GN

Question 1

glomerular disease is diagnosed by?

Answer 1

biopsy! (pathological, not clinical dx)

Question 2

three types of microscopy used to examine renal biopsies

Answer 2

light + staining, immunofluorescence, electron

Question 3

three types of cells in the glomerulus

Answer 3

podocyte (epithelial), endothelial cell, mesangial cell (at the neck)

Question 4

fenestrated endothelial cell is separated from the podocyte by?

Answer 4

glomerular basement membrane

Question 5

primary sx of nephrotic syndrome

Answer 5

edema, proteinuria, hypoproteinemia, hyperlipidemia, lipiduria (with oval fat bodies in urine)

Question 6

primary sx of nephritic syndrome

Answer 6

hematuria, azotemia, HTN, RBC casts

Question 7

major causes of nephrotic syndrome

Answer 7

minimal change GN, FSGS, membranous glomerulopathy, diabetic nephropathy, amyloidosis, (membranoprolif, lupus)

Question 8

major causes of nephritic syndrome

Answer 8

IgA nephropathy, lupus GN, IgA vasculitis, cryoglobulinemic vasculitis, anti-GBM GN, ANCA GN (membranoprolif)

Question 9

what does minimal change glom look like on microscopy?

Answer 9

normal by LM, normal by IM, foot process effacement on EM

Question 10

who gets minimal change glom?

Answer 10

children

Question 11

tx of minimal change glom

Answer 11

corticosteroids (empiric in a kid, don’t need biopsy first)

Question 12

what does membranous glom look like on microscopy?

Answer 12

thick capillary walls on LM, granular capillary wall staining on IM, dense subepithelial deposits on EM (these are immune complexes)

Question 13

primary membranous glom is caused by?

Answer 13

anti-phospholipase A2 receptor auto-antibodies (antigen comes from podocyte)

Question 14

secondary causes of membranous glom

Answer 14

SLE, infections (hep B, syph), metal drugs, malignancy

Question 15

what does FSGS look like on microscopy?

Answer 15

parts of some glomeruli have consolidation of glomerular tufts

Question 16

primary FSGS is _____; secondary causes include?

Answer 16

idiopathic; HIV, mutation in podocyte genes, drug toxicity (heroin, pamidronate, interferon-alpha), adaptive structural response (obesity, sickle cell, congenital heart disease)

Question 17

what does membranoproliferative glom look like on microscopy?

Answer 17

thick capillary walls AND hypercellularity (from leukocyte infiltration), variable IM based on immune complex vs. dense deposit dz

Question 18

causes of immune complex MPGN

Answer 18

chronic bacterial infection (osteomyelitis, endocarditis), hep C (cryoglob), malignancy

Question 19

causes of dense deposit MPGN

Answer 19

abnormalities in alternative complement pathway activation (antibodies or mutations)

Question 20

most common cause of ESRD in US

Answer 20

diabetic glomerulopathy

Question 21

signs of diabetic nephropathy

Answer 21

proteinuria, progressive decline in GFR, HTN

Question 22

what does DN look like on microscopy?

Answer 22

progressive thickening of GBM, increase in mesangial matrix, KW nodules

Question 23

which types of amyloid cause nephrotic syndrome?

Answer 23

AL amyloid, AA amyloid

Question 24

by EM, amyloid looks like?

Answer 24

randomly arranged fibrils

Question 25

name three types of glomerulonephritis that cause nephritic syndrome

Answer 25

immune complex (granular), anti-GBM (linear), ANCA (no IF)

Question 26

name the major patterns of glomerular injury

Answer 26

mesangioprolif, prolif (inside lumen), crescent (extracapillary), sclerosing (order of severity)

Question 27

order glomerulonephritis in order of severity

Answer 27

acute postinfectious, IgA < lupus (huge range) < ANCA, anti-GBM

Question 28

acute postinfectious GN most often presents with what pathological features

Answer 28

diffuse proliferative GN with PMNs inside the lumen, subepithelial humps, and granular staining on IF

Question 29

the primary reason for a renal biopsy of a patient with SLE is to?

Answer 29

assess disease severity and direct management

Question 30

class V lupus shows what histologic manifestations?

Answer 30

membranous GN, thick BM

Question 31

IgA nephropathy has IgA dominant ____ immune deposits

Answer 31

mesangial (so mesangioprolif GN is common presentation)

Question 32

when IgA vasculitis is systemic, it is called?

Answer 32

Henoch-Schonlein purpura

Question 33

systemic vasculitis from Hep C is called?

Answer 33

cryoglobulinemic vasculitis

Question 34

ANCA GN and vasculitis is due to antibodies against?

Answer 34

myeloperoxidase or proteinase 3 (proteins in cytoplasm of PMNs and monocytes)

Question 35

pathology of ANCA GN

Answer 35

capillary necrosis and rupture, leading to crescent GN

Question 36

ANCA associated pulm lesions

Answer 36

hemorrhagic (hemoptysis), granulomatous, or eosinophilic inflammation

Question 37

when ANCA strictly affects the kidneys only, it is called?

Answer 37

Pauci-Immune Crescentic GN

Question 38

why doesn't ANCA-GN show up on IF

Answer 38

ANCA directly attacks cells rather than the membrane

Question 39

in anti-GBM disease, patients have antibodies against?

Answer 39

type IV collagen in the GBM (leads to linear IF staining)

Question 40

ANCA GN presents in a (younger/older) population

Answer 40

older

Question 41

measurement of proteinuria

Answer 41

24-hour urine collection, spot urine-creatinine ratio (should be less than 0.2)

Question 42

transient proteinuria can occur in the present of ?

Answer 42

fever

Question 43

proteinuria must be ____ in order to suspect glomerular disease

Answer 43

fixed

Question 44

complications of nephrotic syndrome

Answer 44

thrombosis! (due to loss of anticoag factors) -- can be DVT or renal vein thrombosis; infection (due to loss of Ig); accelerated atherosclerosis

Question 45

clues that hematuria is glomerular

Answer 45

brown color, proteinuria, dysmorphic RBCs (acanthocytes especially), RBC casts, rash

Question 46

GN associated with low C3 (alternative pathway)

Answer 46

postinfectious, endocarditis, membranoprolif.

Question 47

GN associated with low C3 and C4 (classic pathway)

Answer 47

lupus, cryoglobulinemic

Question 48

GN associated with normal complement levels

Answer 48

ANCA, IgA nephritis, Henoch-Schonlein purpura, Goodpasture's

Question 49

signs of necrotizing vasculitis

Answer 49

systemic, skin, respiratory, and ENT symptoms