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REGUB > 7. Rapidly Progressive Renal Failure > Flashcards

7. Rapidly Progressive Renal Failure Flashcards

1
Q

What is nephrotic syndrome?

A

Damage to visceral epithelial cells ie. no inflammation

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2
Q

What are the clinical features of nephrotic syndrome?

A 
>3.5g/24hours proteinuria
Hypoalbuminaemia
-oedema
-hypercholesterolaemia
Increased coaguability
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3
Q

What causes hypercholesterolaemia in nephrotic syndrome?

A

Loss of albumin makes the liver think it’s in a state of starvation so it increases cholesterol

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4
Q

What causes thrombophilia in nephrotic syndrome?

A

Blood is more viscous than usual

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5
Q

What are the causes of nephrotic syndrome?

A 
Minimal change disease
Focal and segmental glomerulosclerosis
Membranous glomerulonephritis
Amyloid
Diabetes
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6
Q

What is minimal change disease?

A

Most often seen in extremes of age
Acute onset nephrotic syndrome w v high proteinuria
Secondary to URTI
Full recovery and responds well to steroids

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7
Q

Why is a full recovery the norm for minimal change disease?

A

Only the foot processes of epithelial cells are damaged, not the nuclei: flattening of the processes can be seen on an electron microscope

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8
Q

What is Focal and Segmental Glomerulosclerosis?

A

Persistent damage to foot processes by a circulating factor/genetic abnormality causes them to be lifted off BM
Bind to Bowman’s capsule and cause sclerosis
Disease progresses over years, more and more glomeruli lost until renal failure occurs

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9
Q

What are the 2 types of FSGS?

A
  1. Steroid responsive and dependent: high doses steroids, recurs in transplants
  2. Steroid unresponsive: younger patients with genetic abnormality in foot process protein, does not recur in transplant
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10
Q

What is membranous glomerulonephritis?

A

IgG autoantibodies to phospholipase A2 receptor on epithelial side
Antibody produced in response to diseases or drugs

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11
Q

How long does it typically take to recover from membranous glomerulonephritis?

A

3 years as no white cells can cross BM: foot processes gain phagocytic function

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12
Q

What can be seen on microscopy in membranous glomerulonephritis?

A

Deposits and ‘spike’ membranes in between them

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13
Q

What is the most common cause of amyloid affecting the kidney?

A

Multiple myeloma

All types can affect the kidney except for Alzheimer’s related

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14
Q

What are the effects of amyloid on the kidney?

A

Severe nephrotic syndrome

Some renal function impairment

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15
Q

What types of diabetes can cause nephrotic syndrome?

A

Type 1, 2 or pre-diabetes after 10-15 years

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16
Q

How does diabetes cause nephrotic syndrome?

A

Glycosylation of lipoproteins in mesangium and BM

17
Q

What histological finding can be found in diabetes related nephrotic syndrome?

A

Kimmelstiel Wilson nodule

18
Q

What is a Kimmelstiel Wilson nodule?

A

Micro-aneurysm

Directly related to vascular damage in the eye

19
Q

What are the clinical features of nephritic syndrome?

A

Haematuria
Acute renal failure
Proteinuria
Hypertension due to RAAS

20
Q

What are the phases of a post strep glomerulonephritis?

A

Antigenic
Immune
Inflammatory

21
Q

What can be seen in post strep GN under a light microscope?

A

Infiltration of the glomerulus with neutrophils and macrophages

22
Q

What an be seen in post strep GN on fluoroscopy?

A

Deposition of c3

23
Q

What an be seen in post strep GN under an electron microscope?

A

Bumps under epithelium

24
Q

What would urinalysis of post strep GN show?

A

Albumin and high MW proteins due to BM, but not massively high as difficult to squeeze out through inflammatory cells

25
Q

What is membranoproliferative glomerulonephritis?

A

Chronic endothelial cell injury with immune complex deposition
Chronic inflammation of mesangium and BM leading to a ‘double layered’ BM
Can present as nephrotic or nephritic

26
Q

What are the causes of membranoproliferative glomerulonephritis?

A

c3 glomerulonephritis
Cryoglobulinaemia
Severe SLE

27
Q

What can be seen under the light microscope in membranoproliferative glomerulonephritis?

A

Diffuse infiltration with inflammatory cells

Chronic damage to BM causing double contours

28
Q

What can be seen under fluoroscopy in membranoproliferative glomerulonephritis?

A

c3 deposition in capillary loops

29
Q

What can be seen under the electron microscope in membranoproliferative glomerulonephritis?

A

Diffuse mesangial and sub-epithelial deposits

REGUB (31 decks)

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