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54 Cards in this Set
- Front
- Back
What disease might this be?
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Anti-GBM disease
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If there is also lung involvement, this histology would indicate what disease?
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Anti-GBM disease
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What ANCA pattern is this showing
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cANCA
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List the cellular mediators of glomerular injury.
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PMNs, monocytes, macrophages, lymphocytes, platelets, intrinsic glomerular cells
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List the non-cellular mediators of glomerular injury.
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Immune complexes, complement, chemokines, growth factors, ROS, coagulation factors, vasoactive substances, enzymes
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Define nephrotic syndrome.
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Proteinuria>3.5g/day
edema hyperlipidemia hypoalbuminemia |
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Define nephritic syndrome.
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Microscropic-gross hematuria
RBC casts Dark urine proteinuria HTN |
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List the indications for renal biopsy.
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Proteinuria w/ or w/o nephritic syndrome
Hematuria Unexplained ARF or CRF Systemic dz w/suspected renal involvement Renal allograft dysfunction |
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Define intracapillary hypercellularity.
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too many cells w/in a glomerular capillary tuft (area bordered by GBM)
Includes glomerular capillaries & mesangium |
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Define extracapillary hypercellularity.
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too many cells in bowman's capsule (outside of the GBM)
also "crescentic" |
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Describe segmental glomerular sclerosis.
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methenamine silver or PAS stained ECM accumulates in parts of the glomerulus leading to obliteration of glomerular capillary lamina
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Describe global glomerular sclerosis.
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methenamine silver or PAS+ ECM accumulates-->totally obliterates glomerular tuft
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Membranous GN has what kind of IF pattern?
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Peripheral
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What shows mesangial IF?
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IgA nephropathy
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What shows both mesangial and peripheral IF?
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Lupus nephritis
MPGN |
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What kind of deposits are seen in EM with post-infectious glomerulonephritis?
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Subepithelial humps
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What kind of IF stain appears with post-infectious GN?
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C3 and IgG
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What kinds of Strep can cause post-infectious GN?
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Group A beta-hemolytic Strep strains 12, 4,1,49
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What kind of labs are seen with post-infectious GN?
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Low C3
Normal C4 High ASO |
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What differentiates Staph GN from post-strep GN?
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Occurs during active infection
Also see mesangial IgA deposits |
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What is the most common age group to get post strep GN?
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Kids
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What kind of glomerulopathy shows tram tracks?
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MPGN type I
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What is seen on IF with MPGN?
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Large capillary loops & mesangial C3, IgG
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What is seen in the EM of MPGN type I?
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Large subendothelial deposits, mesangial cell interposition
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What is seen in the EM of MPGN type II?
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Ribbon-like deposits in GBM
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What is the prognosis of MPGN type I?
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slow progression to ESRD
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What is associated w/MPGN type I?
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Immune complexes
Hep C |
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What is associated with MPGN type II?
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Renal transplant
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Where is IgA nephropathy most common?
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Asia
Not found often in African-Americans |
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What is the clinical manifestation of IgA nephropathy?
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Microscopic hematuria with episodic gross hematuria
Non-nephrotic range proteinuria Nephritic syndrome |
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What is the outcome of IgA nephropathy?
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Slowly progressive
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What are poor prognostic factors for progression in IgA nephropathy?
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Glomerular sclerosis
Crescents Heavy proteinuria HTN Interstitial fibrosis |
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What presents like IgA nephropathy but in children?
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H-S purpura
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What is the most common crescentic GN?
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Pauci-Immune Crescentic GN
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What is associated with Pauci-Immune Crescentic GN?
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ANCA
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Who gets Pauci-Immune Crescentic GN?
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Adults and the elderly
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What is pANCA and what is it associated with?
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Antibody to myeloperoxidase
Found in microscopic polyarteritis |
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What is cANCA and what is it associated with?
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Antibody to proteinase
Found in Wegeners |
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What indicates renal-limited Pauci-Immune Crescentic GN?
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pANCA>cANCA
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What is the clinical presentation of Pauci-Immune Crescentic GN?
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ARF w/nephritic syndrome
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What does LM show in Pauci-Immune Crescentic GN?
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glomerular crescents & necrosis w/intracapillary hypercellularity
Uninvolved glomeruli are normal |
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What is the outcome of Pauci-Immune Crescentic GN?
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Rapidly progresses to ESRD if untreated
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How do you treat Pauci-Immune Crescentic GN?
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Steroids
Cyclophosphamide |
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What age group is affects by anti-GBM disease?
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Adults
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What is the clinical presentation of anti-GBM disease?
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ARF, nephritic syndrome, pulmonary hemorrhage (Goodpastures)
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What GN is associated with Goodpasture's disease?
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Anti-GBM disease
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What is the antigen associated with anti-GBM disease?
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alpha3 chain of collagen type iV
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What is the antigen associated with Goodpastures?
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alpha3 chain of collagen type iV
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What is the IF of anti-GBM disease?
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Linear IgG along the GBM-->LINEAR
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What is the outcome of anti-GBM disease?
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Poor
Plasmapheresis |
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What are the 2 types of immune complex crescentic GN?
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Primary: idiopathic
Secondary: superimposed on known underlying immune complex GN |
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What is the outcome of immune complex crescentic GN?
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Poor except in postinfectious secondary ic crescentic GN
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What is the morphology of immune complex crescentic GN by LM?
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Crescents (extracapillary hypercellularity) AND intracapillary hypercellularity
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What is the morphology of immune complex crescentic GN by IF?
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Granular glomerular deposits
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