CPRS 86 87: Diseases of Kidney I&II Flashcards
Location of Kidney
T12-L3
Can glomerulus regenerate
no
3 ways to investigate a renal biopsy sample?
Light Microscopy
Direct Immunofluorescence Study
Electron Microscopy
Consider Nephrotic Syndrome
Name 1 MAJOR Presentation and 3 Associated derived presentation
- Proteinuria (>3.5 gm per day)
- Hypoalbuminemia
- Oedema
- Hyperlipidaemia
Consider Nephrotic Syndrome Name 4 Associated Glomerular Disease with it - M N - MPGN - M C D - FSGS
- Membranous nephropathy
- Membranoproliferative Glomerulosclerosis
- Minimal Change Disease
- Focal Segmental Glomerulosclerosis
Consider Nephrotic Syndrome
Name 2-3 Associated Complications with it
Hypercoagulability
Hyperlipidaemia
Decrease serum binding protein
Consider Nephritic Syndrome
Name 1 MAJOR Presentation and 3 Associated derived presentation
- Haematuria
- Mild to moderate proteinuria
(Diminished GFR)
(Hypertension)
Consider Nephritic Syndrome Name 3 Associated Glomerular Disease with it - A P G - IgA.. - SLE
- Acute Postinfectious Glomerulonephritis
- IgA Nephropathy
- Systemic Lupus Erythematous
Consider Nephritic Syndrome
Name 2 Associated Complications with it
Hypercoagulability
Hyperlipidaemia
Decrease serum binding protein
Acute Kidney Injury
Name 2 Presentations of this disease
Rapidly decline in GFR in hours to days
Oliguria or Anuria (reduced or no urine output)
Chronic Kidney Disease
Presentation: Persistent decline in GFR (less than ______ml per minute/ 1.73m^2) for at least ____ months
Chronic Kidney Disease
Presentation: Persistent decline in GFR (less than 60ml per minute/ 1.73m^2) for at least 3 months
Stage 3 or worse; 3 months
End stage renal disease is irreversible.
It has GFR less than ___ % of normal
Requires ______________ therapy
less than 5%
Requires renal replacement therapy
What is it called when there is elevation of blood urea and creatinine levels due to decrease in GFR
Azotemia
What is it called when there is toxic condition where waste products normally excreted are retained in blood
Uraemia
Consider Glomerulonephritis: 3 major causes
Immune Mechanism Causes
Metabolic Alterations of GBM- _____________
Genetic Defects of GBM- ________________
Consider Glomerulonephritis: 3 major causes
Immune Mechanism Causes
Metabolic Alterations of GBM- Diabetes
Genetic Defects of GBM- Alport Syndrome
Consider Glomerulonephritis: 3 major causes
Immune Mechanism Causes:
- Antibodies bind to intrinsic glomerular antigen against _________ receptors on ________ (In-situ): __________
- Antibody binds to normal components of ______ (In-situ): _____________
- Deposition of circulating antigen-antibody complexes in glomerulus (Circulating): __________ and ______________
Consider Glomerulonephritis: 3 major causes
Immune Mechanism Causes:
- Antibodies bind to intrinsic glomerular antigen against PLA2R receptors on podocytes (In-situ):
Membranous Nephropathy - Antibody binds to normal components of GBM (In-situ):
Goodpasture Syndrome - Deposition of circulating antigen-antibody complexes in glomerulus (Circulating):
IgA Nephropathy and Systemic Lupus Erythematous
Consider Glomerulonephritis
What are the results?
- Podocyte injury: Do they have good capacity in replication and repair?
