Kidney 2

Front 1

Granular IF

Back 1

Type 3 rxn.

Front 2

Linear, smooth IF

Back 2

Anti-GBM Ab

Front 3

Minimal change disease LM & IF

Back 3

normal glomeruli
lipid droplet in proximal tubular epithelium

no deposit

Front 4

Nephrotic syndrome in children 2-6 yrs.

Back 4

minimal change disease

Front 5

Test for minimal change disease

Back 5

steroids

Front 6

Minimal change disease EM

Back 6

effacement of epithelial (podocytes) foot processes

Front 7

Minimal change disease C/F & lab

Back 7

proteinuria of albumin 4+
slightly cloudy urine
yellow urine
oval fat body

Lab:
high serum cholesterol
normal complement levels

Front 8

Nephrotic syndrome in adults
& etiology

Back 8

membranous nephropathy
Etiology:
idiopathic or genetic
Drug (penicillamine), renal transplantation, Heymann nephritis
SLE, DM, amyloidosis
Adenocarcinoma of lung and colon

Front 9

Morphology of MGN

Back 9

LM: H& E Stain--> diffuse thickening of capillary wall
Silver stain--> spikes
IF: granular deposits of IgG and C3
EM: Sub epithelial deposit along BM

Front 10

Urinalysis and Lab of MGN

Back 10

urine:
protein 4+
WBC/hpf = <2/hpf
Lab:
low complements

Front 11

MGN C/F

Back 11

HTN
hematuria
may progress to renal failure

Front 12

Types of Acute glomerulonephritis

Back 12

acute post streptococcal glomerulonephritis

non-streptococcal causes

Front 13

Acute nephritic syndrome in a child

Back 13

Acute post-streptococcal glomerulonephritis
ASO titer: high
Age: 2-4 years

Front 14

Acute post-streptococcal glomerulonephritis

Etiology-->
Path-->
Hypersensitivity rxn-->

Back 14

beta hemolytic group A strep infection of THROAT & SKIN

complement mediated tissue damage w/ the help of PMN

Type 3 (circulating IC)

Front 15

Non-streptococcal glomerulonephritis

Causes-->
D/D-->
Test-->

Back 15

pneumococcal pneumonia
Hep B, C
SLE, PAN
Malaria

Acute post-strep

ASO titre

Front 16

Morpho Acute post-strep glomerulonephritis

Back 16

LM: hypercellular, large glomeruli contain neutrophils
Tubules: RBC cast
IF: granular deposit of IgG, IgM, C3 in all glomerulous
EM: subepithelial humps

Front 17

Urinalysis, C/F
Acute post-strep glomerulonephritis

Back 17

Urine: smoky b/c of acid hemetin (due to hematuria), dysmorphic RBC (b/c RBC squeezing through glomerulus)

Serum complement low (C3 & C5). Complements used up by IC

ARF = acute nephritic syndrome

C/F: abrupt onset, malaise, slight fever, nausea

Front 18

Past hx. of post strep glomerulonephritis?

Back 18

pharyngitis, dermatitis, impetigo (honey-crusted lesions)

Front 19

Complication of post strep glomerulonephritis

Back 19

may progress to crescentric GN
may progress to chronic GN

Front 20

rapidly occurring acute nephritic syndrome?

LM-->
C/F-->

Back 20

CrGN

all types show glomerular crescent

hematuria and in 2-3 days ARF + uremia

Front 21

Composition of crescent in CrGN

Back 21

epithelial cells (podocytes)
fibrin
monocytes

Front 22

Type 1 CrGN

C/F
D/D

Back 22

1. AKA Anti-GBM DISEASE
2. AKA: Good pasture syndrome.
- Presence of Anti GBM antibody in serum: this react with alveolar capillary → pulmonary alveolar hemorrhage.
- Present as hematuria and hemoptysis
3. IF: Linear and smooth deposit of IgG, and C3 on GBM.

C/F--> decrease C3
D/D--> wegener (+c-anca)

Front 23

Ab to which antigens in CrGN

Back 23

lung and GBM

Front 24

Which type of hypersensitivity rxn is type 1 CrGN?

Back 24

Type 2

Front 25

Type 2 CrGN

Back 25

Etiology: mainly SLE
IF: Granular deposit
Clinical : progress to renal failure.
Serum: ANA present

Type 3 hypersensitivity

Front 26

C/F of SLE

Back 26

butterfly rash over bridge of nose
photosensitivity
anemia
anti-smith Ab, dsDNA Ab

Front 27

Type 3 CrGN

Back 27

Aka: Pauci-immune (no immune reaction)
Disease association:
Wagner Granulomatosis, polyarteritis Nodosa
Serum:
Normal complements
Positive ANCA (c or p)
LM: glomerular crescent
IF and EM: no deposit

Front 28

C/F PAN

Back 28

malaise, HTN, fever, purpura in skin (ulcer)

Front 29

C/F Type 3 CrGN

Back 29

acute onset of hematuria, hemoptysis,
RPGN--> ARF, uremia

Front 30

Prognosis of crescentric glomerulonephritis

Back 30

depends upon the number of crescent in kidney: so biopsy is indicated

Front 31

Causes of IgA elevation

Back 31

longstanding-->
lung infection
GI disease (celiac sprue)

Front 32

IgA elevation leads to deposits in...

