15&16 Pathology of Glomerulus Flashcards
What happens in glomerulonephritis at a cellular level?
Leukocytes
Fusion of foot processes
Increased number- mesangial cells
Narrowed capillary lumen
List 4 structures that can get damaged in the glomerulus due to glomerulonephritis.
Capillary enothelium
Glomerular basement membrane
Mesangial cells
Podocytes
What are the 5 different presentations of glomerular nephritis and give an example of what can cause each of these?
Differentiate between the pathophysiology of nephrotic and nephritic syndrome.
How does nephrotic syndrome present?
How can nephrotic syndrome be managed?
-
Oedema
- Diuretics
- Salt and fluid restriction
-
ACE-inhibitor
- Anti-proteinuric BUT CAUTION if volume depleted
-
Hypercholesterolaemia
- Statins
TREAT UNDERLYING CONDITION
How does nephritic syndrome present?
List some causes of nephritic syndrome
How is nephritic syndrome managed?
- Oedema
- Diuretics
- Salt and fluid restriction
- BP control
- Reduce proteinuria- ACE inhibitor
- TREAT UNDERLYING CONDITION
- Immunosupressants
- CVS risk management
- Stop smoking, statins
- Dialysis- short term
What is ANCA-associated vasculitis? What are the symptoms?
(antineutrophili cytoplasmic antibody)
Granulomatosis with polyangitis - affecting small arterioles
Kidneys and lungs
Endothelial damage
Symptoms:
Fatigue
Arthralgia
Myaligia
Weight loss
How is Anti-GBM (glomerular basement membrane disease) caused? How does it present?
Presentation:
V.similar to ANCA vasculitis
Pathophysiology:
Antibodies to alpha-3 chain of type 4 collagen in glomerular basement membrane
For reference (don’t need to learn)
Lupus is autoimmune disease- many presentations and affecting many systems
What is the most common cause of End Stage Renal Disease?
Diabetic nephropathy
What pathological changes occur as a result of diabetic nephropathy?
Why does GFR increase as a result of diabetic nephropathy?
Hyperglycaemia- glomerular hypertension
What are Kimmelstiel-Wilson nodules?
Sclerotic areas seen in pathology of diabteic nephropathy
What are the clinical signs and symptoms in diabetic nephropathy? What are the pathological changes?
Not all patients with diabetes develop diabetic nephropathy. Of the patients that do- how long will they have had to have diabetes for to develop glomerular nephropathy?
8-15yrs
Useful summary notes:
What is the most common cause for nephrotic syndrome in adults?
Membranous nephropathy
Describe the structure of Loop of Henle cells.
Thin walled
Few mitochondria
No brush border
What pathological features are characteristic for rapidly progressive glomerulonephritis?
Crescents- leakage of fibrinogen into Bowman’s space
What pathology is shown in the following image and what might have caused this?
RBC casts
Due to severe glomerular damage
