Term
| What are the 3 functions of mesangial cells within the mesangial matrix (contiguous with the lamina rara interna of the BM) |
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Definition
1) Tether BM to mesangium, creating central mesangial unit connected to many glomerular segments.
2) Phagocytosis of debris
3) Cytokine production for glomerular proliferation in response to injury |
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Term
What glomerular disease is described by each of the following sets of signs/symptoms?
1) Hematuria, azotemia, proteinuria, oliguria, edema, HTN
2) Acute nephritic syndrome with acute renal failure
3) >3.5 gm/24 proteinuria, hypoalbuminemia, hyperlipidemia, hyperlipiduria, edema
4) Azotemia progressing to renal failure
5) Non-progressive, subclinial hematuria or proteinuria |
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Definition
1) Acute nephritic syndrome
2) Rapidly progressive glomerulonephritis
3) Nephrotic syndrome
4) Chronic renal failure
5) Asymptomatic |
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Term
| How do you correctly describe the Distribution of glomerular injury on light microscopic investigation? |
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Definition
1) Diffuse (>50% of glomeruli) vs. Focal (<50 %)
- Can be random, subscapular or juxtamedullary
2) Global (entire glomerulus) vs. segmental vs. mesangial
- Segmental is peripheral + mesangial
- Peripheral is podocyte + GBM
- Central mesangial is just mesangium |
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Term
| What distributions of ECM "sclerosis" are seen in glomerular disease under the light microscope? |
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Definition
1) Mesangial
- nodular vs. non-nodular expansion
2) Capillary wall
3) Bowman's space |
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Term
| What patterns of "hypercellularity" are seen in glomerular disease under the light microscope? |
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Definition
1) Intraglomerular
- Mesangium= mesangioproliferation
- Mesangium + capillary= mesangiocapillary
** can be membranoproliferative or exudative (PMNs)
2) Extraglomerular
- Crescentic |
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Term
What would you see in the following on light microscopy.
1) Focal segmental glomerulosclerosis with hyalinosis
2) Focal segmental endocapillary proliferative and necrotizing glomerulonephritis with focal cellular cescents. |
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Definition
1)
- Few glomeruli (focal) with mesangial and capillary involvement in sub-regions of those glomeruli (segmental).
- There would be increased plasma protein (eosinophillic)
2)
- Focal, segmental is the same.
- Endocapillary proliferative means there is increased mesangial & capillary cellularity
- Necrotizing means that there should be inflammation and fibrosis.
- Focal crescents are epithelial/fibrin/inflammatory cell/fibroblast/collagen entities. |
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Term
| What are the different distributions and patterns of staining that you should look for on IF evaluation of glomerular disease? |
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Definition
1) Distribution
- Glomerular (diffuse vs. focal, global vs. segmental, mesangial vs. peripheral loop).
- Extraglomerular (tubules, interstitium, blood vessels)
2) Pattern
- Granular
- Linear
- Homogenous or irregular
- Intracellular droplet staining |
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Term
What is the IF staining profile for each of the following glomerular diseases?
1) Focal segmental glomerulosclerosis
2) IgA nephropathy
3) Lupus |
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Definition
1) homogenous, segmental IgM and C3
2) Granular mesangial IgA, C3
3) Granular mesangial and/or peripheral loop IgG, IgM, IgA, C3, C1q, C4 (full house) |
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Term
| What types of glomerular disease lend themselves to EM analysis? |
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Definition
Diffuse disorders
**Focal processes may be missed in small section** |
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Term
| What changes are assessed in EM analysis? |
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Definition
1) Cellular changes (docyte fusion, intracellular inclusion)
2) Extracellular matrix changes
- BM (duplications, increase, thinning, interruption)
- Mesangium
3) Electron dense deposits.
- Location
- Substructual detail (immune complex?)
- |
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Term
| What are the 2 primary mechanisms of glomerular immune deposition? |
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Definition
1) Injury mediated by circulating antibodies binding in-situ to intrinsic glomerular antigens.
** Example is anti-BM (Goodpastures) with linear IF and necrotizing glomeruloneprhitis**
- Type II
2) Injury resulting from deposition of preformed soluble circulating antibody-antigen ICs.
- Type III |
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Term
True or False:
Cellular proliferation correlates with the presence of IC deposits in the mesangial-subendothelial space, but not the subepithelial space. |
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Definition
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Term
| What pathological changes cause Hematuria and/or Proteinuria? |
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Definition
1) Hematuria occurs with glomerular capillary rupture
2) Proteinuria occurs with damage to BM and/or podocytes without capillary break |
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Term
| What types of glomerulopathy produce norma vs. decreased renal function? |
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Definition
1) Normal
- Focal +/- proliferation
- Diffuse without proliferation
2) Decreased
- Diffuse + proliferation +/- crescentic/necrosis (acute)
- Diffuse glomerulosclerosis (chronic) |
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