Back 32

kidney
blood vessels --> HSP
dermis--> dermetitis herpetiformis

Front 33

recurrent hematuria in children and young adults

Back 33

Berger's (IgA nephropathy)

Front 34

Berger's

Back 34

Syndrome: recurrent hematuria
This hematuria occur 1-2 days after upper respiratory tract infection.
May progress to Chronic renal Failure(25%-50%).
IgA deposit in skin- dermatitis herpetiformis.
Asso: Gluten enteropathy.

LM: focal proliferation of mesangial cells
IF: IgA is deposited mainly in mesangium.

Front 35

Henoch-Schonlein Purpura

Back 35

It is associated with
1.Skin purpuric Rash
2.Abdominal Pain
3.Arthritis
4.And Kidney change

Q: What is the similarity?
A: Both are caused by IgA deposition in Mesangium and skin deposit of IgA.

Front 36

nephrotic syndrome in adults

Back 36

MPGN type 1

Front 37

MPGN Type 1

Back 37

Etiology: Hepatitis B and C, HIV, SLE, chronic liver diseases, chronic Bacterial Infection.
LM:
H&E: hyper cellular glumeruli ( but no PMNs) and thick GBM.
Silver stain : Tram track
IF: Granular deposit.

Serum: low complements ( particularly C3)

Front 38

Tram-tracking

Back 38

double basement membranes b/c of basement membrane splitting

MPGN 1

Front 39

Syndrome: Hematuria/ chronic renal failure-->

Back 39

MPGN 2

Front 40

MPGN 2

Back 40

40% progress to end stage renal failure
IF: Dense deposit in GBM .
Aka dense deposit diseases.
Serum: C3NeF (C3 Nephritic Factor) autoantibody is Present.

Front 41

Where are the dense deposits in MPGN 2?

Back 41

C3 deposits in capillary walls and mesangium
--> bad prognosis. Why? deposition on mesangium is inescapable b/c of lack of blood supply


Granular

Front 42

Back 42

podocyte effacement
minimal change disease

Front 43

Back 43

MGN

Front 44

Back 44

MGN

Front 45

Back 45

hypercellular glomeruli
acute post-strep glomerulonephritis

Front 46

Back 46

subepithelial humps
acute post-strep glomerulonephritis

Front 47

Back 47

CrGN

Front 48

Back 48

Focal proliferation of mesangial cells
Berger's

Front 49

Back 49

IgA deposit in mesangium
Berger's

Front 50

Back 50

tram-tracking
MPGN 1

Front 51

Back 51

Proliferative

Front 52

Back 52

anasarca
nephrotic syndrome

Front 53

Back 53

granular
circulating immune complex

Front 54

Back 54

linear, smooth
anti-GBM

Front 55

Back 55

FSGS

Front 56

Back 56

Trichrome stain demonstrating blue, collagen deposits
FSGN

Front 57

Non-selective proteinuria of nephrotic range

Back 57

FSGS

Front 58

nephrotic syndrome in child and adult

Back 58

FSGN

Front 59

proteins in non-selective proteinuria

Back 59

albumin
fibrinogen
globulin

Front 60

Morpho
FSGN

Back 60

H&E: sclerosis of some glomeruli, w/ partial involvement
Trichrome: blue

Front 61

Urinalysis of FSGS

Back 61

frothy b/c of albumin
thick b/c of fibrinogen

Front 62

D/x of FSGS

Back 62

biopsy

Front 63

FSGS
clinical

Back 63

Clinical:
A. Poor response to corticosteroid
B. Hematuria, Hypertension
C. Progression to chronic renal failure
D. 50% develop End stage Renal failure within 10 years.

Front 64

D/D of FSGS from minimal change disease

Back 64

poor response to steroids

Front 65

Secondary glomerulonephritis

Back 65

Diabetes Mellitus
Systemic Lupus Erythematosus.
Amyloidosis
Goodpasture Syndrome
Wagner granulomatosis
Henoch-Schönlein Purpura
Bacterial Endocarditis

Front 66

Complications of nephrotic syndrome

Back 66

1. MI
2. repeated infection
3. DVT

Front 67

An adult comes in with nephrotic syndrome, what is the order of possible causes you will suspect?

