Nephropathology
16 important questions on Nephropathology
In a physical exam doctors can test your pee on albumine, should albumine be present normally?
What is the results of an injured podocyte(s)?
Minimal change glumerualpathy (Nephrotic disease)
can be cased by toxins, drugs etc.
this injury also disappears again and will not cause nephron loss or sclerosis (all other or other two do)
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Focal and segmental glomerulosclerosis (nephrotic disease)
Membranous glomerulopathy (nephrotic disease, no inflammation)
dark part in picture. Can more easily be seen with immunoflorescence
What is Sub-endothelial complex formation?
ANCA disease cause inflammation when complexes directed against which kind of proteins?
Proteinase-3 (PR3)
Myeloproxidase (MPO)
These ANCA's (antibodies) cause inflammation in every part of the body (not sure if only in capillaries) where they are located.
we don't see immune complexes in ANCA diseases
Which glomerulopathies can cause nephrotic syndrome?
- Minimal change glomerylopathy (MCN)
- Focal and segmental glomerulosclerosis (FSGS)
- Membranous glomerulopathy (MG)
- Others (deposition disease, diabetes, membranoproliferazive glomerulonephritis)
What is Minimal change glomerulopathy?
- Mild and transient podocyte injury, multiple causes
- normal light microscopy
- extensive effacement of podocyte foot-processes (EM)
- steroid sensitive
- does not lead to fibrosis/chronic damage
What is focal and segmental glomerulosclerosis?
- More severe/prolonged podocyte injury, multiple causes
- focal and segmental scarring of glomeruli
- steroid insensitive
- leads to nephron loss and ultimately renal insufficiency
What is Membranous glomerulopathy?
- Podocyte injury due to formation of subepithelial immune complexes
- steroid insensitive
- primary (auto-immune reaction) or secondary to other disease (SLE, RA, Medication, cancer)
- Leads to nephron loss if disease persists
With fluorescence microscopy lining in membrane of glomerulus would be visible -> IgG
Which infections are related to glomerulonephritis?
- Post-streptococcal GN (tonsillitis)
- Formation of immune complexes in the glomeruli (mostly C3, subendothelial)
- Endocapillary proliferative GN
- Resolves after infection has been cleared
What is ANCA disease?
- Anti Neutrophil Cytoplasmatic Antibodies
- Proteinase-3 (PR3) and myeloperoxidase (MPO) 'specific' ANCA
- cause small vessel vasculitis
- small vessel vasculitis in various organs (renal, skin, ear-nose-throat, pulmonary, neurological system)
Clinical syndromes
- granulomatous polyangiitis (GPA): ENT involvement, mostly PR3-ANCA.
- Microscopic Polyangiitis (MPA): mostly MPO-ANCA
- Granulomtous polyangiitis with eosinophilia (EGPA): asthma, eosinophilia, mostly MPO-ANCA
Name some ANCA disease histology?
- Necrotizing, crescentic, sclerosino lesions
- No signs of immune complex disease (no mesangial proliferation, endocapillary proliferation or GBM abnormalities)
- Negative (pouch-immune) immunofluorescence
- absence of immune deposits by EM
What is Anti GBM disease?
- Anti glomerular basement membrane antibodies (collagen IV alpha 3)
- necrotizing lesions and often diffuse crescentic ('destructive') glomerulonephritis
- sometimes with pulmonary hemorrhage (good pasture syndrome)
- strong linear staining of the GBM for IgG
Other compartments of kidney can also be primary affected
- Acute tubular necrosis
- tubulo-interstitial nephritis
- thrombotic micro-angiopathy
- vasculitis
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