Renal Pathology 5: Kidney Disease & Immunological Aspects

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Questions and Answers

What is the primary mechanism by which reduced nephron numbers contribute to progressive glomerulosclerosis?

  • Reduced endothelial cell proliferation
  • Diminished epithelial cell turnover
  • Decreased mesangial cell activity
  • Increased glomerular pressure (correct)

Which of the following is the most direct consequence of chronic renal failure affecting the cardiovascular system?

  • Small scarred kidneys
  • Fibrinous pericarditis (correct)
  • Decreased erythropoietin production
  • Reduced calcium absorption

In the context of Systemic Lupus Erythematosus (SLE) and kidney involvement, which of the following is the basis for the WHO classification?

  • Severity of the disease (correct)
  • Specific autoantibodies present
  • Affected kidney size
  • Patient's age at the time of diagnosis

Which of the following best describes the typical glomerular finding in Type 1 SLE kidney disease, according to the WHO classification?

<p>Normal glomeruli with positive findings on immunofluorescence (C)</p> Signup and view all the answers

Which of the following characteristics is most indicative of Type 4 SLE kidney involvement, based on the WHO classification?

<p>Segmental lesions affecting &gt;50% of glomeruli (C)</p> Signup and view all the answers

Why are thrombotic vascular lesions in the kidney of particular concern in pregnant women with Systemic Lupus Erythematosus (SLE)?

<p>They are associated with increased risk of maternal and fetal morbidity (C)</p> Signup and view all the answers

What pathological process is most directly indicated by the presence of proteinuria?

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

In the context of the kidney's role in maintaining overall health, what is the primary implication of determining the amount of proteinuria?

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

In diabetic nephropathy, what is the primary mechanism by which glycosylation contributes to renal damage?

<p>Glycosylation of lipo-proteins alters mesangium and basement membranes. (A)</p> Signup and view all the answers

In the context of diabetic nephropathy, what is the significance of the term 'Kimmelstiel-Wilson lesion'?

<p>Describes a specific type of lesion (A)</p> Signup and view all the answers

In the context of the kidney's overall function in individuals with diabetes mellitus, what is the primary clinical relevance of detecting proteinuria?

<p>Identifying early stage disease (C)</p> Signup and view all the answers

How does chronic disease described in prior lectures typically manifest in the context of chronic renal failure?

<p>Small, scarred kidneys. (A)</p> Signup and view all the answers

What is a key distinction in the underlying pathophysiology between nephrotic and nephritic syndromes?

<p>Nephrotic syndrome involves primarily glomerular basement damage, whereas nephritic syndrome involves glomerular inflammation (D)</p> Signup and view all the answers

Which of the following pathological processes is most directly linked to the development of uraemia in individuals with chronic renal failure?

<p>Build-up of waste products (B)</p> Signup and view all the answers

Which factor primarily determines the classification of SLE-related kidney disease according to the WHO?

<p>Severity of the disease based on glomerular lesions (D)</p> Signup and view all the answers

Which of the following is the primary effect of reduced nephron numbers on individual glomeruli?

<p>Increased glomerular pressure (B)</p> Signup and view all the answers

What is the most common cause of death?

<p>Left Ventricular Hypertrophy (B)</p> Signup and view all the answers

How does the presence of immune complex deposits in various components of the glomerulus contribute to the pathogenesis of SLE-related kidney disease?

<p>Stimulates immune cell activation and inflammation, causing tissue damage (A)</p> Signup and view all the answers

What distinguishes Type 5 SLE kidney involvement from other types in WHO classification?

<p>A membranous pattern (C)</p> Signup and view all the answers

Which of the following is not a pathological feature commonly observed in the kidneys of individuals with Systemic Lupus Erythematosus (SLE)?

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

What is the clinical significance of observing severe arteriolar sclerosis in the kidney?

<p>Impairs renal blood flow (C)</p> Signup and view all the answers

In the context of diabetic nephropathy, what structural alteration of the glomerulus is specifically referred to as a 'Kimmelstiel-Wilson lesion'?

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

In the context of renal pathology associated with diabetes mellitus, what is a notable characteristic of renal damage?

<p>Damage precedes the actual diagnosis (A)</p> Signup and view all the answers

Select the option that best describes the pathogenesis of the butterfly rash seen in many SLE patients.

<p>Deposition of complement products (D)</p> Signup and view all the answers

According to the WHO classification, what dictates the types in SLE?

<p>Number of Glomular lesions above or below 50%. (D)</p> Signup and view all the answers

What is the primary implication of increased glomerular pressure due to reduced nephron numbers?

<p>Damage to mesangial, endothelial, and epithelial cells. (C)</p> Signup and view all the answers

Which of the following is a common clinical consequence observed in individuals with chronic renal failure (CRF)?

