how do you describe all glomeruli
focal or diffuse
what do focal and diffuse mean
focal - less that half
diffuse - half or more
how do you describe a single glomerulus
segmental or global
what do segmental or global mean
segmental - portions of glomerulus affected
global - entire glomerulus affected
segmental or global
segmental
segmental or global
global
subtypes of hypercellularity
intrinsic - within glomerular tuft
extrinsic - in glomerulus but outside glomerular tuft
types of intrinsic hypercellularity
mesangial, endocapillary, lobular
types of extrisic hypercellularity
extracapillary, crescents
normal glomerulus
describe a normal capillary in the glomerulus
patent lumina, smooth GBM contours, small endothelial cells, inconspicuous podocytes
describe a normal mesangium
1-3 cells per contiguous area; small amount of matrix
endocapillary intrinsic hypercellularity
the cells are encroaching upon capillary lumina
hard to find open capillary lumina
mesangial intrinsic hypercellularity
patent capillary lumina but misangeal matrix abnormal
crescent extrinsic hypercellularity
crescent extrinsic hypercellularity
silver stain highlights BM
intrinsic HC often associated with what
immune complex deposition
extrinsic HC often associated with what
GBM break/rupture
goodpasture, ANCA vasculitis…
double contour BM
“tram tracking” extra BM laid down due to injury
double contours typically due to what
endothelial/subendothelial injury
endothelial cells make new BM, so do podocytes if they need to
can be accompanied by mesangial cell migration (interpositioning) or immune cell infiltration
mesangial matrix expansion
glue that holds everything together shows tons of matrix
nodular mesangial expansion
seen in DM
causes of MME
DM, HTN
immunoglobulin or immune complex deposition
capillary pattern (granular) glomerular injury
mesangial pattern glomerular injury
GBM linear pattern think goodpastures
diffuse
what are arrows pointing to
granular deposits
fibrillar desposits
seen in amyloid
tubular pattern
thumbprint deposit
seen in lupus
when do you seen thrombosis in glomeruli
as part of thrombotic microangiopathy
also in DIC
causes of TMA
SLE, HUS/TTP, PSS, HTN
Fibrin thrombus
TMA
tuft necrosis is associated with what
immune mediated injury
tuft necrosis
nuclear debris, karyorexis
insudate
when fluid passes thru capillary or epithelial cell and causes glassy appearance
scar in glomerulus in bowmans space
entire glomerulus scarred tf up
segmental sclerosis
scar with associated insudate (note glassy/hyaline apperance of cells at bottom)