Renal Pathology 5: Kidney Disease & Immunological Aspects

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Questions and Answers

Which of the following is the primary effect of reduced nephron numbers on the remaining nephrons in chronic renal failure?

  • Reduced mesangial cell activity.
  • Decreased endothelial cell proliferation.
  • Decreased glomerular pressure.
  • Increased glomerular pressure. (correct)

What is a common cardiovascular finding associated with chronic renal failure (CRF) that can be a cause of death?

  • Concentric left ventricular hypertrophy (LVH) (correct)
  • Right ventricular hypertrophy
  • Mitral valve prolapse
  • Aortic valve stenosis

Which of the following best describes the pathogenesis of proteinuria in the context of glomerular abnormalities?

  • Reduced protein reabsorption in the proximal tubule.
  • Enhanced protein secretion by podocytes.
  • Increased protein filtration due to glomerular damage. (correct)
  • Decreased protein production by tubular cells.

In the context of kidney pathology in Systemic Lupus Erythematosus (SLE), what is the significance of the WHO classification?

<p>It is based on disease severity. (A)</p> Signup and view all the answers

Which of the following is a key characteristic of kidney damage in diabetes mellitus (DM)?

<p>Glycosylation of lipoproteins in the mesangium and basement membranes (B)</p> Signup and view all the answers

A patient with chronic renal failure (CRF) develops fibrinous pericarditis. Which of the following best describes this condition?

<p>Inflammation of the pericardium with fibrin deposition (D)</p> Signup and view all the answers

What is the typical timeframe by which diabetes mellitus (DM) antedates renal damage?

<p>10 to 15 years (C)</p> Signup and view all the answers

Which of the following pathological findings is associated with the most severe form of SLE kidney disease according to the WHO classification?

<p>Segmental lesions affecting more than 50% of glomeruli (A)</p> Signup and view all the answers

Which pathological change would suggest diabetic nephropathy?

<p>Nodular mesangial expansion. (A)</p> Signup and view all the answers

Upon electron microscopy (EM) of a kidney biopsy from a patient with Systemic Lupus Erythematosus (SLE), what pattern of immunoglobulin deposition is typically observed?

<p>All immunoglobulins (IgG, IgA, IgM) (A)</p> Signup and view all the answers

What vascular abnormality must be considered in pregnant patient with SLE?

<p>Thrombotic vascular lesions (B)</p> Signup and view all the answers

Which of the following represents the most common clinical manifestation of kidney disease in diabetes mellitus?

<p>Proteinuria (C)</p> Signup and view all the answers

What describes the term 'uraemia' in the context of chronic renal failure?

<p>Elevated nitrogenous waste products in the blood (A)</p> Signup and view all the answers

In the context of kidney disease, what is the clinical significance of proteinuria?

<p>It signifies the extent/volume of glomerular involvement. (A)</p> Signup and view all the answers

A patient with SLE presents with kidney involvement. A biopsy shows normal glomeruli under light microscopy but immunofluorescence is positive. According to the WHO classification, which type of SLE kidney disease does this represent?

<p>Type 1 (A)</p> Signup and view all the answers

In electron microscopy of diabetic nephropathy, what characteristic finding is often observed in the glomerular basement membrane (GBM)?

<p>GBM thickening (B)</p> Signup and view all the answers

A patient with diabetes mellitus has developed kidney damage possibly due to hypertension and drug use. What additional factor could contribute to kidney damage?

<p>Fallacy of pre-diabetic Type 2 renal damage. (D)</p> Signup and view all the answers

Which type of lesions are characterized as <50% gloms in SLE and the kidney?

<p>Type 3 (A)</p> Signup and view all the answers

Which part of the nephron are directly affected by increased glomerular pressure?

<p>Glomerulus (C)</p> Signup and view all the answers

In SLE renal pathology, why is EM important?

<p>EM detects all immunoglobulins (C)</p> Signup and view all the answers

What finding characterizes Type 5 classification of SLE?

<p>Membranous type pattern (A)</p> Signup and view all the answers

What part of the kidney does severe arteriolar sclerosis affect?

<p>Arterioles. (D)</p> Signup and view all the answers

Other than prolonged drug therapies, what causes kidney damage?

<p>Hypertension (B)</p> Signup and view all the answers

Which of the following statements encapsulates the definition of proteinuria?

<p>Excess protein in urine (C)</p> Signup and view all the answers

What is the primary mechanism by which increased glomerular pressure in remaining nephrons contributes to progressive glomerulosclerosis?

<p>Stimulation of mesangial cell proliferation and extracellular matrix deposition within the glomerulus. (D)</p> Signup and view all the answers

Which of the following best describes the relationship between uraemia and systemic effects in chronic renal failure?

<p>Build-up of uraemic toxins leads to systemic inflammation, oxidative stress, and endothelial dysfunction. (A)</p> Signup and view all the answers

In the context of kidney disease associated with Systemic Lupus Erythematosus (SLE), what is the key distinction between Type 3 and Type 4 lesions according to the WHO classification?

