Pathology of Nephrosclerosis and Glomerulosclerosis

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Questions and Answers

What is the most common cause of end-stage renal disease?

Inflammation

Aging (correct)

Ischemia

Diabetic nephropathy

What is the term for fibrotic scarring of glomeruli?

Glomerulonephritis

Glomerulosclerosis (correct)

Focal global glomerulosclerosis

Nephrosclerosis

What is the characteristic of focal global glomerulosclerosis?

Segmental lesion affecting more than half of the glomeruli

More than 50% of all glomeruli are involved

Global lesion affecting the entire glomerulus

Less than 50% of all glomeruli are involved with majority showing sclerosis (correct)

What is the primary cause of segmental lesion in glomerulosclerosis?

Inflammation Signup and view all the answers

What is the role of antibodies in inflammation as a cause of glomerulosclerosis?

Antibodies are involved in the formation of immune complexes Signup and view all the answers

What is the location of the deposits of immune complexes in the first localization?

Under the sub-endothelium Signup and view all the answers

What is the term for the capsel around the capillary in a glomerulus?

Bowman's capsule Signup and view all the answers

What is the term for the disease characterized by fibrotic scarring of glomeruli, resulting in end-stage renal disease?

Nephrosclerosis Signup and view all the answers

What is the primary source of alloantigens in the context of glomerulonephritis?

Micro-organisms Signup and view all the answers

What is the role of granulocytes in the inflammatory response?

To recognize and remove immune complexes Signup and view all the answers

What is the consequence of the proliferation of cells in the glomeruli?

Renal dysfunction Signup and view all the answers

What is the characteristic feature of the nephritic syndrome?

Hematuria, renal dysfunction, and hypertension Signup and view all the answers

What is the location of the immune complexes in the second type of glomerulonephritis?

Glomerular basal membrane Signup and view all the answers

What is the consequence of the binding of antibodies to the glomerular basal membrane?

Complement activation and granulocyte degranulation Signup and view all the answers

What is the therapy used to remove antibodies from the bloodstream in the second type of glomerulonephritis?

Plasmapheresis Signup and view all the answers

What is the characteristic feature of the sub-epithelial deposits in the third type of glomerulonephritis?

Linear binding pattern with immunofluorescence Signup and view all the answers

What is the cause of the sub-epithelial deposits in the third type of glomerulonephritis?

Small, separate molecules that can pass through the glomerular basal membrane Signup and view all the answers

What is the common consequence of the immune complex-mediated glomerulonephritis?

Hematuria, renal dysfunction, and hypertension Signup and view all the answers

What is the outcome of the binding of antigen and antibody in the chemical environment where the equilibrium shifts more to the right?

The immune complexes/aggregates irritate the glomerulus, leading to problems in the long run Signup and view all the answers

What is the characteristic of the sub-epithelial space where autoantibodies are formed against epitopes?

It is a location where integrin is involved in the binding of epithelial cells with the basal membrane Signup and view all the answers

What is the result of the frustrated chemotaxis of granulocytes in the glomerulus?

No inflammation is initiated, but the basal membrane is still affected Signup and view all the answers

What is the consequence of the changes in the basal membrane due to the immune complexes/aggregates?

The basal membrane loses its charge and holes get bigger, leading to proteinuria Signup and view all the answers

What is the characteristic of membranous glomerulopathy?

Thickening of the basal membrane Signup and view all the answers

What is the difference between nephrotic syndrome and nephritic syndrome?

Nephrotic syndrome is characterized by proteinuria, while nephritic syndrome is characterized by hematuria Signup and view all the answers

What is the cause of the deposits in the mesangial space?

Circulating antibodies that are abnormal in structure and bind to the mesangial matrix Signup and view all the answers

What is the result of the accumulation of extracellular matrix in the mesangial area?

Decrease in the filtration area, leading to hypertension and renal dysfunction Signup and view all the answers

What is the characteristic of IgA nephropathy?

IgA is produced in abnormal structures and binds to the mesangial matrix Signup and view all the answers

What is the consequence of the involvement of IgA in other capillaries?

The skin and belly are affected, leading to symptoms in these areas Signup and view all the answers

Study Notes

Glomerulosclerosis and End-Stage Renal Disease

Glomerulosclerosis is characterized by fibrotic scarring of glomeruli, a common cause of end-stage renal disease.
Aging is the most common cause of glomerulosclerosis, with focal global glomerulosclerosis being a typical pattern.

Focal Global Glomerulosclerosis

Less than 50% of all glomeruli are involved, with the majority showing sclerosis.
Segmental lesion because it is less than half of the glomerulus that is affected.
Causes include: • Ischemia: aging, arteriosclerosis • Inflammation: glomerulonephritis, (chronic) rejection • Endocrine: diabetic nephropathy • Epithelial damage: genetic (congenital nephrotic syndrome, PKD), minimal change disease/FSGS • Infection: HIV, CMV, hepatitis C • Hyperperfusion: nephron loss, cell damage • Unknown: 'primary FSGS'

Inflammation and Glomerulosclerosis

Antibodies play a major role in inflammation, binding to specific antigens and resulting in inflammation.
Four localizations for deposits of immune complexes: • Under the sub-endothelium (I) • In the glomerular basal membrane (II) • In the sub-epithelial space (III) • In the mesangial space (IV)

Deposits of Immune Complexes (I)

Immune complexes deposit under the sub-endothelium, with antibodies binding to antigens in the bloodstream.
Granulocytes recognize and degranulate, leading to inflammation and tissue damage.

Deposits of Immune Complexes (II)

Immune complexes deposit in the glomerular basal membrane, with antibodies binding to molecules within the basal membrane.
Autoantibodies can bind to molecules in the basal membrane, leading to inflammation.
Alloantigens can also bind to the basal membrane, leading to inflammation.

Deposits of Immune Complexes (III)

Immune complexes deposit in the sub-epithelial space, with circulating immune complexes passing through the glomerular basal membrane.
Autoantibodies or alloantibodies can bind to epitopes in the sub-epithelial space, leading to inflammation.

Deposits of Immune Complexes (IV)

Immune complexes deposit in the mesangial space, with abnormal IgA production or autoantibodies directed against molecules in the mesangium.
IgA nephropathy is a common cause of mesangial localization of antibodies.
The immune response is slower, but can lead to scarring, accumulation of extracellular matrix, and increased mesangial area.

Morphology and Pathology

Glomerulosclerosis is characterized by fibrotic scarring of glomeruli.
Focal global glomerulosclerosis has a segmental lesion, with less than half of the glomerulus affected.
Membranous glomerulopathy has a characteristic spike-like structure.

Clinical Features and Treatment

Nephritic syndrome: hematuria, renal dysfunction, hypertension
Nephrotic syndrome: proteinuria, hypo-proteinemia, edema
Treatment: anti-inflammatory drugs, plasmapheresis, protein-free diet

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Description

This quiz covers the morphology of end-stage renal disease, including glomerulosclerosis, and its causes, such as aging. Learn about the different types of glomerulosclerosis, including focal and segmental.