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i move into uh the glomerular region
up until this point uh what we've done
over and over again is giving you an
overview
as far as laying down the foundation and
then we've built upon it well with
glomerular diseases first and foremost
think about where you are
you're in the glomerulus and there are
numerous
issues or factors that may then result
in glomerular disease
let's begin now first
and most importantly at this point is
the fact that your operative word here
is biopsy so the fact that you are
taking a biopsy specimen based on
the symptoms of your patient remember
once again remember when we did our
section with urine analysis
and with urine analysis you used
information that you had
derived based on the history that you
got from the patient either through a
clinical vignette
or from attending whatnot and you put
all this together so that you can arrive
at the proper diagnosis
well with the biopsy there are
a couple of important imaging studies
that you'll have to conduct
you can do an h e stain and with this we
mean hematoxylin and eosin
and with this this then allows us to
classify the type of glomerular disease
and this for the most part will be
light microscopy what does light
microscopy mean to you well
as we go through the various diseases
when it's relevant and pertinent we will
then take a look at
diseases in which it is best to classify
them
through light microscopy well let's say
that you don't find exactly
what you need to or perhaps there's
further investigation that is warranted
then you'll go into other types of uh
stains
and this includes something like
immunofluorescence
this is stain number two upon what
biopsy
was the first one light microscopy and
we're using h e stain
with immunofluorescence it's the fact
that as the name implies
you're literally immune immuno well
you're looking for the immuno
particles and you're fluorescing them
and with this particular stain you
probably have seen you have seen the
color
that bright green type of appearance
whenever there's
immunoglobulins that are being deposited
in your
glomerulus identifies proteins
and such the linear pattern is something
that well it's part of
immunofluorescence
and let's take for example we have good
pasture
from immunology you've heard good
pasture being type 2
hypersensitivity what does that mean to
you it means it's an antibody dependent
issue isn't it well when you're antibody
dependent what does that mean it means
that you are literally
attacking your target
so for example another name for good
pasture would be anti
a glomerular base of membrane antibodies
there are no complexes here that you're
forming is that clear
no complexes so what are they doing
these immunoglobulins are then
literally attacking the glomerular base
membrane
and so therefore if you have these
immunoglobulins attacking the basement
membrane
therefore what kind of pattern would you
expect to see on immunolog
immunofluorescence you're going to light
up the glomerular base membrane in a
linear pattern and as we walk through
this and i'll give you specifically
a good pasture or anti-global basement
membrane disease
you will see this pattern under
immunofluorescence
now if that is attacked in the
glomerular base membrane what if you
actually had immune complexes
for example we have type three
hypersensitivity that may occur with
sle we have type three top
hypersensitivity in which
what does that mean even from immunology
once again it means antigen antibody
complexes
you see the difference in good pasture
discussion above
what was it a type 2 upper sensitivity
what does that mean you're attacking the
glomerular base
membrane and type 3 you have
immunofluorescence
here that is then recognizing the immune
complexes
of antigen antibody that is depositing
where
either under the side of the epithelium
when you say epithelium you tell me
what's out of e
what are the glomerular base membrane
are you on if i say
epithelium good urine side
whereas if i say sub endothelial between
the basal membrane and the endothelium
that is the side of the blood is that
clear now
when you have such complexes that can be
deposited
either underneath the endothelial cell
or maybe perhaps under the epithelial
cell
what have you formed immune complexes
what can hypersensitivity
type three cannot be detected by
electron microscopy
and if it cannot so therefore what do
you do
you do an immunofluorescence in which
you find a pattern known as
a granular a granular so the granular
would then be a lumpy bumpy
quote unquote all this means is immune
complex deposition
if by chance you cannot find certain
things under electron microscopy
such as your linear pattern then you
have to use your immunofluorescence
to find that linear pattern but let's
say that you have electron microscopy
for
the granular pattern it recognizes as
immune complexes perhaps
and you want further confirmation then
upon immunofluorescence it is then
called your lumpy bumpy
three major patterns of imaging that are
important
based on the type of pathology that
you'll get and as we go through both
nephritic and nephrotic
i'll be asking you these questions such
as does this warrant
require lm light microscopy
on hne number two biopsy
immunofluorescence based on protein
deposition
and is it a linear pattern or a granule
pattern and then the third and final one
would be electron microscopy and we had
a previous discussion
where we went into great detail about
electron microscopy
where we then identify the glomerular
basement membrane the epithelial side
and the endothelial side let us now
continue
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you