- Glomerular Injury: What is compensatory hypertrophy? How would it lead to glomerulosclerosis
Consider Glomerulonephritis
What are the results
- Podocyte injury: Podocytes have very limited capacity in replication and repair
- Glomerular Injury: Compensatory hypertrophy by remaining glomeruli => Progressive fibrosis and further decrease in number of functional glomeruli => Glomerulosclerosis
Nephrotic Syndromes Associated Glomerular Disease: Membranous Nephropathy - Nature? - Major Prevalence - Primary cause - Secondary cause - Light Microscopy - IgG Immunofluorescence - Electron Microscopy - Treatment Primary - Treatment Secondary
Nephrotic Syndromes
Membranous Nephropathy
- Nature: Immune Complex Glomerulonephritis
- Major Prevalence: 30-50 years old adults
- Primary cause: PLA2R expressed on podocytes
- Secondary cause: Hepatitis B and C, Drugs like NSAIDs
- Light Microscopy: Spikes under Silver Stain
- IgG Immunofluorescence: Spotty and Green
- Electron Microscopy: Subepithelial Electron Dense Deposits
- Treatment Primary: Steroids
- Treatment Secondary: Treat the underlying causes
Nephrotic Syndromes Associated Glomerular Disease: Membranoproliferative Glomerulonephritis - Nature - Features (2) - Light Microscopy - IgG Immunofluorescence - Electron Microscopy - Treatment (2) - What are not useful/ should be avoided
Nephrotic Syndromes
Associated Glomerular Disease: Membranoproliferative Glomerulonephritis
- Nature: Immune Complex Glomerulonephritis
- Features (2): Capillary wall thickened + Cells markedly increased
- Light Microscopy: Basement Membrane Splitting under Silver Stain
- IgG Immunofluorescence: Spotty and Green
- Electron Microscopy: Basement Membrane Splitting
- Treatment: Treat underlying Causes + Drugs targetting C3 complement pathway for glomerulonephritis
- What are not useful/ should be avoided: Steroids
Nephrotic Syndromes Associated Glomerular Disease: Minimal Change Disease - Nature - Major Prevalence - Which type of the cell are problematic? and why? - IgG Immunofluorescence - Electron Microscopy - Treatment
Nephrotic Syndromes
Associated Glomerular Disease: Minimal Change Disease
- Nature: NOT immune complex
- Major Prevalence: Children
- Which type of the cell are problematic? and why?: Podocytes, loss of protein filter function for GBM
- IgG Immunofluorescence: No staining (Not immune complex)
- Electron Microscopy: Diffuse effacement of foot processes of podocytes
- Treatment: Steroids
Nephrotic Syndromes Associated Glomerular Disease: Focal Segmental Glomerulosclerosis (FSGS) - Nature - Major Prevalence - Which type of the cell are problematic? and why? - Primary Cause: - Secondary Cause: - IgG Immunofluorescence - Electron Microscopy - What should NOT be used in treatment?
Nephrotic Syndromes
Associated Glomerular Disease: Focal Segmental Glomerulosclerosis (FSGS)
- Nature: NOT immune complex
- Major Prevalence: Children
- Which type of the cell are problematic? and why?:
Podocytes, loss of protein filter function for GBM
- Primary cause: Idiopathic
- Secondary cause: HIV, Obesity, Hypertension
- IgG Immunofluorescence: No staining (Not immune complex)
- Electron Microscopy: Diffuse effacement of foot processes of podocytes
- What should NOT be used in treatment: Steroids
Nephrotic Syndromes Associated Glomerular Disease: Focal Segmental Glomerulosclerosis (FSGS) What does the following mean? - Focal - Segmental - Glomerulosclerosis - What disease is it very similar to?
Nephrotic Syndromes
Associated Glomerular Disease: Focal Segmental Glomerulosclerosis (FSGS)
What does the following mean?
- Focal: Less than 50% of the glomerulus
- Segmental: A certain section of 1 glomerulus
- Glomerulosclerosis: Replacement of capillary loops of glomerulus by acellular materials
- What disease is it very similar to? Minimal Change Disease
Nephritic Syndromes Associated Glomerular Disease: Acute Post-infectious Glomerulonephritis - Nature - Major Prevalence - Pathologic Agent - Preceding infection - Light microscopy - IgG Immunofluorescence - Electron Microscopy - Treatment therapy
Nephritic Syndromes
Associated Glomerular Disease: Acute Post-infectious Glomerulonephritis
- Nature: Immune Complex Glomerulonephritis
- Major Prevalence: Children
- Pathologic Agent: Streptococcal infection (Group A)
- Preceding infection: Pharynx or skin
- Light microscopy: Hypercellular glomeruli with neutrophils
- IgG Immunofluorescence: Spotty and green
- Electron Microscopy: Subepithelial humps
- Treatment therapy: Conservative therapy
Consider Acute Renal Failure
Type I: Anti-GBM Antibody- ___________
Type II: Immune Complex- ____________
Type III: Pauci-immune- ______________
Consider Acute Renal Failure
Type I: Anti-GBM Antibody- Goodpasture Syndrome
Type II: Immune Complex- IgA Nephropathy
Type III: Pauci-immune- ANCA-associated
Consider Acute Renal Failure
Type I: _______________- Goodpasture Syndrome
Type II: _______________- IgA Nephropathy
Type III: _______________- ANCA-associated
Consider Acute Renal Failure
Type I: Anti-GBM Antibody- Goodpasture Syndrome
Type II: Immune Complex- IgA Nephropathy
Type III: Pauci-immune- ANCA-associated
Consider Acute Renal Failure
Type I: Goodpasture Syndrome- Anti-GBM Antibody Mediated
- Nature
- Light Microscopy
- IgG Immunofluorescence
- Electron Microscopy, and why?
