Glomerular Injury
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Various types of glomerulopathies are characterized by one or more of four basic tissue reactions: ______

Hypercellularity, Basement Membrane Thickening, Hyalinosis, Sclerosis

Hypercellularity results from one or more of the following: Proliferation of ______ or endothelial cells

mesangial

Infiltration of ______

leukocytes

Formation of ______

<p>crescents</p> Signup and view all the answers

Deposition of amorphous electron-dense material, most often immune complexes, on the endothelial or epithelial side of the basement membrane or within the GBM itself. Fibrin, amyloid, cryoglobulins, and abnormal fibrillary proteins may also deposit in the GBM.

<p>Basement membrane thickening</p> Signup and view all the answers

By electron microscopy such thickening takes one of three forms: 1. Deposition of amorphous electron-dense material, most often immune complexes, on the endothelial or epithelial side of the basement membrane or within the GBM itself. Fibrin, amyloid, cryoglobulins, and abnormal fibrillary proteins may also deposit in the GBM. Cont. By electron microscopy such thickening takes one of three forms: 2.

Signup and view all the answers

Glomerular diseases Dr. Ala Aljehani Outlines: Structure of the ______

<p>glomerulus</p> Signup and view all the answers

Pathologic Responses of the Glomerulus to Injury Part 1 Pathogenesis of ______

<p>Glomerular Injury</p> Signup and view all the answers

Nephrotic syndrome Nephritic syndrome Rapidly Progressive Glomerulonephritis Chronic ______

<p>Glomerulonephritis</p> Signup and view all the answers

Part 2 Glomerular diseases part 1 Structure of the glomerulus Cont. Pathologic Responses of the Glomerulus to Injury Various types of ______

<p>glomerulopathies</p> Signup and view all the answers

Glomerular Injury Pathogenesis and Clinical Presentation

<p>pathogenesis</p> Signup and view all the answers

The manifestations of ______ include massive proteinuria, hypoalbuminemia, generalized edema, and hyperlipidemia

<p>nephrotic syndrome</p> Signup and view all the answers

Membranous nephropathy is characterized by diffuse thickening of the glomerular capillary wall due to the accumulation of deposits, and does not respond well to corticosteroid therapy

<p>membranous nephropathy</p> Signup and view all the answers

Hylanosis is the accumulation of homogeneous, eosinophilic material in glomerular structures

<p>hylanosis</p> Signup and view all the answers

Podocyte injury is common in both primary and secondary glomerular diseases

<p>podocyte</p> Signup and view all the answers

Immune mechanisms underlie most forms of primary and many secondary glomerular disorders

<p>immune mechanisms</p> Signup and view all the answers

Factors affecting glomerular localization of antigens, antibodies, or immune complexes include molecular charge, size, and hemodynamics

<p>factors</p> Signup and view all the answers

Antibody-associated injury occurs in situ within the glomerulus or from deposition of circulating immune complexes

<p>antibody-associated injury</p> Signup and view all the answers

Formation of additional layers of basement membrane ______ in membranoproliferative glomerulonephritis

<p>matrices</p> Signup and view all the answers

Increased synthesis of basement membrane protein components occurs in ______

<p>diabetic glomerulosclerosis</p> Signup and view all the answers

Minimal-Change Disease Pathophysiology

<p>This relatively benign disorder is characterized by diffuse effacement of foot processes of visceral epithelial cells (podocytes), detectable only by electron microscopy, in glomeruli that appear virtually normal by light microscopy. Morphology light microscopy: The glomeruli are normal electron microscopy the GBM appears normal, and no electrondense material is deposited uniform and diffuse effacement of foot processes Immunofluorescence studies show no Ig or complement deposits. Clinical features The most frequent cause of the nephrotic syndrome in children Usually response dramatically to corticosteroid therapy. Most children (&gt;90%) respond rapidly to this treatment. However, proteinuria may recur</p> Signup and view all the answers