<p>The percentage of glomeruli affected by segmental lesions. (A)</p> Signup and view all the answers

Among the various classes of SLE kidney disease according to the WHO classification, which class is most likely to present with nephrotic syndrome?

<p>Class V: Membranous lupus nephritis (B)</p> Signup and view all the answers

In the context of SLE-related kidney pathology, what is the primary significance of detecting thrombotic microangiopathy (TMA)?

<p>It suggests the superimposition of anti-phospholipid syndrome, which can complicate pregnancy. (C)</p> Signup and view all the answers

What is the significance of the 'fallacy of pre-diabetic Type 2 renal damage' in the context of diabetic nephropathy?

<p>Renal damage can occur prior to diagnosis. (D)</p> Signup and view all the answers

What is the primary mechanism by which glycosylation of lipoproteins contributes to kidney damage in diabetes mellitus?

<p>Stimulation of mesangial cell proliferation and extracellular matrix accumulation. (A)</p> Signup and view all the answers

In a patient with diabetic nephropathy, what is the significance of observing Kimmelstiel-Wilson lesions on renal biopsy?

<p>They are suggestive of advanced diabetic glomerulopathy. (C)</p> Signup and view all the answers

Which structural component of the glomerulus is primarily affected by severe arteriolar sclerosis in the context of chronic kidney disease?

<p>Afferent and efferent arterioles (A)</p> Signup and view all the answers

What distinguishes nephrotic syndrome from nephritic syndrome in terms of pathophysiology?

<p>Nephrotic syndrome is characterized by increased glomerular permeability to protein, while nephritic syndrome is characterized by glomerular inflammation. (C)</p> Signup and view all the answers

Which aspect of patient history is most critical when evaluating kidney disease in the context of Systemic Lupus Erythematosus (SLE)?

<p>History of prolonged NSAID use (B)</p> Signup and view all the answers

What is the best approach to describe the cause of death for somebody suffering from chronic renal failure (CRF) with concentric left ventricular hypertrophy (LVH)?

<p>Reduced cardiac output. (B)</p> Signup and view all the answers

What should be considered when a pregnant Systemic Lupus Erythematosus presents with kidney issues?

<p>Thrombotic vascular lesions (B)</p> Signup and view all the answers

What best describes the classification based on severity of kidney damage of kidney disease in Systemic Lupus Erythematosus?

<p>WHO classification (A)</p> Signup and view all the answers

If a patient has segmental glomerular lesions and <50% gloms. Which of the following WHO categories would the patient belong to?

<p>Type 3 (B)</p> Signup and view all the answers

If somebody is suffering from chronic renal failure, what kind of heart issue could they have?

<p>Fibrinous pericarditis (D)</p> Signup and view all the answers

What is a common cause of death for chronic renal failure?

<p>LVH (concentric) (D)</p> Signup and view all the answers

In diabetic patients, after what time after being diagnosed with diabetes does renal damage occur?

<p>10 to 15 years (A)</p> Signup and view all the answers

What causes kidney damage?

<p>Prolonged drug therapies eg NSAIDS. (A)</p> Signup and view all the answers

If a patient with diabetes mellitus has kidney damage, which other condition can cause kidney damage?

<p>Hypertension (B)</p> Signup and view all the answers

Which of the following is the most insidious finding in kidney disease?

<p>Proteinuria (A)</p> Signup and view all the answers

Apart from the glomerulus itself, which other part of the kidney is particularly susceptible to damage from increased glomerular pressure due to reduced nephron numbers?

<p>The proximal convoluted tubule (A)</p> Signup and view all the answers

Which statement describes Proteinuria?

<p>It's protein in the urine (B)</p> Signup and view all the answers

In cases of SLE, what does a positive result on FM indicate?

<p>Normal glomeruli (D)</p> Signup and view all the answers

In the context of kidney disease, what does severe arteriolar sclerosis often affect?

<p>The blood vessels (D)</p> Signup and view all the answers

Flashcards

Haematuria

Presence of blood in the urine.

Glomerulonephritis

Inflammation of the glomeruli.

Nephrotic Syndrome

A kidney disorder characterized by proteinuria, hypoalbuminemia, edema, and hyperlipidemia.

Nephritic Syndrome

A kidney disorder characterized by hematuria, hypertension, and impaired renal function

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Post-infectious Glomerulonephritis

A type of glomerulonephritis that develops after an infection and involves inflammation of the glomeruli.

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Glomerulosclerosis

Progressive scarring of the glomeruli, leading to reduced kidney function.

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Kidney involvement in SLE

Kidney disease resulting from immune complex deposition

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Uraemia

Condition caused by the accumulation of urea and other nitrogenous waste products in the blood.

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LVH

A type of heart disease where the heart muscle becomes abnormally thick.

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Fibrinous pericarditis

Inflammation of the pericardium, often resulting in chest pain.

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SLE Type 3 and 4

Inflammation of glomerulus.

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Butterfly rash

Skin rash associated with SLE, shaped like a butterfly across the nose and cheeks.