<p>Development of Uraemia. (B)</p> Signup and view all the answers

What cardiovascular manifestation is often associated with chronic renal failure (CRF), contributing to increased mortality?

<p>Fibrinous Pericarditis. (C)</p> Signup and view all the answers

In the context of Systemic Lupus Erythematosus (SLE), which of the following is a key consideration regarding thrombotic vascular lesions in the kidney of pregnant women?

<p>They can lead to significant maternal and fetal morbidity. (D)</p> Signup and view all the answers

In the context of the kidney, what does the finding of 'protein in the urine' typically indicate?

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

In the context of proteinuria, what does the total amount of protein signify?

<p>Extent/volume of glomerular involvement. (B)</p> Signup and view all the answers

In the context of diabetic nephropathy, what is the typical sequence of events leading to renal damage?

<p>Diabetes mellitus typically antedates renal damage by 10 to 15 years. (B)</p> Signup and view all the answers

In the context of diabetic nephropathy, what is the significance of glycosylation?

<p>Altered structure and function of basement membranes. (A)</p> Signup and view all the answers

In the context of diabetic nephropathy, what is the key finding?

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

What pathological process is suggested by the presence of 'Small scarred kidneys'?

<p>Chronic Renal Failure. (D)</p> Signup and view all the answers

In the context of SLE and the kidney, what is the primary basis for the WHO classification?

<p>Severity of renal damage. (A)</p> Signup and view all the answers

What feature characterizes Type 1 SLE kidney disease, based on the WHO classification?

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

Which feature primarily distinguishes Type 5 SLE kidney involvement from other types according to the WHO classification?

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

Which of the following best describes the deposition pattern of immunoglobulins observed in the glomeruli of individuals with Systemic Lupus Erythematosus (SLE)?

<p>All immunoglobulins in all components. (D)</p> Signup and view all the answers

What is the primary finding that characterizes proliferative glomerulonephritis?

<p>Increased number of cells within the glomerulus. (B)</p> Signup and view all the answers

How does proteinuria typically manifest in the context of kidney disease?

<p>Asymptomatic presence of protein in the urine. (B)</p> Signup and view all the answers

What is the primary effect of reduced nephron numbers on the remaining glomeruli within the kidney?

<p>Increased glomerular pressure. (D)</p> Signup and view all the answers

In the context of Systemic Lupus Erythematosus (SLE), what is the primary concern associated with thrombotic vascular lesions found in the kidney, especially during pregnancy?

<p>Increased risk of maternal and fetal morbidity. (C)</p> Signup and view all the answers

What is the primary mechanism by which chronic hypertension contributes to renal damage?

<p>Thickening and hardening of arterial walls, reducing blood flow to the kidneys. (D)</p> Signup and view all the answers

What is the role of glycosylation in the pathogenesis of diabetic nephropathy?

<p>Leads to structural changes in the mesangium and basement membranes. (B)</p> Signup and view all the answers

Other than diabetes mellitus, what other disease may cause similar damage to the kidney?

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

In the context of Systemic Lupus Erythematosus (SLE), what is the primary characteristics of kidney damage?

<p>All immunoglobulins in electron microscopy. (D)</p> Signup and view all the answers

What is 'bread and butter' what can occur in CRF?

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

What type of vascular lesions are of particular concern in kidney disease, especially in pregnant women with Systemic Lupus Erythematosus (SLE)?

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

In the context of kidney diseases, what finding is classified as an insidious indicator of glomerular abnormality?

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

Flashcards

Haematuria

Blood in the urine.

Glomerulonephritis

Inflammation of the glomeruli, the filtering units of the kidney

Nephrotic Syndrome

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

Nephritic Syndrome

Kidney disorder defined by hematuria, hypertension, and renal insufficiency.

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Post infectious Glomerulonephritis

Glomerulonephritis that develops after an infection, often a streptococcal infection.

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Kidney Pathology in SLE

Kidney inflammation due to Systemic Lupus Erythematosus.

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Impact of Reduced Nephrons

Reduced number of nephrons leads to glomerular pressure.

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Uraemia

A condition marked by the presence of urea in the blood.

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Left Ventricular Hypertrophy (LVH)

Thickening of the heart muscle due to overwork, often seen in chronic renal failure.

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Fibrinous Pericarditis

Inflammation of the pericardium, the membrane around the heart, often with fibrin deposits.

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Kidney in Systemic Lupus Erythematosus (SLE)

Chronic disease where immune complexes deposit in the kidney, leading to inflammation and damage.

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SLE Thrombotic Vascular Lesions

Thrombotic lesions in kidney vessels, a significant concern during pregnancy with SLE..

