RENAL PATHOLOGY 4

Question 1

This strong negative charge prevents negatively charged proteins like (1) from being filtered into the urinary space

Answer 1

1. albumin

Question 2

Immunological damage to the glomeruli can either produce predominantly (1) (nephrotic symptoms and signs) or predominantly (2) (nephritic symptoms and signs).

Answer 2

1. mainly protein loss

2. bleeding and more severe injury

Question 3

Clinically, patients with heavy proteinuria have the (1) syndrome which consists of proteinuria (usually 3.5 grams of protein in a 24 hour urine collection), (2)

Answer 3

1. nephrotic

2. hypoalbuminemia, edema, hyperliipidemia, and lipiduria

Question 4

The proteinuria leads directly to the (1) because the kidney is excreting the protein from blood into urine.

Answer 4

1. hypoalbuminemia or low serum albumin

Question 5

The hypoalbuminemia causes (2) because of the decreased plasma oncotic pressure from decreased serum proteins.

Answer 5

2. edema (fluid within tissues)

Question 6

The hyperlipidemia occurs because the (1) produces more (2) in the generalized response to produce more (3).

Answer 6

1. liver
2. lipoproteins
3. albumin

Question 7

(1) happens because of the increased lipoproteins carrying lipid and because of loss of the filtration barrier.

Answer 7

1. Lipiduria (lipid in urine)

Question 8

There can be extensive (1) in patients without any histopathological changes that can be seen by light microscopy (MCD/lipoid nephrosis)

Answer 8

1. selective proteinuria

Question 9

However, ultra-structural changes can be seen by electron microscopy generally show (1) in nephrotic syndrome in Minimal Change disease (MCD).

Answer 9

1. loss of the epithelial podocyte foot processes

Question 10

Minimal change disease (biopsy (1) is the most common cause of nephrotic syndrome in children. Children who do not develop any complications have a completely normal life span without any later renal disease.

Answer 10

1. H&E stains- no change in glomeruli; hyaline (protein and lipid) droplets in tubular cells

Question 11

Although the cause of minimal change disease is unknown, it is thought to be the result of (1) occurring in glomeruli

Answer 11

lymphokines of the T cells

Question 12

Membranous nephropathy can be either primary (Anti-phospholipase A2 receptor antibody) or secondary from a disease which is producing (2) within the kidney

Answer 12

2. antigens or immune complexes

Question 13

Some of the secondary causes of secondary membranous nephropathy include inflammation disorders like (1)

Answer 13

1. SLE, infections (IE), drugs (gold, penicillamine), and adenocarcinomas, DM

Question 14

An experimental animal model called Heymann nephritis suggest that (1) are more often present first in the (2) or surrounding cells before the (3) arrive to form immune complexes.

Answer 14

1. antigens
2. basement membrane
3. antibodies

Question 15

Light microscopy can show (1) in membranous nephropathy (silver stains show (2) material so they can show immune complexes as areas where the silver stain is lost)

Answer 15

1. thickened basement membranes

2. basement membrane

Question 16

Electron microscopy of membranous nephropathy shows antigen-antibody complexes present in the subepithelial region between the (1)

Answer 16

1. basement membrane and the podocyte

Question 17

The course of membranous nephropathy is

Answer 17

1. CRF to end stage renal disease

Question 18

Most common (adult) cause of nephrotic syndrome is (1)

Answer 18

1. focal segmental glomerulosclerosis (FSGS)

Question 19

Immune microscopy in membranous nephropathy can show the presence of (1) antibody or (2) components including (3) and the components of the (4) which actually causes the injury

Answer 19

1. IgG
2. complement
3. C3
4. membrane attack complex (C5b, C6-C9)

Question 20

GBM predominantly of _____
2. Also laminin, fibronectin, and glycosaminoglycans.
Relative exclusion of negatively charged molecules such as albumin due to _____

Answer 20

type IV collagen;

polyanionic glycosaminoglycans, (heparan sulfate).

Question 21

IgA deposit location

Answer 21

Mesangium

Question 22

How is edema caused in nephrotic syndrome: 2 causes

Dec. _____ due to loss of albumin;

1. fluid escapes into tissues causing edema;
2. Dec. onc. pressure leads to dec. ____ –> dec. ____ –> INC. _____–> fluid retention–> edema

Answer 22

Dec. plasma oncotic pressure due to loss of albumin; 1. fluid escapes into tissues causing edema; 2. Dec. onc. pressure leads to dec. plasma volume –> dec. GFR –> INC. aldosterone–> fluid retention–> edema

Question 23

Min. change disease -Occasional association with ___
and with ____ has led to the
speculation that it is a T lymphocytes disorder

Answer 23

Hodgkin disease; atopic asthma etc

Question 24

Minimal change disease
Light microscopy:
EM:
Immunofluoresence for immunoglobulins (IF) and complement:

Answer 24

Light microscopy: Normal
Electron microscopy: diffuse obliteration of podocyte foot processes
IF–> negative

Question 25

In intermediate disease stages, silver stains (which demonstrate basement membrane
material) reveal multiple projections or “spikes” on the epithelial surface of BM

Answer 25

Membranous nephropathy

Question 26

M embranous Nepropathy

Immunofluorescence microscopy reveals ____ staining of capillary walls for IgG and C3. There is intense staining for terminal complement components, including
the _____, which induces glomerular injury

Answer 26

diffuse granular; membrane attack complex;

Question 27

Membranous glomerulopathy. Caused by the ____ accumulation of immune complexes and the accompanying changes in the ____.

Answer 27

subepithelial; basement membrane (BM)

Question 28

IF- linear deposit see in glomeruli in_______

Answer 28

Type II hypersensitivity, Anti-GBM disease-aka CrGN (type 1)

Question 29

FEATURES OF Glomerulus in DM

Answer 29

Nodular (PAS positive DEPOSIT) nephrosclerosis

Question 30

Risk factors- FSGS

Answer 30

HIV, OBESITY, ETC.

Question 31

C3 NEPHRITIC FACTOR POSTIVE SERUM- GLOMERULAR FINDINGS

Answer 31

DENSE DEPOSIT

Question 32

DEPOSIT OF IGG, IGM, AND C3 IN GLOMERULI, INFECTION BY____

Answer 32

INFECTION WITH GROUP A-STREPTOCOCCI

Question 33

RESP. INFECTION FOLLOWED BY HEMATURIA- POSSIBLE CONDITION

Answer 33

IGA NEPHROPATHY

Question 34

INFECTION, ATHEROSCLEROSIS, AND DVT- POSSIBLE COMPLICATIONS OF_______

Answer 34

NEPHROTIC SYNDROME

Question 35

NON SELECTIVE PROTENIRIA

Answer 35

FSGS

Question 36

HEMATURIA AND +4 PROTEINURIA

Answer 36

FSGS AND MGN