Glomerulonephritis

1. Glomerulonephritis • Week 27

2. Nephritic Syndrome • If glomeruli involved: • hematuria • RBC casts in urine • azotemia • oliguria • HTN • proteinuria (<3.5g/day)

3. A 13yo boy is brought to the ED with periorbital edema, HTN, and tea-colored urine. His parents say that he had a sore throat about 3 weeks ago. Urinalysis shows RBCs with casts. A positive antistreptolysin O titer and decreased levels of complement are also noted. What findings would be expected in this patient’s glomeruli? • a. granular subendothelial deposits • b. linear subendothelial deposits • c. mesangial deposits • d. subendothelial deposits • e. subepithelial deposits

4. A 25 yo man comes to the ED with bloody sputum. A few weeks later, he progresses to renal failure with significant hematuria & HTN. A renal biopsy shows linear IF. Which of the following types of hypersensitivity reactions is this patient experiencing? • a. Type I hypersensitivity • b. Type II hypersensitivity • c. Type III hypersensitivity • d. Type IV hypersensitivity

5. A 16yo boy comes to the physician with a 1-yr hx of intermittent, painless hematuria w/o dysuria or increased frequency of micturition. He says he has also had several respiratory infections and adds that the hematuria increased within several days of the infections. Which of the following is most likely to be found? • a. increased antistreptolysin O titer • b. lumpy-bumpy electron dense deposits • c. mesangial deposits • d. proteinuria exceeding 3.5gm/24h • e. subepithelial deposits

6. Nephrotic Syndrome • Triad of: • Associated w/: • proteinuria (>3.5g/day) • edema • hypoalbuminemia • hyperlipidemia • fatty casts • thromboembolism • increased risk of infection

7. The nephrotic syndrome is characterized by severe proteinuria, decreased serum albumin level, and edema. This results from damage to one or more components of the glomerular capillary wall. In particular, the glomerular basement membrane is essential for maintaining serum oncotic pressure. In nonpathologic states, which of the following properties of the glomerular basement membrane prevent albumin from being freely filtered into the urine? • a. a combination of small pore size and negatively charged pore-forming molecules prevents albumin filtration • b. a combination of small pore size and positively charged pore-forming molecules prevents albumin filtration • c. albumin is freely filtered across the basement membrane but is readily reabsorbed along the nephron • d. the positive charge of proteoglycans in the basement membrane repels albumin • e. the small size of the glomerular basement membrane pores excludes albumin molecules

8. A 7yo boy with nephrotic syndrome is BIBA to the ED with altered mental status. His mother reports that this morning he had difficulty moving the right side of his body, and that she couldn’t arouse him from an afternoon nap. On physical exam, the patient obtunded and has absent R-sided movement. His prothrombin time is 12 sec. What is the most likely etiology of this patient’s symptoms? • a. decreased antithrombin III levels • b. decreased factor II levels • c. decreased fibrinogen levels • d. increased protein S levels • e. increased protein C levels

9. A 50 yo man with a history of large bowel obstruction is diagnosed with colon cancer and undergoes resection of his colon. He returns to his physician for his regular check-up and complains that in the past 3 weeks he has not been feeling well and has noticed significant swelling of his legs. On physical exam, the physician notes 2+ pitting edema and a BP of 155/94 mmHg. Urinalysis shows 4+ protein with no RBCs or casts. The pt has otherwise been healthy. Which of the following would most likely be present on a kidney biopsy from this patient? • a. a spike and dome pattern of deposition on EM • b. a tram-track pattern on light microscopy • c. lumpy subepithelial deposits on light microscopy • d. nonlinear mesangial staining with IgA IF • e. “splintering” of the lamina densa

10. An 18yo African-American man has had increasing lethargy, proteinuria, and edema following a bout of the flu 3 weeks ago. At that time, the patient visited his primary care physician, who prescribed corticosteroids for 3 weeks without improvement of his condition. His physician then referred him to a nephrologist, who performed a renal biopsy and diagnosed him with focal segmental glomerulosclerosis. Which of the following was the most likely histologic description in this patient’s biopsy report? • a. entire glomerular tufts show obliterated capillaries; >50% glomeruli affected • b. entire glomerular tufts show obliterated capillaries with cellular proliferation • c. parts of the glomerular tufts show obliterated capillaries; <50% of glomeruli affected • d. parts of the glomerular tufts show obliterated capillaries; >50% of glomeruli affected • e. parts of the glomerular tufts show obliterated capillaries with cellular proliferation

11. A 43yo man has had type 1 diabetes mellitus for 30 years. He uses insulin to treat his diabetes, but his blood glucose levels are poorly controlled. Over the years, he has developed painful peripheral neuropathy and nonhealing diabetic foot ulcer. Recently he has experienced increased urinary frequency, which prompted his visit to the physician. His temperature is 37.6, BP 155/95, HR 72, RR 16. Which of the following would most likely be found on a biopsy of this man’s kidney? • a. crescent-shaped lesions in the glomeruli • b. nodular glomerular changes • c. proliferation of the mesangial membranes • d. segmental sclerosis and hyaline cysts • e. tram-track appearance on LM

12. A 7yo boy presents to the physician with acute-onset edema and facial swelling. Dipstick urinalysis reveals 4+ proteinuria. Renal biopsy shows no appreciable changes under light and fluorescence microscopy, but EM demonstrates glomerular epithelial foot process effacement. How does this disease affect the pressures governing the flow of fluid across the glomeruli? • a. Bowman’s space hydrostatic pressure will be decreased • b. Bowman’s space hydrostatic pressure will be increased • c. Bowman’s space oncotic pressure will be decreased • d. Glomerular capillary hydrostatic pressure will be increased • e. Glomerular capillary oncotic pressure will be decreased