Thin basement membrane disease pathophysiology: Difference between revisions
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*Erythrocytes in between renal tubules ad bowman's membrane<ref name="pmid2371004">{{cite journal |vauthors=Bailey RR |title=Familial haematuria due to thin basement membrane nephropathy |journal=N. Z. Med. J. |volume=103 |issue=893 |pages=312–3 |date=July 1990 |pmid=2371004 |doi= |url=}}</ref> | *Erythrocytes in between renal tubules ad bowman's membrane<ref name="pmid2371004">{{cite journal |vauthors=Bailey RR |title=Familial haematuria due to thin basement membrane nephropathy |journal=N. Z. Med. J. |volume=103 |issue=893 |pages=312–3 |date=July 1990 |pmid=2371004 |doi= |url=}}</ref> | ||
*Diffuse thinning of GBM in electron microscopy in around 50% of population with TBMD.<ref name="pmid15880325">{{cite journal |vauthors=Foster K, Markowitz GS, D'Agati VD |title=Pathology of thin basement membrane nephropathy |journal=Semin. Nephrol. |volume=25 |issue=3 |pages=149–58 |date=May 2005 |pmid=15880325 |doi=10.1016/j.semnephrol.2005.01.006 |url=}}</ref> Occassionally, segmental thinning of GBM is present in TBMD.<ref name="pmid17090197">{{cite journal |vauthors=Ivanyi B, Pap R, Ondrik Z |title=Thin basement membrane nephropathy: diffuse and segmental types |journal=Arch. Pathol. Lab. Med. |volume=130 |issue=10 |pages=1533–7 |date=October 2006 |pmid=17090197 |doi=10.1043/1543-2165(2006)130[1533:TBMNDA]2.0.CO;2 |url=}}</ref> | *Diffuse thinning of GBM in electron microscopy in around 50% of population with TBMD.<ref name="pmid15880325">{{cite journal |vauthors=Foster K, Markowitz GS, D'Agati VD |title=Pathology of thin basement membrane nephropathy |journal=Semin. Nephrol. |volume=25 |issue=3 |pages=149–58 |date=May 2005 |pmid=15880325 |doi=10.1016/j.semnephrol.2005.01.006 |url=}}</ref> Occassionally, segmental thinning of GBM is present in TBMD.<ref name="pmid17090197">{{cite journal |vauthors=Ivanyi B, Pap R, Ondrik Z |title=Thin basement membrane nephropathy: diffuse and segmental types |journal=Arch. Pathol. Lab. Med. |volume=130 |issue=10 |pages=1533–7 |date=October 2006 |pmid=17090197 |doi=10.1043/1543-2165(2006)130[1533:TBMNDA]2.0.CO;2 |url=}}</ref> | ||
*Minimal glomerular change or mesangial expansion may be present on light microscopy.<ref name="urlRedirecting">{{cite web |url=https://doi.org/10.1016/B978-1-4160-3966-2.00029-1 |title=Redirecting |format= |work= |accessdate=}}</ref> | |||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pathophysiology
Physiology
Glomerular Basement membrane consists of laminin, Type 4 collagen, heparan sulfate proteoglycan and nidogen. Type 4 collagen is generally composed of Gly-X-Y amino acids rich in six alpha chains (alpha 1-6) that gives type 4 collagen a trimeric shape. The nascent GBM is made up of alpha 1 and 2 initially, then alpha 3-4 trimers are secreted after glomerular capillaries formation which becomes the major component of type 4 collagen and giving the GBM its stability.[1]
Pathology
Heterozygous mutation in COL4A3 and COL4A4 gene is responsible for causing autosomal dominant pattern of 40-50% of Thin basement membrane disease in which people have defective alpha 3, alpha 4 , alpha 5 chains. [1] And heterozygous mutation in COL4A5 gene in X-chromosome may cause Thin basement mamebrane disease in female.
Genetics
Thin basement membrane disease is an inherited pattern disease affecting successive generations. It may be due to-
- Autosomal dominant inheritance due to heterozygous mutation in COL4A3 and COL4A4 gene
- Heterozygous mutation in COL4A5 gene in X-chromosome causing Thin basement membrane like disease in female
- 'De novo' mutation.[2]
Associated condition
Condition associated with Thin basement membrane disease include:
- Alport syndrome
- Alport syndrome is caused by homozygous or heterozygous mutation of both or either COL4A3, COL4A4 and COL4A5 gene, thus 36% of cases of TBMN with COL4A3, COL4A4 mutation are shown to be associated with Alport Syndrome.[3]
- IgA nephropathy.
Gross pathology
On gross pathology, there is no distinctive features suggesting TBMD.
Microscopic pathology
On microscopic histopathological analysis, the followings features are noted:
- Erythrocytes in between renal tubules ad bowman's membrane[4]
- Diffuse thinning of GBM in electron microscopy in around 50% of population with TBMD.[5] Occassionally, segmental thinning of GBM is present in TBMD.[6]
- Minimal glomerular change or mesangial expansion may be present on light microscopy.[7]
References
- ↑ 1.0 1.1 Miner JH (May 2012). "The glomerular basement membrane". Exp. Cell Res. 318 (9): 973–8. doi:10.1016/j.yexcr.2012.02.031. PMC 3334451. PMID 22410250.
- ↑ Rana K, Wang YY, Buzza M, Tonna S, Zhang KW, Lin T, Sin L, Padavarat S, Savige J (May 2005). "The genetics of thin basement membrane nephropathy". Semin. Nephrol. 25 (3): 163–70. doi:10.1016/j.semnephrol.2005.01.008. PMID 15880327.
- ↑ Buzza M, Wilson D, Savige J (May 2001). "Segregation of hematuria in thin basement membrane disease with haplotypes at the loci for Alport syndrome". Kidney Int. 59 (5): 1670–6. doi:10.1046/j.1523-1755.2001.0590051670.x. PMID 11318937.
- ↑ Bailey RR (July 1990). "Familial haematuria due to thin basement membrane nephropathy". N. Z. Med. J. 103 (893): 312–3. PMID 2371004.
- ↑ Foster K, Markowitz GS, D'Agati VD (May 2005). "Pathology of thin basement membrane nephropathy". Semin. Nephrol. 25 (3): 149–58. doi:10.1016/j.semnephrol.2005.01.006. PMID 15880325.
- ↑ Ivanyi B, Pap R, Ondrik Z (October 2006). "Thin basement membrane nephropathy: diffuse and segmental types". Arch. Pathol. Lab. Med. 130 (10): 1533–7. doi:10.1043/1543-2165(2006)130[1533:TBMNDA]2.0.CO;2. PMID 17090197.
- ↑ "Redirecting".