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SLE Kidney - Type 1

Normal glomeruli, but positive immunofluorescence.

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SLE Kidney - Type 2

Increased number of mesangial cells in the glomeruli.

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SLE Kidney - Type 3

Less than 50% of glomeruli have damage.

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SLE Kidney - Type 4

More than 50% of glomeruli show damage.

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SLE Kidney - Type 5

Pattern similar to membranous glomerulonephritis.

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Proteinuria

Protein in the urine, a sign of glomerular abnormality.

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Kidney in Diabetes Mellitus (DM)

Kidney damage can occur in diabetic patients after years of diabetes.

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Proteinuria (Diabetic Kidney)

Protein loss in urine, a hallmark of diabetic kidney disease.

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Nodular Mesangial Expansion

Expansion of the mesangial matrix in the glomerulus, a key feature of diabetic nephropathy.

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Kimmelstiel Wilson Lesion

A specific type of nodular lesion seen in diabetic nephropathy.

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Thickened Glomerular BM

Thickening of the glomerular basement membrane.

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Severe Arteriolar Sclerosis

Hardening of the small arteries in the kidney, associated with diabetes.

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Glomerulosclerosis

Progressive glomerular damage due to overworked nephrons from chronic disease.

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Kidney in SLE

The kidney can be affected by immune complex deposition and WHO classification based on severity.

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Butterfly rash in SLE

A butterfly-shaped rash on the face, common in SLE cases.

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Immunoglobulins in SLE

Deposition of all major antibody types in the glomerular structures.

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EM Deposits in Glomerulus

Affecting various parts of the glomerulus, seen via electron microscopy.

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Segmental Glomerular Inflammation

Active inflammation impacting only parts of the glomerulus.

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Diabetes Renal Damage Timing

Diabetes renal damage can appear 10-15 years after onset.

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Hypertension Renal Damage

Kidney damage can be caused by uncontrolled high blood pressure.

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Glycosylation of Lipo-proteins

These cause secondary effects in the mesangium and basement membranes if Glycosylated.

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Study Notes

  • Pathology and immunological aspects of medical kidney disease are under discussion in Renal Pathology 5

Renal Pathology Objectives

  • Pathophysiology of haematuria needs explanation, including listing the causes.
  • Glomerulonephritis pathophysiology requires clarification.
  • Definition of the nephrotic syndrome, including its causes and pathophysiology.
  • Definition of the Nephritic syndrome, including its causes and pathophysiology.
  • Pathogenesis of post-infectious glomerulonephritis needs explaining.
  • Kidney pathology in SLE requires description.

Chronic Renal Failure (CRF)

  • Reduced nephron numbers result in overworked remaining nephrons and increased glomerular pressure
  • Effects of overworked nephrons can affect the mesangium, endothelial and epithelial cells
  • Can result in progressive glomerulosclerosis
  • Uraemia can result from chronic renal failure
  • Can be caused by chronic disease described in previous lectures
  • CRF leads to small scarred kidneys
  • All systems effected by chronic renal failure
  • Discussion in Medicine is substantial
  • Left Ventricular Hypertrophy (LVH) can be a common cause of death in CRF
  • Fibrinous pericarditis ("bread and butter") can occur

Kidney in Systemic Lupus Erythematosus (SLE)

  • SLE is an immune complex deposition disease
  • The WHO classification of SLE is based on severity
  • Thrombotic vascular lesions are important in pregnancy
  • Effects of prolonged drug therapy eg NSAIDS, are factors
  • Butterfly rash is a symptom of of SLE kidney issues
  • All immunoglobulins are positive on EM in SLE
  • EM deposits in all components of glomerulus
  • Segmental glomerular acute inflammation occurs in SLE
  • Large subendothelial deposits can occur in SLE

SLE and the Kidney: WHO Classification

  • Type 1: Normal glomeruli, 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 GN
  • Combinations like type 5 plus type 3 or type 4 can occur

The Kidney in Diabetes Mellitus (DM)

  • Types 1 and 2 diabetes are relevant
  • Diabetes Mellitus typically antedates renal damage by 10 to 15 years
  • There is a fallacy of pre-diabetic Type 2 renal damage,
  • Damage may be due to Hypertension and drugs
  • Proteinuria in the nephrotic range is seen
  • Glycosylation of lipoproteins occurs in the mesangium and basement membranes, with secondary effects on epithelial cells
  • Nodular mesangial expansion can occur
  • Severe nodular mesangial expansion occurs
  • Kimmelstiel Wilson lesion
  • There is markedly thickened BM on EM
  • Severe arteriolar sclerosis

Proteinuria

  • Protein is present in the urine
  • It is an insidious, and points to a glomerular abnormality
  • The amount of protein signifies the extent/volume of glomerular involvement

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