Focal Segmental Glomerulosclerosis (FSGS) Pathophysiology

<p>The characteristic degeneration and focal disruption of visceral epithelial cells with effacement of foot processes resemble the diffuse epithelial cell change typical of minimal-change disease and other podocytopathies is the hallmark of FSGS FSGS classified into: primary (idiopathic) secondary to other conditions Morphology light microscopy focal and segmental lesions may inolve only a minority of the glomeruli In the sclerotic segments there is collapse of capillary loops increase in matrix segmental deposition of plasma proteins along the capillary wall (hyalinosis) Lipid deposition electron microscopy : both sclerotic and nonsclerotic areas show diffuse effacement of foot processes immunofluorescence microscopy: IgM and C3 may be present in the sclerotic areas and/or in the mesangium. Clinical features Primary focal segmental glomerulosclerosis is the most common cause of nephrotic syndrome in adults in the United States Accounts for 10% and 35% of cases of nephrotic syndrome in children and adults, respectively. Is frequently manifest clinically by the acute or subacute onset of nephrotic syndrome or nonnephrotic proteinuria. Hypertension, microscopic hematuria, and some degree of azotemia are commonly present when the disease is first clinically recognized. Cont. Little tendency for spontaneous remission in idiopathic FSGS, and responses to corticosteroid therapy are variable. Children have a better prognosis than adults do. Progression to renal failure occurs at variable rates.</p> Signup and view all the answers

Minimal-Change Disease Pathophysiology

<p>This relatively benign disorder is characterized by diffuse effacement of foot processes of visceral epithelial cells (podocytes), detectable only by electron microscopy, in glomeruli that appear virtually normal by light microscopy. Morphology light microscopy: The glomeruli are normal electron microscopy the GBM appears normal, and no electrondense material is deposited uniform and diffuse effacement of foot processes Immunofluorescence studies show no Ig or complement deposits. Clinical features The most frequent cause of the nephrotic syndrome in children Usually response dramatically to corticosteroid therapy. Most children (&gt;90%) respond rapidly to this treatment. However, proteinuria may recur Some patients may become steroid-dependent or resistant</p> Signup and view all the answers

Focal Segmental Glomerulosclerosis (FSGS) Pathophysiology

<p>The characteristic degeneration and focal disruption of visceral epithelial cells with effacement of foot processes resemble the diffuse epithelial cell change typical of minimal-change disease and other podocytopathies is the hallmark of FSGS FSGS classified into: primary (idiopathic) secondary to other conditions Morphology light microscopy focal and segmental lesions may inolve only a minority of the glomeruli In the sclerotic segments there is collapse of capillary loops increase in matrix segmental deposition of plasma proteins along the capillary wall (hyalinosis) Lipid deposition electron microscopy : both sclerotic and nonsclerotic areas show diffuse effacement of foot processes immunofluorescence microscopy: IgM and C3 may be present in the sclerotic areas and/or in the mesangium. Clinical features Primary focal segmental glomerulosclerosis is the most common cause of nephrotic syndrome in adults in the United States Accounts for 10% and 35% of cases of nephrotic syndrome in children and adults, respectively. Is frequently manifest clinically by the acute or subacute onset of nephrotic syndrome or nonnephrotic proteinuria. Hypertension, microscopic hematuria, and some degree of azotemia are commonly present when the disease is first clinically recognized. Cont. Little tendency for spontaneous remission in idiopathic FSGS, and responses to corticosteroid therapy are variable. Children have a better prognosis than adults do. Progression to renal failure occurs at variable rates.</p> Signup and view all the answers

