Pathology Glomerular Disease

Question 1

Patterns of Immunofluorescent staining in Glomerular disease

Answer 1

1. Linear (Type I RPGN, Diabetic)
2. Granular (IgA; Membranous; SLE; C3 type)
3. Irregular/fluffy: Amyloidosis

Question 2

Nephrotic syndrome S/S

Answer 2

• Massive proteinuria > 3.5
• Hyp[opalbuminemia
• Edema
• Hyperlipidemia

Question 3

Nephrotic Syndrome Pathogenesis

Answer 3

• Glomerular damage to podocytes/epithelium
• INC Permability leading to proteinuria/hypoproteinemia –> DEC plasma oncotic pressure -> DEC volume -> DEC GFR -> Edema
• Hypoproteinemia -> protein synthesis -> Hyperlipidemia

Question 4

Minimal Change Disease
- Eti
- Path
- LabDx
- A/S
-

Answer 4

• Eti: Unknown; Immune trigger
• Path: Cytokines -> Podocyte effacement + INC glomerular permeability
• LabDx: Nothing on light Mx or IF; Effacement on Electron microscopy
• A/S: Hodgkins Lymphoma

Question 5

Focal Segmental Glomerulosclerosis

• Epi
• Path
• LabDx
• Genetics
• A/S

Answer 5

• EPI: AAs
• Path: Segmental obliteration of capillary w/ glomerular sclerosis due to matrix accumulation, adhesions, + hyalinosis
• LabDx: Focal/segmental consolidation; No immune complexes; effacement of podocytes
• Genetics: ACTN4 gene
• A/S: Obesity, SCD, Heoin use, Infx, loss of nephrons

Question 6

Membranous glomerulonephritis

• EPI:
• Path
• LabDx

Answer 6

• EPI: Asians
• Path: Deposits -> projections/spikes -> BM formation surround deposits -> irregular thick BM
• LabDx: Diffuse wall thickening; Subepithelial Immune deposits against PLA2R

Question 7

Membranoproliferative glomerulonephritis

• PAth
• LabDx:

Answer 7

• LabDx: Capillary wall thickensing w/ endocapillary hypercellularity; dense deposits (type II)

Question 8

FSGS Variants (5)

Answer 8

• Collapsing: Podocyte hypertrophy collapsing vesselks; C3 IF
• “Tip”: More likely to respond to steroids; herniation of tuft into Proximal tubule
• Cellular variant: segmental endocapillary hypercellularity;
• Perihilar: sclerosis localizes to perihilar segments within glomeruli + in deep cortical glomeruli
• NOS: random distribution of scarring