Back 67

1. MGN
2. DM
3. SLE
4. Amyloid

Front 68

Test for
DM?
SLE?
amyloidosis?

Back 68

DM--> PAS positive, deposit composition
SLE --> anti-smith Ab, dsDNA Ab
amyloidosis--> congo red

Front 69

D/x for lupus nephritis?

Back 69

decrease in C1q

Front 70

Which diseases have a normal looking glomerulus?

Back 70

minimal change disease & (FSGS?) Type 3 CrGN?

Front 71

LM of SLE

Back 71

wire loop

Front 72

IF of lupus nephritis

Back 72

C1q deposits
Circulating IC nephritis (Type 3)
granular

Front 73

All Type 3 hypersensitivity rxns (nephrotic) have anasarca, proteinuria, and lipiduria, but if oliguria is present also what will you suspect?

Back 73

CrGN

Front 74

1. CrGN= RPGN
2. Focal proliferative GN = ANS
3. Wire loop= NS
4. Mesangial lupus GN = NS
5. Normal glomerulus = NS

Back 74

Lupus nephritis

Front 75

Etiology of scleroderma and kidney

Back 75

interlobular arteries of the kidney show intimal thickening (deposits on and w/in intima).

Front 76

C/F of scleroderma and the kidney

nephritic or nephrotic?

Back 76

shiny taught skin, increased dermal collagen, HTN, proteinuria +2 (non-nephrotic)

Front 77

What is difference between CREST and Scleroderma?

Back 77

CREST--> focal
Scleroderma--> diffuse, HTN, increased collagen

Front 78

Composition of deposits inside glomerulus of diabetic kidney?

Nephrotic or nephritic?

Back 78

increased glucose & subendothelial collagen

nephrotic

Front 79

A diabetic kidney is at risk of....

Back 79

infection
MI
thrombosis (DVT

Front 80

What vascular change does a diabetic kidney undergo?

Back 80

hyaline arteriosclerosis

Front 81

Which test will not be useful in diagnosing a diabetic kidney?

Back 81

IF

Front 82

Amyloidosis of Kidney

Gross?

Back 82

waxy pale surface

Pale b/c of lack of blood vessels

Front 83

LM of amyloidosis of kidney

Back 83

pink hyaline like deposit in mesangium

Front 84

What are the diagnosing features of primary amyloidosis of the kidney?

Back 84

Primary: (multiple myeloma)
M spike
Bence-Jones protein in urine
(amyloid light chain)

Front 85

Where do you expect to find amyloid in the kidney?

Back 85

acellular paraprotein deposits in the extracellular space causing atrophy

Front 86

What is the secondary (reactive- in rheumatoid arthritis) type of amyloid?

Back 86

AA

Front 87

C/F of secondary type of amyloid of the kidney?

Back 87

symmetrical joint pain in the morning, morning stiffness.

Front 88

Hereditary recurrent hematuria in children?

Back 88

Alport syndrome

Front 89

Which organs are involved in Alport syndrome and what is the resulting effect?

Back 89

ears--> nerve deafness
eye--> cataract, lens dislocation, corneal dystrophy

Front 90

Sign of Alport syndrome?

Back 90

family history of chronic renal failure

Front 91

Inheritance of Alport syndrome?

Back 91

X-linked autosomal recessive or dominant

Front 92

What do we find in the tubules?

Back 92

deposition of foamy cells (macrophages) containing mucopolysaccharide (MPS)

Seen on LM

Simulates a storage disease

Front 93

What is the pathogenesis of Alport syndrome?

Back 93

defective gene (alpha5) produces abnormal collagen type IV

Front 94

Differential for alport syndrome and is there a genetic history with this differential disease?

Back 94

thin membrane disease

No genetic hx. like Alport does.

Front 95

What is found in the glomeruli of Alport syndrome under a light microscope?

Back 95

irregular thickening b/c of collagen

Front 96

Where do we find recurrent hematuria?

Back 96

IgA nephropathy (Berger's disease)- kidney only

Henoch-Schonlein Purpura- systemic ( joint, abdomen, GIT, skin)

Alport syndrome (+ family hx. of hematuria)

Front 97

Where do we find RPGN?

Back 97

CrGN

Front 98

What are the associates of CrGN?

Back 98

1. Good pasture syndrome--> lungs
2. Wegner granulomatosis--> lungs
3. PAN--> kidney, skin
4. SLE--> multi organ (crescent, wire-looped, normal?)

Front 99

C/F chronic glomerulos nephritis?

Back 99

increasing BUN and creatinine, uremia, HTN, CRF, specific gravity= 1010, occasional polyuria unless in terminal stage

Front 100

How long does it usually take to achieve CGN?

