9/23- Renal Review 1- Pathology Flashcards by Kathryn Kudlaty

What are characteristics of Acute renal failure?

Oliguria or anuria
Increased BUN and creatinine
Decreased GFR
Injury of any compartment of the kidney can result in ARF
Glomeruli
Tubules/Interstitium
Vessels

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What are characteristics of Chronic renal failure?

Prolonged course

Diminished reserve, GFR 50%
Renal insufficiency, GFR 20-50%
Chronic renal failure, GFR <20%
End stage, GFR 5%

Systemic changes

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What is seen here?

Chronic renal failure (Thyroid-like?)

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What glomerular properties account for the very low urinary protein content or normal urine?

Charge barrier

GBM negatively charged (Heparan sulphate)
Podocyte and endothelium negatively charged (Sialoproteins)

Size barrier

Porous GBM
Slit diaphragm

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What are the arrows pointing at?

Slit diaphragms

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What are the issues at play in nephrotic syndrome (mechanistic)?

Charge issues

Increased matrix of GBM (with diabetes or electron dense deposits with membranous glomerulopathy)

Podocyte changes

Effaced foot processes (minimal change disease, focal segmental glomerulosclerosis)

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What are the issues at play in nephritic syndrome (mechanistic)?

Disruption of capillary loops with spillage of protein and red cells

Active urinary sediment Spilled proteins may incite crescent formation

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What are histologic alterations of glomerular injury?

Hypercellularity

Mesangial cells
Endothelial cells
Leukocyte infiltrates
Crescents

Basement membrane thickening

Immune complex deposition
Membrane reduplication
Increased matrix

Hyalinosis and Sclerosis

Extracellular insudated plasma proteins
Sclerosis contains collagen
FSGS

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What is seen here?

Normal glomerulus

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What is seen here?

Hypercellular mesangium

Still see open cap loops branching off

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What is seen here (what disease does it indicate)?

IgA immune deposits in mesangium -> IgA Nephropathy

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What is seen here (what disease does it indicate)?

IgA nephropathy

Mesangial immune deposits

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What is seen here (what disease does it indicate)?

IgA nephropathy

Variable, mesangial hypercellularity
Ranging to crescents

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What is seen here?

Endocapillary and mesangial proliferation

Can’t see cap loops
Mesangium all blurred together
Looks like catcher’s mitt

Membranoproliferative GN

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IgA nephropathy with skin rash is what?

Henoch-Schonlein purpura

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What is seen here?

Leukocyte infiltration

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What is seen here?

Crescent formation

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What is Crescent Glomerulonephritis/RPGN?

Variant of acute nephritis
Three groups:

1. Immune complex GN

SLE
Post-infectious
IgA/HSP

2. Anti-GBM GN

3. Pauci-immune (ANCA)

IF/EM will distinguish

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What is the #1 cause of crescentic GN?

ANCA (Pauci-immune) GN

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What is Pauci-immune GN?

(ANCA GN)

No 1 cause of crescentic GN
May be renal limited or systemic (Wegener’s, Churg-Strauss, Microscopic polyangiitis)
80% of pts have circulating ANCA
ANCA is pathogenic (mouse studies)

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What is seen here?

Increased matrix

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What is seen here? Where are deposits?

What diseases are indicated?

Left: granular/globular epimembranous distribution (?)

Seen in Membranous GN (or lupus or 2’…)

Right: linear epimembranous distribution (?)

Seen in Anti-GBM

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What are possible locations for deposits?

Study These Flashcards

Subepithelial (humps)
Epimembranous
Subendothelial
Mesangial
Intramembranous

What disease?

Study These Flashcards

Membranous GN

What disease?

Lupus GN

What disease?

IgA nephropathy

Where are the deposits?

Epi/intramembranous deposits

Where are the deposits?

Subendothelial deposits

Where are the deposits?

Mesangial deposits

What is this (arrow)?

Subepithelial hump ?

What disease is this?

Postinfectious glomerulonephritis

What other blood tests would be ordered if suspected postinfectious GN?

- Anti-streptococcal antibody (ASO) titers - Streptozyme - Complements (alternate pathway)

What disease is this describing? - Young female presents with shortness of breath and rapid loss of renal function?

- Crescentic glomerulonephritis! - Linear IgG deposits along glomerular BM (also along tubular BM, inset) - This is Anti-GBM disease

How do you treat pt with anti-GBM?

- Immunosuppression - Plasmapheresis

What antigen is the anti-GBM antibody against? Located where?

Non collagenous portion of the alpha 3 chain of collagen type IV - In GBM - In tubules - In pulmonary system

What is seen here?

Membranoproliferative glomerulonephritis

What are 2' causes of Membranoproliferative GN?

- Infection (Hepatitis B,C ) - Malignancy (lymphoma, CLL) - Cryoglobulinemia - Hereditary complement deficiency - Alpha -1 antitrypsin deficiency

What is seen here?

Type I MPGN - Membrane reduplication (splitting- tram track) - Asterisks = interposition

What is seen here?

Type II MPGN - Ribbon like densities (worm-like darkening of GBM)

What is seen here?

Global glomerulosclerosis

What is seen here?

Segmental glomerulosclerosis

What is seen here?

Nodular glomerulosclerosis

What is seen here?

Focal Segmental Glomerulosclerosis (pattern)

What is seen here?

Podocyte effacement... FSGS

What will IF show for FSGS?

Typically negative

What are the 1' causes of FSGS? 2'?

_Primary:_ - Inherited mutations (nephrin, podocin) _Secondary:_ - HIV - Heroin - Sickle Cell disease - Obesity - HTN - Reflux nephropathy - Single kidney

Reflux of infected urine may cause what?

Pyelonephritis

What can cause infection of tubulointerstitial compartment?

- Reflux of infected urine -\> pyelonehpritis - Toxins -\> damage tubular epithelium as urine is concentrated - Allergic reactions from excreted substances - Ischemic injury -\> tubule damage due to their high metabolic demands Degree of tubulointerstitial damage correlates with decline in renal function

What is seen here?

AIN- Acute interstitial nephritis - Hypercellular

What is seen here?

ATN- Acute tubular necrosis - Pink and dead - Not rich in inflammatory cells - "Just quietly die"

What are vascular changes that may affect kidney?

- Flow related changes (e.g. hypertensive changes) - Inflammatory (such as vasculitis) * Remember that the capillary loops of the glomerulus are small vessels and can be inflamed and damaged in vasculitis settings (such as ANCA vasculitis). - Embolic disease * Cholesterol emboli * Septic emboli

Thin basement membranes present how?

- Diffuse thinning of GBM - Present with hematuria

What is Hereditary nephritis? - Presentation - Pathophysiology - Genetics

Hereditary nephritis - **Hematuria** - **Deafness, ocular** disorders (**Alport** syndrome) - Defective assembly of **type IV collagen** - Most are **X-linked**

What is seen here?

"Basket weaving" appearance to GBM in Alport Syndrome (Hereditary Nephritis)

Fibrinous vs. fibrinoid

**Fibrinous** (left) - chronic **Fibrin** (right)- acute; pink coagulum of fibrin and serum proteins

9/23- Renal Review 1- Pathology Flashcards

(55 cards)