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Proteinuria

A condition characterized by the presence of protein in the urine.

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Immunoglobulin deposits in SLE

Deposits of immunoglobulins in the glomeruli.

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Diabetic nephropathy

A condition characterized by damage to the kidney due to long-standing diabetes mellitus.

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Nodular mesangial expansion

Refers to the nodular accumulation of matrix components within the glomerulus.

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Kimmelstiel-Wilson lesion

Specific type of nodular glomerulosclerosis seen in diabetic nephropathy.

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Arteriolar sclerosis

Thickening and hardening of the walls of arterioles.

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Effects of Reduced Nephrons

Reduced nephron numbers increase workload & glomerular pressure, impacting mesangium, endothelial, and epithelial cells, leading to glomerulosclerosis.

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SLE and Kidney Disease

Systemic Lupus Erythematosus (SLE) affecting the kidney. Use the standard to classify this disease (WHO).

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Kidney in SLE

Immune complex deposition disease that affects the glomerulus in the kidney.

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SLE Thrombotic Vascular Lesions

These kidney lesions are thrombotic and vascular. Monitor during pregnancy carefully.

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SLE Kidney - Type 1

Normal glomeruli with positive immunofluorescence (IF) findings.

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SLE Kidney - Type 2

Mesangial proliferation (increase in mesangial cells) within glomeruli.

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SLE Kidney - Type 3

Segmental lesions affecting less than 50% of the glomeruli.

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SLE Kidney - Type 4

Segmental lesions affecting more than 50% of glomeruli.

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SLE Kidney - Type 5

This condition includes Type 5 or Membranous type pattern (Like Membranous GN). Can also have type 3 or type 4.

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Diabetes Mellitus

Renal damage may occur 10-15 years after diagnosis

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Glycosylation

Condition in which there is glycosylation of lipoproteins in mesangium and basement membranes of the kidneys. Secondary effects on epithelial cells.

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Study Notes

  • Pathology and immunological aspects of medical kidney disease are covered in Renal Pathology 5.

Renal Pathology 5 Objectives

  • Explain the pathophysiology of haematuria and list its causes.
  • Explain the pathophysiology of glomerulonephritis.
  • Define nephrotic syndrome, including its causes and pathophysiology.
  • Define nephritic syndrome, including its causes and pathophysiology.
  • Explain the pathogenesis of post-infectious glomerulonephritis.
  • Describe kidney pathology in Systemic Lupus Erythematosus (SLE).

Clinical Presentation of Chronic Renal Failure

  • Reduced nephron numbers lead to overworked the remaining nephrons.
  • Increased glomerular pressure impacts the mesangium, endothelial cells, and epithelial cells.
  • Progressive glomerulosclerosis results.

Clinical Effects of Chronic Renal Failure

  • Uraemia occurs.
  • It is caused by chronic diseases described in presentations 1-4.
  • Small, scarred kidneys are present.
  • All systems are affected by chronic renal failure.
  • There is more substantial discussion in Medicine.

Heart Conditions Linked to Renal Failure

  • Concentric Left Ventricular Hypertrophy (LVH) is a common cause of death in Chronic Renal Failure (CRF).
  • Fibrinous pericarditis ("bread and butter") can occur in CRF.

Kidney in Systemic Lupus Erythematosus (SLE)

  • It is an immune complex deposition disease with WHO classification based on severity.
  • Thrombotic vascular lesions are important in pregnancy.
  • Effects of prolonged drug therapy, such as NSAIDs, are a factor.

SLE and the Kidney: WHO Classification

  • Type 1: Normal glomeruli that are positive on FM.
  • Type 2: Mesangial proliferation.
  • Type 3: Segmental lesions affecting less than 50% of glomeruli.
  • Type 4: Segmental lesions affecting more than 50% of glomeruli.
  • Type 5: Membranous type pattern, similar to Membranous Glomerulonephritis (GN).
  • Type 5 can occur with type 3 or type 4.
  • A butterfly rash is associated with SLE.
  • All immunoglobulins are positive on EM in SLE, with EM deposits in all components of the glomerulus
  • Segmental glomerular acute inflammation occurs in SLE.
  • Large subendothelial deposits form in SLE.

The Kidney in Diabetes Mellitus (DM)

  • This applies to both Types 1 and 2.
  • Renal damage is typically antedated by DM for 10-15 years.
  • There is a fallacy of pre-diabetic Type 2 renal damage.
  • Damage may be due to hypertension and drugs.
  • Proteinuria is present in the nephrotic range.
  • Glycosylation occurs of lipoproteins in mesangium and basement membranes with secondary effects on epithelial cells.
  • Nodular mesangial expansion, severe nodular mesangial expansion, and Kimmelstiel Wilson lesions form
  • Markedly thickened Basement Membrane (BM) is seen on EM.
  • Severe arteriolar sclerosis occurs.

Proteinuria

  • Protein is present in the urine.
  • It is an insidious finding indicating glomerular abnormality.
  • The amount signifies the extent/volume of glomerular involvement.

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