causes the kidneys to leak large amounts of protein into the urine and leads to widespread oedema and increased susceptibility to infections

  • It presents with proteinuria, low albumin and high serum lipid levels
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13
Q

What is Nephritic Syndrome?

A
  • ​Nephritic syndrome is a condition comprising signs of nephritis, which is kidney disease involving inflammation
  • It presents with proteinuria, haematuria and hypoalbuminaemia
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14
Q

What factor determines the presentation of glomerular pathology?

A

The site of glomerular injury determines clinical presentation

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15
Q

What are some likely sites of injury in Nephrotic Syndrome?

A
  • Podocyte/subepithelial damage
  • GBM damage
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16
Q

Identify some common primary causes of Nephrotic Syndrome

A
  • Minimal change glomerulonephritis
  • Focal segmental glomerulosclerosis (FSGS)
  • Membranous glomerulonephritis
17
Q

What is Focal Segmental Glomerulosclerosis?

A

FSGS is a type of glomerular disease involving the scarring (sclerosis) of the kidney which only occurs in small sections of each glomerulus and only damages a limited number of glomeruli at first

18
Q

What is Minimal Change Glomerulonephritis?

A

- Minimal change glomerulonephritis is a condition affecting the kidneys, commonly occuring in adolescence, which causes nephrotic syndrome

  • It presents with proteinuria and podocyte damage rarely progresses to renal failure
19
Q

Describe the pathogenesis occuring in Minimal Change glomerulonephritis

A
  • Unknown circulating factor damages podocytes
  • No immune complex deposition
20
Q

Which drug can be used to treat minimal change glomerulonephritis?

A

Steroids

21
Q

How does FSGS differ from minimal change?

A
  • FSGS occurs in adults
  • FSGS is less responsive to steroids
  • FSGS involves glomerulosclerosis
  • FSGS involves circulating factor which damages podocytes
  • FSGS can progress to renal failure
22
Q

What is membranous glomerulonephritis?

A
  • Membranous glomerulonephritis is a condition affecting the kidneys due to pathology in the glomerular basement membrane involving the build-up of immune complexes within the kidney
  • It is the commonest cause of nephrotic syndrome in adults and can occur by itself or in conjunction with other disease e.g. lymphoma
23
Q

Identify some common secondary causes of Nephrotic Syndrome

A
  • Diabetes Mellitus
  • Amyloidosis
24
Q

Describe 5 clinical presentations of Diabetes Mellitus

A
  • Progressive proteinuria
  • Progressive renal failure
  • Microvascular
  • Mesangial sclerosis → nodules
  • Basement membrane thickens
25
Q

Identify two conditions associated with nephritis

A
  • Goodpasture Syndrome (Anti-GBM disease)
  • Vasculitis
26
Q

Identify three conditions presenting with haematuria

A
  • IgA Nephropathy
  • Thin glomerular basement membrane disease
  • Hereditary Nephropathy (Alport)
27
Q

What is IgA nephropathy?

A
  • IgA nephropathy is a kidney disease that occurs when IgA deposits build up in the kidneys, causing inflammation (commonest cause of GN – occurs at any age)
  • It presents with visible/invisible haematuria (+/- proteinuria) and a significant proportion progresses to renal failure as there’s no effective treatment
28
Q

What is thin GBM nephropathy?

A

Thin GBM Nephropathy is a benign familial nephropathy involving isolated haematuria, a thin basement membrane and a benign course

29
Q

What is Alport syndrome?

A

- Alport syndrome is an X-linked recessive disease involving abnormal type IV collagen and an abnormally appearing GBM

  • It is associated with deafness and progresses to renal failure
30
Q

What is Goodpasture’s Syndrome?

A
  • Goodpasture Syndrome is a condition involving the rapid progression of GN due to an autoantibody to collagen IV in the BM, leading to the acute onset of severe nephritic syndrome
  • It is associated with pulmonary haemorrhage (smokers) and is treatable by immunosuppression and plasmaphoresis
31
Q

What is vasculitis?

A
  • Vasculitis is a group of systemic disorder that destroy blood vessels through inflammation.
  • There is no immune complex/antibody deposition and presents as GN (treatable if caught early)