SM 208 Nephrosis

Question 1

What is urinalysis?

Answer 1

A basic tool for evaluation of renal function

Question 2

What does urinalysis evaluate for?

Answer 2

Protein, cells, electrolytes

Question 3

What characterizes a nephritic syndrome?

Answer 3

RBC’s in the urine

Question 4

Is blood in the urine during a nephritic syndrome macroscopic or microscopic?

Answer 4

Both!

Question 5

What does fluorescent microscopy identify?

Answer 5

IgG, IgM, IgA and Complement components that deposit on the Glomerulus

Question 6

What supports a capillary loop?

Answer 6

Mesangial cells

Question 7

What does electron microscopy identify?

Answer 7

Exact location of deposition of various inciting agents and other subtle alterations of other components

Question 8

Is kidney disease diagnosed with clinical pictures or biopsy evaluation?

Answer 8

Both; combine imaging with clinical picture

Question 9

What is the difference between focal and diffuse?

Answer 9

Focal involves some glomeruli, while diffuse involves all glomeruli

Question 10

What is the difference between segmental and global?

Answer 10

Segmental involves part of the glomeruli while global involves the entire glomeruli

Question 11

How can PCT and DCT cells be differentiated on slides?

Answer 11

PCT cells form larger tubules and had thick cells due to lots of mitochondria to power active transport DCT cells are thinner and form smaller tubules

Question 12

What causes a “crescent” on slides?

Answer 12

“Crescent” forms due to parietal epithelial cells abnormally proliferate

Question 13

How does a “crescent” effect the Glomeruli?

Answer 13

“Crescent” compresses the Glomeruli and causes a loss of function

Question 14

What is this?

Answer 14

A crescent compressing a glomeruli

Question 15

What is this?

Answer 15

“Hyaline” glomeruli, since it’s so thick and pink

Question 16

What is this?

Answer 16

Tram-Track staining where the Base Membrane has thickened and appears as two layers

Question 17

What is this?

Answer 17

Wire-loop staining because of even thickening of all basement membrane around the capillary loops

Question 18

What 5 things can cause glomerular disease?

Answer 18

Circulating IC’s
IC deposition in-situ
Cell-mediated and Complement mediated
Epithelial injury
Renal Ablation

Question 19

What do anti-GBM antibodies target?

Answer 19

Anti-GBM antibodies target Type IV Collagen

Question 20

What can cause Immune Complex deposition other than anti-GBM antibodies?

Answer 20

Planted Haptens which induce an immunogenic response against the Glomerulus

Question 21

Why is Renal Ablation a death spiral?

Answer 21

Renal Ablation refers to the loss of one glomerulus causing another one to hypertrophy and compensate
However, the pressure and volume in the surviving nephron increases while the wall remains thin, leading to failure
This causes other nephrons to try and copmensate

Question 22

What does Minimal Change Disease cause?

Answer 22

Nephrotic syndrome in young children after an URI, causing edema and effacement of podocyte foot processes

Treat with corticosteroids

Question 23

A young child presents with an URI and swollen limbs, as well as heavy proteinuria. What disease does he have?

Answer 23

Minimal Change Disease

Question 24

What causes nephrotic syndrome after an URI?

Answer 24

Minimal Change Disease

Question 25

How is Minimal Change Disease treated?

Answer 25

Corticosteroids

Question 26

Is FSGS a disease?

Answer 26

No, it's a pattern of injury

Question 27

How does FSGS present on slides?

Answer 27

Partial scarring of only some glomeruli

Question 28

Is FSGS primary or acquired?

Answer 28

May be primary or drug-induced, especially after HIV + Heroin

Question 29

HIV + Heroin predisposes which disease?

Answer 29

FSGS

Question 30

What is FSGS?

Answer 30

A pattern of injury that causes partial scarring of some glomeruli that tends to follow HIV + Heroin use

Question 31

How does FSGS appear on light microscopy?

Answer 31

Sclerosis affect some parts of some glomeruli

Question 32

Is FSGS specific or non-specific on fluorsecent microscopy?

