2. Nephritic And Nephrotic Conditions Flashcards
How can glomerular disease be classified?
Hereditary
Primary (most common)
Secondary to systemic diseases
What does glomerular disease result in?
Inflammation of the glomerulus - glomerulonephritis
What are the 4 clinical structures within the glomerulus that are prone to damage?
Capillary endothelial cell lining
Glomerular basement membrane
Mesangium supporting the capillaries
Podocytes on the outer surface of the capillary
What is nephrotic syndrome characterised by?
Proteinurea (>3g/d)
Hypoabluminaemia
Oedema
Hyperlipidaemia
What causes nephrotic syndrome?
Increased permeability of glomerular filter to albumin as a result of glomerular basement membrane damage and increase in pore size
What is the management of nephrotic syndrome?
Blood pressure control
Reduction in proteinurea using ACE inhibitors
Control of hyperlipidaemia
Anticoagulation if hypercoaguable
Treatment of underlying cause where possible
What happens in diabetic nephropathy?
Excess glucose in blood binds to proteins esp. at efferent arteriole
Hyaline atherosclerosis obstructs blood flow
Initially increased GFR
Over time mesangial cells secrete more structural matrix
Thickening of BM
Decreased GFR
What is the treatment for diabetic nephropathy?
Hypertension
Good glycemic control
ACE inhibitors
Angiotensin receptor blockers
What is the most common cause of nephrotic syndrome in children under 6?
Minimal change disease
What happens in membranous glomerulonephritis?
Subepithelial deposition of immune complexes
What are the causes of membranous glomerulonephritis?
Idiopathic Primary or secondary Infections Tumours Drugs Systemic illnesses
What is the treatment for membranous glomerulonephritis?
Immunosuppressants
Treatment of underlying cause
What are the causes of focal segmental glomerulosclerosis?
Primary: idiopathic
Secondary: sickle cell disease, HIV, heroin abuse, kidney hyperperfusion
What happens in focal segmental glomerulosclerosis?
Podocytes damaged
Proteins build up in glomerulus - hyalinosis - leading to sclerosis
What is the treatment for focal segmental glomerulosclerosis?
Steroids
Inconsistent results can lead to chronic renal failure
What are the signs and symptoms of acute nephritic syndrome?
*Oliguria/anuria
*Hypertension
*Hematuria - microscopic or macroscopic
Fluid retention
Uraemia
Proteinuria
What is the treatment of acute nephritic syndrome?
Steroids
What is IgA nephropathy?
Causes recurrent hematuria
Hypertension and IgA levels raised, deposited in mesangium, sclerosis of damaged segment
What is the treatment for IgA nephropathy?
Steroids
Control BP
Antihypertensives
What is rapidly progressive glomerulonephritis?
Severe glomerular injury, leakage of fibrin, macrophages and epithelial cells proliferate
Crescent shape masses form, reducing glomerular blood supply
Loss of renal function within days to weeks
What is the treatment for rapidly progressive glomerulonephritis?
High dose steroids
Immunosuppressants and plasma exchange
What is post-streptococcal glomerulonephritis?
Presents 1-3 weeks following group A beta-hemolytic streptococcal infection of tonsils, pharynx or skin
What is the treatment for post-streptococcal glomerulonephritis?
Antibiotics to treat remaining infection
What is Goodpastures syndrome?
Antibodies o type IV collagen in glomerular BM develop, causing inflammation
Results in rapidly progressive glomerulonephritis, acute renal failure and lung haemorrhage
What is the treatment for goodpastures syndrome?
Plasma exchange, corticosteroids
What is acute nephritic syndrome?
Some proteinuria, mostly hematuria, oliguria and hypertension
