Membranoproliferative Glomerulonephritis (MPGN)

by Carlo Raj, MD

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    About the Lecture

    The lecture Membranoproliferative Glomerulonephritis (MPGN) by Carlo Raj, MD is from the course Glomerulonephritis. It contains the following chapters:

    • MPGN - Overview
    • MPGN - Classification
    • Type I MPGN
    • Type II MPGN
    • Membranoproliferative Glomerulonephritis
    • Diabetic Glomerulopathy
    • Diabetic Glomerulosclerosis & Renal Amyloidosis

    Included Quiz Questions

    1. Type 1 is immune complex mediated, while type 2 is complement mediated.
    2. Type 1 is infection mediated and type 2 is autoimmune mediated.
    3. Type 1 involves autoantibodies and type 2 is related to monoclonal gammopathy.
    4. Type 1 is monoclonal gammopathy related and type 2 is complement mediated.
    5. Type 1 is malignancy related and type 2 is autoimmune mediated.
    1. An autoantibody directed against the Fc portion of the IgG antibody.
    2. An antibody that precipitates on cooling of the blood.
    3. An autoantibody directed against phospholipids.
    4. An autoantibody directed against neutrophil cytoplasmic antibody.
    5. An autoantibody directed against components of the glomerular basement membrane.
    1. HIV infection
    2. Rheumatoid arthritis
    3. Monoclonal gammopathy of undetermined significance
    4. Hepatitis C infection
    5. Multiple myeloma
    1. Subendothelial and mesangial immune complex and C3 deposits
    2. IgA, IgG and C3 deposits in mesangium
    3. No pattern on immunofluorescence
    4. Linear pattern of immune complex deposition
    5. Subendothelial immune complex deposits
    1. Mesangial cells
    2. Parietal epithelial cells
    3. Fenestrated cells
    4. Endothelial cells
    5. Visceral epithelial cells
    1. All statements are correct.
    2. It most commonly has a nephrotic presentation but may also have a nephritic presentation.
    3. Immune complexes may activate the classical complement pathway, the alternative complement pathway, or both.
    4. It may be associated cryglobulinemia.
    5. It is the most common type of MPGN.
    1. Large amount of protein usually immunoglobulins that precipitate at reduced temperatures.
    2. Immunoglobulins that cause agglutination of red blood cells.
    3. It is a type of hypoviscosity syndrome.
    4. It is often associated with bacterial infections.
    5. It often leads to type II membranoproliferative glomerulonephritis.
    1. Dysregulation of the alternative complement pathway.
    2. Overactivation of the classical complement pathway.
    3. Monoclonal gammopathy with decreased clearance.
    4. Overproduction and decreased clearance of IgA.
    5. T cell cytokine mediated damage of podocytes.
    1. All are correct.
    2. C3 convertase
    3. Alternative pathway convertase
    4. C3bBb
    5. C3 nephritic factor
    1. Decreased levels of serum C3
    2. Hypogammaglobulinuria
    3. Decreased levels of serum C3bBb
    4. Elevated levels of serum IgA
    5. Hypoalbuminuria
    1. Hematuria
    2. Hypotension
    3. Bleeding diathesis
    4. Fever
    5. Oliguria
    1. Alport syndrome
    2. IgA nephropathy
    3. Minimal change disease
    4. Osteogenesis imperfecta
    5. Post-streptococcal glomerulonephritis
    1. Thickening of basement membrane with proliferation of mesangial cells.
    2. Linear pattern on immunofluorescence
    3. Proliferation of parietal epithelial cells on light microscopy
    4. Subepithelial deposits on electron microscopy
    5. Damage of visceral epithelial cells on electron microscopy
    1. Type 1 and Type 2 may be differentiated by light microscopy.
    2. Less than half of patients present with hypertension.
    3. Response to corticosteroids is not established.
    4. Majority progress to CRF
    5. Majority of patients present with hematuria.
    1. Osmotic damage to glomerular capillary endothelial cells due to glucose entering the cells.
    2. Nonenzymatic glycosylation of GBM leads to increased permeability to proteins.
    3. No answers are incorrect.
    4. All answers are incorrect.
    5. Nonenzymatic glycosylation of arterioles leads to hyalinization.
    1. Hyaline arteriolosclerosis affects the efferent arteriole before the afferent arteriole.
    2. Osmotic damage increases permeability increasing filtration fraction.
    3. Damage to the visceral epithelial cell podocytes due to chronic pyelonephritis.
    4. Increased deposition of type IV collagen leads to decreased filtration fraction.
    5. Damage to the mesangium leads to loss of structural support for the glomerulus.
    1. …type IV collagen with trapped proteins.
    2. …proliferation of parietal epithelial cells.
    3. …weakened visceral epithelial cell processes.
    4. …damaged mesangial cells.
    5. …immune complex deposits.
    1. It occurs more frequently in patients with type II diabetes.
    2. Occurs in approximately 35-45% of patients with type I diabetes.
    3. It is often associated with other renal diseases such as renal papillary necrosis.
    4. It is highly correlated with coexisting glomerulopathy such as membranous glomerulopathy.
    5. It is the most common cause of chronic renal failure in the US.
    1. Hyalinization of the afferent arteriole.
    2. Damage to the mesangial matrix.
    3. Osmotic damage to the tubular epithelial cells.
    4. Fusion of podocytes.
    5. Renal papillary necrosis.
    1. Nephritic factor
    2. Rheumatoid factor
    3. IgM monoclonal protein
    4. Plasma cell dyscrasias
    5. Bence Jones proteins
    1. Congo red stain
    2. Hematoxylin and eosin stain
    3. Prussian blue stain
    4. Mucicarmine stain
    5. Periodic acid-schiff stain
    1. Eosinophilic acellular material in glomerular tuft and capillary walls.
    2. Proliferation of parietal epithelial cells occupying Bowman’s capsule.
    3. Diffuse thickening of glomerular basement membrane
    4. Empty vacuoles in the glomeruli
    5. Normal glomeruli

    Author of lecture Membranoproliferative Glomerulonephritis (MPGN)

     Carlo Raj, MD

    Carlo Raj, MD

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    Fantastic talk
    By Hamed S. on 07. March 2017 for Membranoproliferative Glomerulonephritis (MPGN)

    Have found this talk immensely useful in understanding the different types of MPGN as well as diabetic nephropathy and the potential underlying mechanism. It would have been good to further talk about the management of latter including blood pressure goals.