Renal Pathology
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| What used to be the most common cause of adult nephrotic syndrome? | membranous glomerulopathy
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| What are the LM findings for membranous glomerulopathy? | diffuse and global thickening of capillary loops and subepithelial spikes on special stains
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| What are the EM findings for membranous glomerulopathy? | subepithelial deposits with spikes of BM material between deposits
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| What are the IF findings for membranous glomerulopathy? | granular uniform staining of capillary loops with IgG > C3
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| With what can membranous glomerulopathy be associated? | 25% of pts >65 yo with membranous glomerulopathy are found to have or known to have a tumor
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| What are secondary causes of membranous glomerulopathy? | lupus class V
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| What is the most common cause of nephrotic syndrome in children? | minimal change disease
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| What can cause minimal change disease? | idiopathic
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| What is minimal change disease treated? | very responsive to steroids
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| What are the LM findings of minimal change disease? | normal gloms
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| What are the IF findings of minimal change disease? | negative IF
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| What are the EM findings of minimal change disease? | effacement of foot processes
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| What are two examples of non-immune mediated nephrotic syndrome? | minimal change disease and FSGS
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| What are 5 variants of FSGS? | NOS
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| What are secondary causes of FSGS? | HIV
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| What is the current most common cause of nephrotic syndrome in adults? | FSGS
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| What is the LM findings of FSGS? | focal segmental sclerosis of gloms
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| What are the IF findings of FSGS? | Trapped IgM and C3 in sclerotic areas - passive not real complexes
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| What are the EM findings of FSGS? | loss of foot processes in all podocytes and lifting off of epithelial cells
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| What variant of FSGS trumps all others? | collapsing
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| What are the LM findings of collapsing FSGS? | glomerular capillary tuft collapse with overlying podocyte hypertrophy and hyperplasia
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| What are the LM findings of diabetic nephropathy? | Kimmestiel-Wilson nodules
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| what are the IF findings of diabetic nephropathy? | nonspecific staining
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| What are the EM findings of diabetic nephropathy? | thick GBM and expanded mesangium
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| What are endothelial tubuloreticular inclusions aka reticular aggregates? | ~25nm diameter structures present in the endoplasmic reticulum of endothelial cells and are related to elevated levels of interferon-alpha. Particularly numerous in HIV or SLE patients and are markers of the underlying systemic condition
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| What are the LM findings of HIV-associated nephropathy? | collapsing form of FSGS
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| What are the IF findings of HIVAN? | No immune complex deposits but may show nonspecific IGM and C3 in mesangial areas. Protein droplets in podocytes may stain for any Ig
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| What are the EM findings of HIVAN? | Collapse and proliferation of podocytes with foot process effacement
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| Who are the typical patients with post infectious glomerulonephritis? | children and young adults
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| What are the LM findings in post infectious glomerulonephritis? | diffuse and global exudative proliferative glomerulonephritis
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| What are the IF findings in post infectious GN? | scattered fine or large chunky deposits along glomerular BM which stain with IgG and C3 in a starry sky
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| What is benign familial hematuria? | Condition thought to be the mild form of Alport's syndrome where patients present with persistent isolated hematuria and thin basement membranes on EM. LM shows no specific lesions and IF is negative.
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| What gene is affected in benign familial hematuria? | COL4A3 and/or COL4A4
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| What is the genetic pattern of classical Alport syndrome? | X-linked dominant
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| What are the genetic mutations of Alport syndrome? | mutation of alpha 5 type IV collagen (COL4A5) in classic
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| What is the clinical manifestation of Alport syndrome? | hearing loss
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| What are the LM findings of Alport syndrome? | unremarkable in early stages but in later stages
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| What are the IF findings of Alport syndrome? | non-specific trapping of IgM and lack of staining of GBM
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| What are the EM findings of Alport syndrome? | irregular thinned and thickened GBM with a "basket weaving" pattern
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| What is Henoch-Schonlein purpura? | immune complex-mediated form of IgA nephropathy with prominent extrarenal involvement.
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| What are the clinical manifestations of HSP? | acute nephritis associated with purpuric lesions of the skin
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| What are the typical patients of HSP? | children predominantly but can affect adults as well
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| What are the LM findings of HSP? | variable ranging from mesangial proliferative glomerulonephritis to focal segmental necrotizing glomerulonephritis to diffuse crescentic glomerulonephritis to MPGN
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| What are the IF findings of HSP? | IgA in glomeruli ranging from mesangial distribution to peripheral capillary distribution. Unlikeo ther forms of IgA nephropathy
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| What are the EM findings of HSP? | abundant mesangial electron deposits usually but can also have subepithelial deposits and mesangial interposition
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