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Lecture 1
Introduction to Renal Pathology
| Question | Answer |
|---|---|
| Lamination in the GBM at EM is diagnostic of ? | Hereditary Alport's Disease |
| What are cryoglobulins | circulating immune complexes that precipitate in serum or plasma at 4-10 degrees C and re-dissolve upon warming to 37C |
| What is a well known renal disease that is Autosomal Dominant with defect located in chromosome 16 | Adult polycystic disease |
| What are extra-renal problems associated with Alport disease | Deafness and leukocyte abnormalities |
| What is the result of hyperfiltration through select nephrons due to persistent decreased regional blood flow | Sclerosisor hyalinization of glomeruli and loss of function |
| Is the charge of the glomerular filter positive or negative | Negative: it is a major barrier to the filtration of anionic proteins |
| What is the hepatic response to hypoalbuminemia | increased cholesterol and increased a2 globulin |
| Nephrotic Syndrome: edema, proteinuria, children>adults, no hematuria, no elevation in creatinine and Highly Responsive to Steroids | Minimal Change Disease |
| Minimal Change Disease is associated with what marker | HLA B12 |
| When you see "fusion" of epithelial cell foot processes think? | Minimal Change Disease |
| If you have a chiild with minimal change disease and they do not respond to steroids think? | Wrong diagnosis it is likely Focal Segmental Glomeruosclerosis |
| Nephrotic syndrome with microscopic hematuria, later creatinine rise, black>white patients affected, poor response to steroids? | Focal Segmental Glomerular Sclerosis |
| Why might an early biopsy of focal segmental glomerulosclerosis miss the diagnosis | because deep cortical glomeruli are affected first |
| what would you see on immunofluorescence with FSGS | IgM and C3 in the sclerotic lesions in the glomerulus |
| What is the etiology of Membranous Nephropathy | In Situ immune complex deposition |
| what is the characteristic finding with Membranous Nephropathy | On silver stain you see highlights of spikes of GBM between the immune deposits |
| What is the peak age of Membranous Nephropathy | 4th or 5th decade rare in children |
| What do you see on Immunofluorescence with membranous nephropathy | granular deposits of IgG and C3 along GBM |
| Are steroids effective in treating Membranous GN | In Stage I patients respond to corticosteroid in Stage II 50% respond to steroid treatments |
| Nodular Diabetic Glomerulosclerosis is also known as? | Kimmelstiel-Wilson Disease (bad prognosis) |
| Kimmelstiel Wilson Disease is often associated with what retinal finding | microaneurysms |
| What is the earliest change noted in Diabetic Glomerulosclerosis | Diffuse thickening of the GBM |
| What is the immunofluorescence finding on Diabetic Glomerulosclerosis | NONSPECIFIC linear highlighting of GBM giving a linear staining with antibody to IgG via Trapping NOT Autoantibodies |
| Does Diabetic arteriosclerosis affect the afferent or efferent arterioles | Both |
| If you have a Congo Red Positive with Apple Green Bi-refringence under polarized light think? | Amyloidosis |
| AL Amyloid is secondary to? | monoclonal gammopathies associated with light chain deposition (lamda most common) |
| AA amyloid is associated with? | chronic inflammatory diseases associated with deposition of acute phase proteins (SAA) |
| What are some diseases associated with AA amyloid | Rheumatoid arthritis, Chronic infections (TB), Some Neoplasms (Renal Cell Carcinoma and Hodgkin's) |
| What are the EM findings of Amyloid | Amyloid fibrils are non-branching with a uniform diameter of 8-12nM with a tangled appearance |
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