Answer 32

FM is non-specific and depends on the underlying diagnosis

Question 33

How does FSGS appear on electron microscopy?

Answer 33

Loss of foot processes and podocyte detachment

Question 34

Compare and contrast FSGS and Minimal Change Disease?

Answer 34

FSGS and MCD both present with the loss of foot processes, but MCD is mostly in kids and steroid responsive while FSGS is mostly in adults and non-responsive

Question 35

Mostly effects kids and steroid responsive: FSGS or MCD?

Answer 35

Minimal Change Disease

Question 36

Mostly effects adults, steroid non-responsive?

Answer 36

FSGS

Question 37

What disease is this?

Answer 37

FSGS, since only some glomeruli and only parts of glomeruli are effected

Question 38

How do you distinguish MCD and FSGS on electron microscopy?

Answer 38

You can't; need to know the clinical picture with respect to age (kids = MCD, adults = FSGS) and steroid responsiveness (MCD = steroid responsive, FSGS = steroid unresponsive)

Question 39

What is Membranous Nephropathy?

Answer 39

A disease in adults with slowly progressive renal failure due to circulating immunocomplexes and in-situ immune complex formation Primary or drug induced

Question 40

Is Membranous Nephropathy a primary or acquired disease?

Answer 40

Both; tends to follow Lupus

Question 41

What causes wire-loop appearance in the glomerular capillaries?

Answer 41

Membranous Nephropathy

Question 42

What causes a spike-and-dome pattern on electron microscopy?

Answer 42

Membranous Nephropathy

Question 43

What is MPGN?

Answer 43

A histomorphologic designation dependent on light microscopy with 2 subtypes

Question 44

What is Type I Membranoproliferative Glomerulonephritis?

Answer 44

A form of MPGN that occurs due to circulating immune complexes Visualized on fluorescent microscopy as C3 + IgG Prognosis depends on underlying disease

Question 45

Which type of MPGN complicates chronic infections?

Answer 45

Type I MPGN

Question 46

What is Type II Membranoproliferative Glomerulonephritis?

Answer 46

A form of MPGN that occurs due to C3 abnormality Shows only C3 on Fluorescent Microscopy Poor prognosis

Question 47

How are Type I and Type II MPGN differentiated on fluorescent microscopy?

Answer 47

Type I = C3 + IgG Type II = C3 only

Question 48

Which type of MPGN involves dysregulation of the complement pathway?

Answer 48

Type II MPGN

Question 49

Which disease causes a tram-track pattern on silver stain?

Answer 49

MPGN

Question 50

What proliferates in MPGN?

Answer 50

The GBM proliferates

Question 51

What are Kimmelstiel Wilson nodules pathopneumonic for?

Answer 51

Diabetic Nephropathy

Question 52

What is the end stage of many kidney diseases?

Answer 52

Chronic Glomerulonephritis

Question 53

How does Chronic Glomerulonephritis present on light microscopy?

Answer 53

Since Chronic Glomerulonephritis is the end-stage of kidney diseases, it presents with diffuse sclerosis of most glomeruli

Question 54

What is this?

Answer 54

Chronic Glomerulonephritis; due to the completely destroyed Glomeruli

Question 55

Is Tubulointerstitail Nephritis infectious or non-infectious?

Answer 55

Both

Question 56

What causes infectious tublulointerstitial nephritis?

Answer 56

Pyelonephritis

Question 57

What are non-infectious causes of tubulointerstitlal nephritis?

Answer 57

Drugs, ischemia

Question 58

What drugs can cause tubulointerstitial nephritis?

Answer 58

AACC Acetaminophen Aspirin (NSAIDS) Caffeine Codeine Long-term large doses

Question 59

How does Acetaminophen cause tubulointerstital nephritis?

Answer 59

Oxidative damage to the tubules

Question 60

How does aspirin cause tubulointerstitial nephritis?

Answer 60

Asprin inhibits Prostaglandin synthesis causing vasoconstriction and ischemia