Back 100

10 years

Front 101

Which nephrotic syndromes are most likely to convert from acute Gn to chronic GN in 10years?

Back 101

MGN & FSGS

Front 102

Rx. for CGN?

Back 102

30%-50% of all patients need hemodialysis and renal transplant

Front 103

Gross of CGN?

Back 103

cortical atrophy

Front 104

LM of CGN?
Does this allow us to find the source of the problem?

Back 104

non-specific findings (biopsy not useful)

Scarring of Glomeruli, bowmen’s space
Hyalinization of glomeruli.
Interstitial fibrosis.
Tubular atrophy
Thickening of the small and medium sized arteries.

NO!

Front 105

GFR of ESKD?

Back 105

less than 5% of the normal

Use GFR to tell when the kidney reaches the end stage

Front 106

What is the appearance of the glomeruli in CGN?

Back 106

all sclerosed

Front 107

Test for proteinuria?

Back 107

24 hour urine collection
dipstick

Front 108

What is the cause of nephritic syndrome in an adult?

Back 108

infections:
1. Hepatitis
2. malaria
3. SLE

Front 109

What is the cause of nephritic syndrome in a child?

Back 109

post-strep

Front 110

What is the name of type 2 hypersensitivity reaction?

Back 110

in-situ IC nephritis

Front 111

What is the cause of hyperlipiduria and lipiduria?

Back 111

decreased albumin in blood triggers lipoprotein synthesis

Front 112

How does lipiduria present?

Back 112

oval fat body in urine

Front 113

What does hyperlipiduria do in the kidney?

Back 113

steatosis of tubular epithelial cells causing increased permeability of GBM to lipoproteins

Front 114

C/F of acute nephritic syndrome

Back 114

anuria or oliguria
proteinuria 2+ 3+
hematuria
azotemia
HTN

Front 115

Onset of nephritic syndrome

Back 115

weeks

Front 116

Diseases where circulating immune complex nephritis (Type 3- B-cell activation) is seen?

Back 116

1. SLE
2. Strep
3. Hep B
4. Treponema pallidum (syphillis)
5. Malaria

IF--> granular deposits

Front 117

Antibody reacting to in-situ antigen in glomeruli (Type 2)?

Back 117

Anti-GBM Ab

Ex. Good pasture syndrome (CrGn type 1)

IF--> linear, smooth deposits

Front 118

Primary glomerular diseases

Back 118

Minimal change disease
Membranous glomerulonephritis
Acute glomerulonephritis
Crescentic glomerulonephritis
Berger's disease (IgA nephropathy)
Membrenoproloferative GN
Alport syndrome

Front 119

What stain is useful for minimal change disease?

Back 119

Oil O-red stain, b/c of fat in tubular epithelium hence the name lipoid nephrosis

Front 120

Mucin deposits from which complication is one of the causes of MGN?

Back 120

adenocarcinoma of lung and colon

Front 121

Acute nephritic syndrome is hand in hand with....

Back 121

ARF b/c of the decrease in GFR caused by the proliferation/ hypercellularity

Front 122

What is responsible for the proliferation in acute glomerulonephritis?

Back 122

neutrophils

Front 123

How would you distinguish post-strep GN from non-strep GN?

Back 123

ASO titer

Front 124

D/D for post-strep GN?

Back 124

pyelonephritis, but WBC casts will signify pyelonephritis

Front 125

Humpy-dumpy lesions- large IC

Back 125

Acute post-strep GN

Front 126

c-anca (+)

Back 126

Wegner's
Type 3 CrGN

Front 127

p-anca (+)

Back 127

PAN
Type 3 CrGN

Front 128

Where would IgA deposit in the skin (dermatitis herpetiformis)?

Back 128

papillary dermis

Front 129

Treatment for IgA nephropathy or elevation?

Back 129

stop primary source of infection

Front 130

Back 130

SLE (lupus nephritis)
LM: wire loop

Front 131

Back 131

Diabetic Kidney
LM: nodular hyaline deposit
PAS positive
Kimmelstiel-Wilson disease or
Nodular glomerulosclerosis

Front 132

Back 132

DM kidney
hyaline arteriosclerosis

Front 133

Back 133

Amyloidosis of kidney
LM: pink hyaline like deposit in mesangium

Front 134

Back 134

CGN
"contracted kidney"
coarse granular surface

Front 135

Back 135

CGN
hyalinized glomeruli

Front 136

Back 136

IF
amyloidosis

Front 137

Back 137

amyloidosis
LM: congo red stain- brick red

Front 138

Back 138

LM
normal glomerulus

Front 139

Back 139

MPGN type 2
Dense deposit
These bright deposits are of C3 in capillary walls and in the mesangium.

Front 140

Back 140

SLE
lupus nephritis
IF: C1q deposits everywhere
granular, Type 3 rxn.