Minimal-Change Disease Pathophysiology

<p>This relatively benign disorder is characterized by diffuse effacement of foot processes of visceral epithelial cells (podocytes), detectable only by electron microscopy, in glomeruli that appear virtually normal by light microscopy. Morphology light microscopy: The glomeruli are normal electron microscopy the GBM appears normal, and no electrondense material is deposited uniform and diffuse effacement of foot processes Immunofluorescence studies show no Ig or complement deposits. Clinical features The most frequent cause of the nephrotic syndrome in children Usually response dramatically to corticosteroid therapy. Most children (&gt;90%) respond rapidly to this treatment. However, proteinuria may recur Adults are slower to respond, their long term prognosis is also excellent. Minimal-change disease in adults can be associated with</p> Signup and view all the answers

Focal Segmental Glomerulosclerosis (FSGS) Pathophysiology

<p>The characteristic degeneration and focal disruption of visceral epithelial cells with effacement of foot processes resemble the diffuse epithelial cell change typical of minimal-change disease and other podocytopathies is the hallmark of FSGS FSGS classified into: primary (idiopathic) secondary to other conditions Morphology light microscopy focal and segmental lesions may inolve only a minority of the glomeruli In the sclerotic segments there is collapse of capillary loops increase in matrix segmental deposition of plasma proteins along the capillary wall (hyalinosis) Lipid deposition electron microscopy : both sclerotic and nonsclerotic areas show diffuse effacement of foot processes immunofluorescence microscopy: IgM and C3 may be present in the sclerotic areas and/or in the mesangium. Clinical features Primary focal segmental glomerulosclerosis is the most common cause of nephrotic syndrome in adults in the United States Accounts for 10% and 35% of cases of nephrotic syndrome in children and adults, respectively. Is frequently manifest clinically by the acute or subacute onset of nephrotic syndrome or nonnephrotic proteinuria. Hypertension, microscopic hematuria, and some degree of azotemia are commonly present when the disease is first clinically recognized. Cont. Little tendency for spontaneous remission in idiopathic FSGS, and responses to corticosteroid therapy are variable. Children have a better prognosis than adults do. Progression to renal failure occurs at variable rates.</p> Signup and view all the answers

Hypercellularity results from one or more of the following: Proliferation of ______ or endothelial cells

<p>mesangial</p> Signup and view all the answers

By electron microscopy such thickening takes one of three forms: 2. ______

<p>fusion of the subendothelial and mesangial areas</p> Signup and view all the answers

Hylanosis is the accumulation of homogeneous, eosinophilic material in glomerular structures

<p>hyalinosis</p> Signup and view all the answers

Factors affecting glomerular localization of antigens, antibodies, or immune complexes include molecular charge, size, and ______

<p>shape</p> Signup and view all the answers

Various types of glomerulopathies are characterized by one or more of four basic tissue reactions: ______

<p>hypercellularity, basement membrane thickening, hyalinosis, sclerosis</p> Signup and view all the answers

Pathologic Responses of the Glomerulus to Injury Part 1 Pathogenesis of ______

<p>Glomerular Injury</p> Signup and view all the answers

Formation of ______

<p>crescents</p> Signup and view all the answers

Podocyte injury is common in both primary and secondary glomerular diseases

<p>podocyte</p> Signup and view all the answers

The manifestations of ______ include massive proteinuria, hypoalbuminemia, generalized edema, and hyperlipidemia

<p>nephrotic syndrome</p> Signup and view all the answers

Increased synthesis of basement membrane protein components occurs in ______

<p>membranous nephropathy</p> Signup and view all the answers

Structure of the ______

<p>glomerulus</p> Signup and view all the answers

Glomerular Injury Pathogenesis and Clinical Presentation

<p>diabetic glomerulosclerosis</p> Signup and view all the answers

Formation of additional layers of basement membrane matrices in membranoproliferative glomerulonephritis

<p>membranes</p> Signup and view all the answers

Hylanosis is the accumulation of homogeneous, eosinophilic material in glomerular structures

<p>hylanosis</p> Signup and view all the answers

Immune mechanisms underlie most forms of primary and many secondary ______

<p>glomerular disorders</p> Signup and view all the answers

Antibody-associated injury occurs in situ within the glomerulus or from deposition of ______ immune complexes

