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Chapter 10 .docx

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University of Calgary
NURS 203

Chapter 10: Glomerular stuff Nomenclature of the Kidney dz: “-itis” = type III HPY – therefore it’s an immunologic dz (glomerulonephritis) Example: Lipoid nephrosis – does that have type III? No Example: Focal segmental glomerular sclerosis? No Example: Diabetic glomerulosclerosis? No. Example: IgA glomerulonephritis, diffuse membranous glomerulonephritis? Yes When we say ‘diffuse’, this means that EVERY glomerulus has something wrong with it on renal bx. What is ‘focal’? not all glomeruli involved. What if dz is focal and dz in the glomerulus is focal? Have a problem – this is called Focal Segmental Glomerulus What does proliferative mean? Have lots of them. So, you have many nuclei. If all the glomeruli have a lot of nuclei, this is diffuse proliferative glomerulonephritis If you just see thick membranes, its membranous glomerulonephritis If you see both increased cell and thickened membrane? Membranoproliferative glomerulonephritis Anatomy/schematic The order is: blood, endothelial cells of the capillaries, underneath there is a BM, and then the visceral epithelial cells (looks like feet = podocytes; which have spaces in between them called slit pores) that line the bowman’s capsule. Who makes/synthesizes the GBM? Visceral epithelial cells (podocytes). What keeps Albumin out of the urine normally? Strong negative charge of the BM. Who is responsible for strong “-“of the BM? A GAG called heparan sulfate, which has a strong neg charge. If we immunologically damage the visceral epithelial cell, what do we automatically also damage? The BM, which means you’re gonna spill a lot of protein in the urine, which means you potentially can have nephrotic syndrome if you spill >3.5 grams in 24 hrs). Test on Renal Bx Stains – routine H & E hemotoxylin stains, silver stains. Immunofluorescent stain – pattern can be linear or granular (aka lumpy bumpy), which are the only 2 patterns. These patterns are immune complexes or patterns/Ab’s that they are detecting. Take bx, and have Ab’s with a fluorescent tag on them. Ie want to see IgA in the glomerulus and have anti IgA Ab’s with a fluorescent tag – if there are any, it will attach to it and make a fluorescent tag. There are also tags for IgG, C3, fibrinogen – so can get an idea of what’s in the glomerulus and an idea of what pattern it is in (ie linear vs. lumpy bumpy granular pattern). It doesn’t tell us where these things are, it just tells us that they are there. What tells us where immune deposits and immune complexes are located are EM. So, we do stains, fluorescence, and EM. How can we tell that the podocytes are fused? Can only tell by EM b/c its so small. Difference between Ab recognition vs. immune complexes Detect with Ab which have 2 Ag recognition sites on the Ab. Goodpasture syndrome is an IgG anti BM Ab’s. So, they get in the blood they get into the glomerular capillary and are directed against the BM. Wherever there was a spot on the BM you will see an IgG Ab. There wouldn’t be one spot on the BM without IgG. So, what if we do a fluorescent tag for IgG overlying the glomerulus – what would you see? Would see outlines of all the BM’s of the entire glomerulus. It is linear. MCC linear pattern on immunufluorescence = Goodpastures. Immune complexes – Ag with Ab attached and is circulating in the bloodstream, hence Ag-Ab complex – ie lupus = immune complex dz: Ag = DNA, Ab = anti-DNA – they attach to e/o
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