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Renal Pathology

QuestionAnswer
What used to be the most common cause of adult nephrotic syndrome? membranous glomerulopathy
What are the LM findings for membranous glomerulopathy? diffuse and global thickening of capillary loops and subepithelial spikes on special stains
What are the EM findings for membranous glomerulopathy? subepithelial deposits with spikes of BM material between deposits
What are the IF findings for membranous glomerulopathy? granular uniform staining of capillary loops with IgG > C3
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
What are secondary causes of membranous glomerulopathy? lupus class V
What is the most common cause of nephrotic syndrome in children? minimal change disease
What can cause minimal change disease? idiopathic
What is minimal change disease treated? very responsive to steroids
What are the LM findings of minimal change disease? normal gloms
What are the IF findings of minimal change disease? negative IF
What are the EM findings of minimal change disease? effacement of foot processes
What are two examples of non-immune mediated nephrotic syndrome? minimal change disease and FSGS
What are 5 variants of FSGS? NOS
What are secondary causes of FSGS? HIV
What is the current most common cause of nephrotic syndrome in adults? FSGS
What is the LM findings of FSGS? focal segmental sclerosis of gloms
What are the IF findings of FSGS? Trapped IgM and C3 in sclerotic areas - passive not real complexes
What are the EM findings of FSGS? loss of foot processes in all podocytes and lifting off of epithelial cells
What variant of FSGS trumps all others? collapsing
What are the LM findings of collapsing FSGS? glomerular capillary tuft collapse with overlying podocyte hypertrophy and hyperplasia
What are the LM findings of diabetic nephropathy? Kimmestiel-Wilson nodules
what are the IF findings of diabetic nephropathy? nonspecific staining
What are the EM findings of diabetic nephropathy? thick GBM and expanded mesangium
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
What are the LM findings of HIV-associated nephropathy? collapsing form of FSGS
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
What are the EM findings of HIVAN? Collapse and proliferation of podocytes with foot process effacement
Who are the typical patients with post infectious glomerulonephritis? children and young adults
What are the LM findings in post infectious glomerulonephritis? diffuse and global exudative proliferative glomerulonephritis
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
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.
What gene is affected in benign familial hematuria? COL4A3 and/or COL4A4
What is the genetic pattern of classical Alport syndrome? X-linked dominant
What are the genetic mutations of Alport syndrome? mutation of alpha 5 type IV collagen (COL4A5) in classic
What is the clinical manifestation of Alport syndrome? hearing loss
What are the LM findings of Alport syndrome? unremarkable in early stages but in later stages
What are the IF findings of Alport syndrome? non-specific trapping of IgM and lack of staining of GBM
What are the EM findings of Alport syndrome? irregular thinned and thickened GBM with a "basket weaving" pattern
What is Henoch-Schonlein purpura? immune complex-mediated form of IgA nephropathy with prominent extrarenal involvement.
What are the clinical manifestations of HSP? acute nephritis associated with purpuric lesions of the skin
What are the typical patients of HSP? children predominantly but can affect adults as well
What are the LM findings of HSP? variable ranging from mesangial proliferative glomerulonephritis to focal segmental necrotizing glomerulonephritis to diffuse crescentic glomerulonephritis to MPGN
What are the IF findings of HSP? IgA in glomeruli ranging from mesangial distribution to peripheral capillary distribution. Unlikeo ther forms of IgA nephropathy
What are the EM findings of HSP? abundant mesangial electron deposits usually but can also have subepithelial deposits and mesangial interposition
Created by: fvietje