<p>circulating</p> Signup and view all the answers

Electron-dense deposits containing immune complexes are found in various locations in the ______

<p>glomerulus</p> Signup and view all the answers

Factors affecting glomerular localization of antigens, antibodies, or immune complexes include molecular charge, size, and ______

<p>hemodynamics</p> Signup and view all the answers

Alternative complement pathway activation occurs in ______ disease

<p>dense-deposit</p> Signup and view all the answers

Podocyte injury is common in both primary and secondary glomerular ______

<p>diseases</p> Signup and view all the answers

Nephrotic syndrome is caused by a derangement in glomerular capillary walls, resulting in increased permeability to ______

<p>plasma proteins</p> Signup and view all the answers

______ is characterized by diffuse effacement of foot processes of visceral epithelial cells (podocytes), detectable only by electron microscopy, in glomeruli that appear virtually normal by light microscopy. Morphology light microscopy: The glomeruli are normal electron microscopy the GBM appears normal, and no electrondense material is deposited uniform and diffuse effacement of foot processes

<p>Minimal-Change Disease</p> Signup and view all the answers

Immunofluorescence studies show no Ig or complement deposits. Clinical features The most frequent cause of the nephrotic syndrome in children Usually response dramatically to corticosteroid therapy. Most children (>90%) respond rapidly to this treatment. However, proteinuria may recur Some patients may become steroid-dependent or resistant Adults are slower to respond, their long term prognosis is also excellent. Minimal-change disease in adults can be associated with

<p>Hodgkin lymphoma</p> Signup and view all the answers

Focal Segmental Glomerulosclerosis is the most common cause of nephrotic syndrome in adults in the United States Accounts for 10% and 35% of cases of nephrotic syndrome in children and adults, respectively. Is frequently manifest clinically by the acute or subacute onset of nephrotic syndrome or nonnephrotic proteinuria. Hypertension, microscopic hematuria, and some degree of azotemia are commonly present when the disease is first clinically recognized

<p>Focal Segmental Glomerulosclerosis (FSGS)</p> Signup and view all the answers

Little tendency for spontaneous remission in idiopathic FSGS, and responses to corticosteroid therapy are variable. Children have a better prognosis than adults do. Progression to renal failure occurs at variable rates

<p>Focal Segmental Glomerulosclerosis (FSGS)</p> Signup and view all the answers

The disease recurs in up to 40% of patients who undergo transplantation for end-stage renal disease

<p>Minimal-Change Disease</p> Signup and view all the answers

The characteristic degeneration and focal disruption of visceral epithelial cells with effacement of foot processes resemble the diffuse epithelial cell change typical of minimal-change disease and other podocytopathies is the hallmark of

<p>Focal Segmental Glomerulosclerosis (FSGS)</p> Signup and view all the answers

primary (idiopathic) secondary to other conditions Morphology light microscopy focal and segmental lesions may inolve only a minority of the glomeruli In the sclerotic segments there is collapse of capillary loops increase in matrix segmental deposition of plasma proteins along the capillary wall (hyalinosis) Lipid deposition electron microscopy : both sclerotic and nonsclerotic areas show diffuse effacement of foot processes immunofluorescence microscopy: IgM and C3 may be present in the sclerotic areas and/or in the mesangium. Clinical features Primary focal segmental glomerulosclerosis is the most common cause of nephrotic syndrome in adults in the United States Accounts for 10% and 35% of cases of nephrotic syndrome in children and adults, respectively. Is frequently manifest clinically by the acute or subacute onset of nephrotic syndrome or nonnephrotic proteinuria. Hypertension, microscopic hematuria, and some degree of azotemia are commonly present when the disease is first clinically recognized.

