High-yield Nephrology

Diseases Clinical Features: Kay words in case Diagnosis Treatment Nots

1. Cystitis
2. Acute Pyelonephritis
3. Polycystic kidney
disease PCKD
4. Haemolytic uremic
syndrome (HUS)
ADAM13

5. Thrombotic
thrombocytopenic
Purpura (TTP)

LM: Enlarged and Enlarged and hypercellular

6. Post streptococcal
glomerulonephritis PSGN
7. Alport’s syndrome - Ocular problem
- Light microscopy: Podocyte
hypertrophy specimen.
Segmental
glomerular sclerosis.
Irregular thickening of the
glomerular basement
membrane.
- Electron microscope:
Longitudinal splitting of the
lamina denca of the
glomerular basement
membrane;
hypercellular glomeruli
glomeruli.  The hypercellularity is diffuse
EM: Subepithelial IC (involves all lobules of all
humps glomeruli) and is caused by
IF: a Granular (“starry leukocyte infiltration, and the
sky”) appearance proliferation of endothelial and
(“lumpy-bumpy”) due mesangial cells.
to IgG, IgM, and C3
deposition along GBM
and mesangium.
LM: Podocyte
hypertrophy specimen.
Segmental glomerular
sclerosis. Irregular
thickening of the
glomerular basement
membrane.
EM: Longitudinal
splitting of the lamina
densa of the
glomerular basement
membrane;
IF: Distribution of the
α5(IV) chain in the
 kidney and the skin
basement membranes

- Immunofluorescence LM: Mesangial

microscopy demonstrated proliferation
IgA 3+ postive EM: Mesangial IC
8. IgA Nephropathy
deposition
IF: IgA-based IC
deposits in mesangium
- Hemoptysis LM: I
- Anti-GBM antibody Positive
EM: E
9. Goodpasture’s disease
IF: a

Nephrotic Syndrome
10. Minimal change Nephrotic Syndrome: - Glomerular capillary totally LM: Normal - Prednisone is first-
disease - Proteinuria lost foot effacement. glomeruli line therapy.
- Hypoalbuminemia EM: Effacement of - immuno
- Edema podocyte foot suppressive drugs,
- Hyperlipidemia processes. such as
- Lipiduria IF: Negative ⊝ cyclophosphamide,
11. Focal segmental LM: Segmental
glomerulosclerosis sclerosis and hyalinosis
EM: Effacement of
podocyte foot
processes
IF: ⊝ may be + for
nonspecific
focal deposits
of IgM, C3, C1
12. Membranous LM: Diffuse capillary
Nephropathy = and GBM thickening
Membranous EM: “Spike and dome”
Glomerulonephritis appearance of
subepithelial deposits
IF: Granular due to

Nephritic-nephrotic syndrome
14. Membranoproliferative
glomerulonephritis.
Acute Renal Failure
immune complex (IC)
deposition
- Thickening of glomerular LM: Mesangial ingrowth
capillary walls, mesangial → GBM splitting
expansion and double tram. → “tram-track”
- positive staining with IgG (Double)
3+; IgM 3+, C3 2+ and 1q 2+. EM: E
- there was found dense IF: a
deposits in mesangium and
subendothelial space;
 Microscopy

