Renal Pathology

Question 1

Focal segmental glomerulosclerosis (LM, IF, EM, associations)

Answer 1

LM - segmental sclerosis and hyalalinosis
EM - effacement of foot process like minimal change
AA and Hispanics
idiopathic, HIV, sicle cell, ovesity, interferon treatment, chronic kidney disease
inconsistent response to steroids

Question 2

Minimal change disease

Answer 2

LM - normal
EM - effacement of food processes
children (recent infection, immune stimulus), Hodgkins lymphoma
excellent response to steroids

Question 3

Membranous nephropathy

Answer 3

LM - diffuse capillary and GBM thickening
IF - granular (immune complex)
EM - “spike and dome” subepithelial deposits
most common cause in Caucasian adults
idiopathic, Ab to phospholipase A2 R, drugs,infections, SLE, solid tumors
poor response to steroids

Question 4

Amyloidosis

Answer 4

LM - congo red stain w/ apple-green birefringence

chronic conditions

Question 5

Membranoproliferative glomerulonephiritis Type I

Answer 5

IF - subendothelial immune complex, tram-track (GBM splitting due to mesangial ingrowth)
HBV, HCV, idiopathic

Question 6

Membranoproliferative glomerulonephritis Type II

Answer 6

IF - intramembranouse IC deposits “ dense deposits”

C3 nephritic factor (stabilize C3 convertase –> dec serum C3)

Question 7

Diabetic glomerulonephropathy

Answer 7

LM - mesangial expansion, GBM thickening, Kimmelstiel-Wilson nodules
nonenzymatic glycosylation of GBM and efferent arterioles
txt: ACE inhibitor

Question 8

Acute post-strep glomerulonephritis

Answer 8

LM - glomeruli enlarged and hypercellular
IF - “starry sky” and “lumpy-bumpy” due to IgG, IgM and C3 deposition
EM - subepithelial immune complex humps
children, 2 wks after group A strep infection of pharynx or skin
Type III HS rxn
cola-colored urine, periorbital edema
inc anti-DNase B titers and dec complement

Question 9

Rapidly progressive (crescentic) glomerulonephritis

Answer 9

LM and IF - crescent-moon shaped (fibrin and plasma proteins with parietal cells, monocytes and macrophages)
poor prognosis
Goodpasture syndrome (Type II HS) - Ab to GBM and alveolar BM –> linear IF
Wegener - PR3 -ANCA/c-ANCA
microscopic polyangiitis (Churg strauss)- MPO-ANCA/p-ANCA

Question 10

Diffuse proliferative glomerulonephritis

Answer 10

LM- “wire looping” of capillaries
EM-subendothelial and intramembranous IgGbased ICs often with C3 deposits
IF- granular
SLE (most common cause of death) or MPGN
txt: cyclophosphamide

Question 11

IgA nephropathy (Berger)

Answer 11

LM- mesangial proliferation
EM - mesangial IC deposits
IF - IgA-based IC deposits in mesangium
presents days after URI or acute gastroenteritis; episodic hematuria with RBC cast
Henoch-Chonlein purapura
Txt: Ace I, corticosteroid

Question 12

Alport syndrome

Answer 12

mutation in type IV collagen –> thinning and splitting of glomerular BM
X-linked
also deaf and eye problems