Jan9 M3-Introduction to Renal Pathology

Question 1

4 main compartments of the kidney

Answer 1

glomeruli, tubules, interstitium, vasculature

Question 2

arterial-venous system in the kidney

Answer 2

arteries: renal, interlobar, arcuate, lobular, afferent, efferent
capillaries: network under capsule + peritub drain in stellate veins. vasa recta drain in arcuate vein
veins: stellate veins-lobular veins-arcuate veins-interlobar-renal

Question 3

normal podocytes on EM

Answer 3

can distinguish individual podocytes and see the space between them

Question 4

2 types of glomerular barriers to proteins

Answer 4

size-selective (large proteins and blood)

charge-selective (albumin): BM is negatively charged

Question 5

selective vs non selective proteinuria + indicates what + particular thing in non-selective

Answer 5

• selective = albumin only = alteration of negative charge

- non selective = not albumin only = anomaly to endoth or GBM or podocytes. can see hematuria

Question 6

pathological consequence of the glomerulus being part of our (micro)vasculature

Answer 6

anything that injures small blood vessels affects it (diabetes, htn, vasculitis, thrombosis)

Question 7

glomerulus is a site of predilection for the deposition of ________ and this is the major form of ________

Answer 7

immune complexes. major form of GN

Question 8

problem in GN nomenclature

Answer 8

many types of glomerular diseases have no inflammatory cells

Question 9

immune vs non immune glomerular injury

Answer 9

immune: often bx, antibody mediated, in situ complex formation or deposition of preformed complexes
non-immune: nephron loss, injury to podocytes, no bx

Question 10

give 2 immune mediated GNs

Answer 10

anti GBM disease

membranous nephropathy

Question 11

anti GBM disease pathophgy

Answer 11

CIRCULATING antibodies attack type IV collagen in GBM: leads to inflam rx

Question 12

membranous nephropathy pathophgy

Answer 12

de novo antibodies attack structures near the podocytes

Question 13

2 types of diseases where deposition of preformed circulating immune complexes exists + where they deposit

Answer 13

-endocarditis and post infection rheumatic
-lupus (SLE)
Deposit on glomerulus

Question 14

what determines the location where preformed circulating immune complexes deposit (2) + where do they deposit

Answer 14

1. their size and their charge
2. the balance of Ag to Ab
   Deposit on the glomerulus

Question 15

type of non immune mechanism of glomerular disease

Answer 15

hyperfiltration injury

Question 16

hyperfiltration injury: 2 main reasons it happens

Answer 16

adaptive changes in glomeruli (hypertrophy + GC htn) and systemic htn

Question 17

pathophgy of hyperfiltration injury and how disease detected

Answer 17

GC htn, G hypertrophy and systemic htn lead to epithelial and endo injury and proteinuria

Question 18

what is the glomerulus’ reponse in hyperfiltration injury and what is typically seen

Answer 18

glomerulosclerosis (mesengial cells prolif, ECM prod, intraglom coagulation, vessels obliterated, tubules and interstitium disappear and become fibrotic)

Question 19

what happens to tubules and interstitium in hyperfiltration injury

Answer 19

they disappear and become fibrotic

Question 20

why is there a vicious circle in hyperfiltration injury

Answer 20

glomeruli that aren’t injured try to compensate so they become hypertrophic and hyperfiltrate so buildup of GC pressure

Question 21

to what extent is hyperfiltration injury reversible

Answer 21

to some extent until too much fibrosis

Question 22

causes of hyperfiltration injury

Answer 22

htn, diabetes, GN, cystic kidney disease

Question 23

9 major renal syndromes

Answer 23

1. asymptomatic proteinuria
2. nephrotic syndrome
3. asymptomatic hematuria
4. nephritic syndrome
5. rapidly progressive GN
6. AKI
7. CKD
8. UTI
9. nephrolithiasis (stones)

Question 24

first test performed on nephro patient and when to check urine sediment

Answer 24

dipstick. when dipstick positive for anything

Question 25

dipstick checks what

Answer 25

blood hemolyzed, non-hemolyzed, protein, glucose, pH, WBCs, ketones, etc.

Question 26

urine sediment checks for what (4)

Answer 26

cells, casts, crystals, organisms

Question 27

nephritic syndrome main features

Answer 27

hematuria, RBC casts, MILD-MODERATE proteinuria, htn

Question 28

RBC casts: how they're formed and sign of what

Answer 28

RBCs pass glomerulus and compact in the tubules. | cast = sign of glomerular injury

Question 29

nephrotic syndrome lab features (5 classical)

Answer 29

``` HEAVY proteinuria (>3g) Hypoalbuminemia Hyperlipidemia Lipiduria Severe edema ```

Question 30

PURE nephrotic syndrome on bx

Answer 30

no cellular proliferation, inflammation, necrosis or crescent formation

Question 31

does finding RBCs in the urine = glomerular problem?

Answer 31

no. casts yes. but blood can come from anywhere in urinary tract until urethra

Question 32

nephrotic syndrome urinary sediment features

Answer 32

fatty and hyaline casts, lipids, oval fat bodies (shedded tubular cells filled with lipids)

Question 33

3 modalities used on renal bx

Answer 33

LM, immunofluorescence(IF), EM

Question 34

what is done in renal bx LM other than usual H&E (2)

Answer 34

other stains to outline GBM and mesengium (silver, PAS, trichrome, ..)

Question 35

3 things that immunofluorescence on renal bx gives us

Answer 35

1. negative or positive for immune complex and Ig presence 2. location (mesengium, capillary wall) 3. patterns: (linear vs granular)

Question 36

3 main things EM tells us on renal bx

Answer 36

- location and appearance of deposits - appearance and thickness of GBM - evaluation of podocytes

Question 37

4 ways a glomerulus can react in GN

Answer 37

- hypercellularity and proliferation of mesengial, epith, inflam cells - necrosis - GBM thickening - sclerosis (scarring)

Question 38

what hypercellularity and proliferation rx of glomerulus shows

Answer 38

there is an inflammatory cell component

Question 39

what's a crescent

Answer 39

proliferation of parietal epithelial cells of Bowman's capsule often associated with glomerular necrosis

Question 40

what crescents show

Answer 40

severe glomerular injury, necrosis, GBM destroyed

Question 41

acute vs chronic crescents

Answer 41

acute: cellular crescent chronic: fibrous crescent

Question 42

4 words in glomerular lesion nomenclature and def

Answer 42

focal: some glomeruli diffuse: most glomeruli segmental: part of glomeruli global: entire glomerulus

Question 43

segmental vs gobal sclerosis or hypercel or wtv: definition

Answer 43

segmental: <50% of glomerular tuft (of the glomerulus) global: >50%

Question 44

exudative injury to the glomeruli meaning

Answer 44

hypercellularity + too many neutrophils