Finding Case
Nephrotic
Renal biopsy revealed:
Light microscope:
31 glomeruli were found. Normal glomeruli was found
Normal glomeruli
under light microscopic examination; Incubation with IgM
Immunoflourescence:
Minimal Change Disease was in mesangium. Incubation with IgG, IgA, C1q, C3 and
There are no complement or immunoglobulin.
Fibrine/fibrinogen was negative. Electron microscope:
Electron microscope:
Glomerular capillary totally lost foot effacement. Electron
Diffuse foot effacement.
dense deposit was not found.
Light microscope:
Segmental sclerosis and hyalinosis Light microscope: Mesangial collapse and sclerosis is seen
Immunofluorescence: but not total glomeruli; Sclerotic changes occur in
Focal Segmental
Usually reveals no immune deposits; very rare it reveals IgM or juxtamedullary, mild hypercellularity;
Glomerulosclerosis
complement C3 in sclerotic areas and mesangium; Immunofluorescence microscope reveals no immune
Electrone microscope: deposits
Diffuse foot effacement
Light microscope:
Thickening of glomerular capilary wall, Glomerular basement
Kidney biopsy showed thickening of glomerular basement
membrane spikes Subepitelial glomerular deposits
membrane on light microscope. 5 percent of tubular atrophy.
Immunoflourescence:
Membranous Immunohistology revealed granular staining with IgG (3+)
- Diffuse granular pattern of immunoglobulin of IgG along GBM
Glomerulonephritis and C3 (3+). On electrone microscope there was found foot
- Diffuse granular pattern of complement factor C3 along GBM
process effacement and glomerular basement spikes and
Electron microscope:
subepithelial deposits.
Sub epithelial electron-dense deposit outer of GBM
Foot process effacement and spikes;
Light microscope:
- Thickening of glomerular capillary walls
- Mesangial expansion and hypercelularity
- Masangial “double tram”
Immunofluorescence: Kidney biopsy showed: Light microscope examination:
Diffuse subendothelial and mesangial staining with imunoglobuline Thickening of glomerular capillary walls, mesangial
Membranoproliferative IgG , IgM, or complement factors C1q and C3; expansion and double tram; Immunohistology revealed
Glomerulonephritis Electrone microscope: positive staining with IgG 3+; IgM 3+, C3 2+ and 1q 2+. On
- MPGN type I is characterized by discrete immune deposits in the electrone microscope there was found dense deposits in
mesangium and subendothelial space; mesangium and subendothelial space;
- MPGN type II (dense deposit disease, or DDD) is characterized by
mesangial and intramembranous dense deposits;
- MPGN Type III – Mesangial, subepithelial and subendothelial dense
deposits
Nephritic
Light microscope:
- Mesangial expansion, mesangial and endocapillary proliferation Renal biopsy: revealed a diffuse proliferative
hypercellularity glomerulonephritis with no crescents, but 30% of his
- Rapidly deteriorating kidney function glomeruli were obsolescent, and there was mild to moderate
IgA Nephropathy segmental necrosis with or without crescent formation interstitial fibrosis. Immunofluorescence microscopy
Immunofluorescence: demonstrated IgA 3+ postive, IgG, IgM, C1q and C3 was
Demonstrated IgA postive. negative. Electron microscopy detected electron dense
Electron microscope: deposits within the mesangium.
Mesangial electrone dense-deposit seen on electrone microscope;
Light microscopy: Podocyte hypertrophy specimen. Segmental
Renal biopsy: Light microscopy: Podocyte hypertrophy
glomerular sclerosis. Irregular thickening of the glomerular
specimen. Segmental glomerular sclerosis. Irregular
basement membrane.
thickening of the glomerular basement membrane.
Immunofluorescence: Distribution of the α5(IV) chain in the kidney
Alport’s Syndrome Immunofluorescence: Distribution of the a5 (IV) chain in the
and the skin basement membranes.
kidney and the skin basement membranes. Electron
Electron microscope:
microscope: Longitudinal splitting of the lamina
Longitudinal splitting of the lamina densa of the glomerular
denca of the glomerular basement membrane;
basement membrane;
Light microscopy:
minor abnormalities
Very rare it has been seen sclerotic changes of glomeruli
Thin Basement Membrane Immunofluorescence:
negative for IgG, IgA, IgM, Clq, C3 and fibrinogen.
Electron microscopy:
irregular thinning of glomerular basement membrane;

Light microscope:
prominent endocapillary proliferation and hypercelluraty with
Renal biopsy was performed that revealed a diffuse
neutrophils
Post-Infective endocapillary proliferation and neutrophiles infiltration.
Immunofluorescence:
Glomerulonephritis Immunofluorescence microscopy demonstrated IgG and C3
A characteristic pattern of deposits of immunoglobulin G (IgG) and
or granular pattern positive staining: The other
C3 distributed in a diffuse granular pattern within the mesangium
Poststreptococcal immunoglobulins lgA, IgM and C1q and Fibrin/fibrinogen
and glomerular capillary walls;
Glomerulonephritis was negative; Electron microscopy detected subepithelial
Electron microscopy :
dense deposits, the same humps were detected.
The dome-shaped subepithelial electron-dense deposits that are
known as humps.

Goodpasture's Disease Light microscopy: Kidney biopsy showed crescent formation on light
Usually shows crescentic glomerulonephritis.
Immunofluorescence:
demonstrates the virtually pathognomonic finding of linear microscope. Thirty percent of glomeruli were globally
deposition of immunoglobulin G (IgG) along the glomerular sclerotic and there was focal mild-to-moderate interstitial
capillaries and occasionally the distal tubules. fibrosis and tubular atrophy. Immunohistology revealed
Electron microscope: linear staining with IgG 3+.
Granular deposits of antigen-antibody complexes along the
glomerular basement membrane.