<p>Focal Segmental Glomerulosclerosis (FSGS)</p> Signup and view all the answers

Primary focal segmental glomerulosclerosis is the most common cause of nephrotic syndrome in adults in the United States Accounts for 10% and 35% of cases of nephrotic syndrome in children and adults, respectively. Is frequently manifest clinically by the acute or subacute onset of nephrotic syndrome or nonnephrotic proteinuria. Hypertension, microscopic hematuria, and some degree of azotemia are commonly present when the disease is first clinically recognized

<p>Focal Segmental Glomerulosclerosis (FSGS)</p> Signup and view all the answers

Podocyte injury is common in both primary and secondary glomerular diseases

<p>Focal Segmental Glomerulosclerosis (FSGS)</p> Signup and view all the answers

Various types of glomerulopathies are characterized by one or more of four basic tissue reactions

<p>Focal Segmental Glomerulosclerosis (FSGS)</p> Signup and view all the answers

Factors affecting glomerular localization of antigens, antibodies, or immune complexes include molecular charge, size, and hemodynamics

<p>Minimal-Change Disease</p> Signup and view all the answers

Study Notes

Glomerular Injury Pathogenesis and Clinical Presentation

  • Increased synthesis of basement membrane protein components occurs in diabetic glomerulosclerosis
  • Formation of additional layers of basement membrane matrices in membranoproliferative glomerulonephritis
  • Hylanosis is the accumulation of homogeneous, eosinophilic material in glomerular structures
  • Immune mechanisms underlie most forms of primary and many secondary glomerular disorders
  • Antibody-associated injury occurs in situ within the glomerulus or from deposition of circulating immune complexes
  • Electron-dense deposits containing immune complexes are found in various locations in the glomerulus
  • Factors affecting glomerular localization of antigens, antibodies, or immune complexes include molecular charge, size, and hemodynamics
  • Alternative complement pathway activation occurs in dense-deposit disease
  • Podocyte injury is common in both primary and secondary glomerular diseases
  • Nephrotic syndrome is caused by a derangement in glomerular capillary walls, resulting in increased permeability to plasma proteins
  • The manifestations of nephrotic syndrome include massive proteinuria, hypoalbuminemia, generalized edema, and hyperlipidemia
  • Membranous nephropathy is characterized by diffuse thickening of the glomerular capillary wall due to the accumulation of deposits, and does not respond well to corticosteroid therapy

Glomerular Injury Pathogenesis and Clinical Presentation

  • Increased synthesis of basement membrane protein components occurs in diabetic glomerulosclerosis
  • Formation of additional layers of basement membrane matrices in membranoproliferative glomerulonephritis
  • Hylanosis is the accumulation of homogeneous, eosinophilic material in glomerular structures
  • Immune mechanisms underlie most forms of primary and many secondary glomerular disorders
  • Antibody-associated injury occurs in situ within the glomerulus or from deposition of circulating immune complexes
  • Electron-dense deposits containing immune complexes are found in various locations in the glomerulus
  • Factors affecting glomerular localization of antigens, antibodies, or immune complexes include molecular charge, size, and hemodynamics
  • Alternative complement pathway activation occurs in dense-deposit disease
  • Podocyte injury is common in both primary and secondary glomerular diseases
  • Nephrotic syndrome is caused by a derangement in glomerular capillary walls, resulting in increased permeability to plasma proteins
  • The manifestations of nephrotic syndrome include massive proteinuria, hypoalbuminemia, generalized edema, and hyperlipidemia
  • Membranous nephropathy is characterized by diffuse thickening of the glomerular capillary wall due to the accumulation of deposits, and does not respond well to corticosteroid therapy

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Glomerular Diseases Part 1 PDF

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Test your knowledge of glomerular injury pathogenesis and clinical presentation with this quiz. Explore topics such as diabetic glomerulosclerosis, membranoproliferative glomerulonephritis, immune mechanisms, antibody-associated injury, electron-dense deposits, complement pathway activation, podocyte injury, nephrotic syndrome, and membranous nephropathy.

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