- Treatment: High dose _____ with _______
Consider Acute Renal Failure
Type I: Goodpasture Syndrome- Anti-GBM Antibody Mediated
- Nature: Autoantibody against NC1 of collagen type 4 that cross react with pulmonary alveolar basement membrane
- Light Microscopy: Cellular Crescent under Silver Stain
- IgG Immunofluorescence: Linear staining pattern
- Electron Microscopy: No deposits, antibodies are too small to be detected
- Treatment: High dose steroid and Cyclophosphamide
Consider Acute Renal Failure Type II: IgA Nephropathy- Immune Complex Mediated - Nature - Prevalence - Presentation (Consider Haematuria and Proteinuria and the degree) - Light Microscopy - Direct Immunofluorescence - Electron Microscopy - Treatment:
Consider Acute Renal Failure
Type II: IgA Nephropathy- Immune Complex Mediated
- Nature: Immune Complex Glomerulonephritis
- Prevalence: Wide Range of Age Presentation
- Presentation: Haematuria (Suggests nephritic) and Proteinuria (little)
- Light Microscopy: Mesangial proliferation
- Direct Immunofluorescence: IgA deposits
- Electron Microscopy: Mesangial electron dense deposits
- Treatment: Corticosteroid
Consider Acute Renal Failure Type III: ANCA-associated- Pauci Immune - Nature - IgG Immunofluorescence - Electron Microscopy
Consider Acute Renal Failure Type III: ANCA-associated- Pauci Immune - Nature: No antibodies and no immune complexes - IgG Immunofluorescence: No deposits - Electron Microscopy: No deposits
Consider Acute Tubular Injury
- Causes (1 Major 1 Minor)
- 3 stages
Consider Acute Tubular Injury
- Causes (1 Major 1 Minor):
Major: Ischaemia; Minor: Direct Toxic Injury
- 3 stages: Initiation, Maintenance, Recovery
Consider Tubulointerstitial Nephritis
- It has raised _______ and _______ level
- Histological Feature: It has lots of which type of WBCs?
- Causes: Which type of drugs?
- Causes: Which type of infection?
Consider Tubulointerstitial Nephritis
- It has raised blood creatinine and Blood urea level
- Histological feature: Lots of eosinophils
- Causes: Which type of drugs? - NSAIDs
- Causes: Which type of infection? - Acute and Chronic pyelonephritis
Consider Acute Pyelonephritis
Note: Acute Pyelonephritis is caused by UTI
- Causes x4 (Consider UTI)
- Features: During autopsy, what colour of pus?
- Features: Large amount of which type of WBCs?
- Symptoms: Name 2-3
- Common pathogens: Name 2-3
- Treatment: _______ therapy
Consider Acute Pyelonephritis
Note: Acute Pyelonephritis is caused by UTI
- Causes x4: Pregnancy, Vesico-ureteric reflux, Catheterization, Obstruction by stones
- Features: During autopsy, yellow colour pus
- Features: Large amount of neutrophils
- Symptoms: Fever, shaking chills, loin pain
- Common pathogens: Escherichia coli, Proteus mirabilis, Mycobacterium tuberculosis
- Treatment: Antibiotic therapy
Consider Chronic Pyelonephritis
- Causes x2
- Symptoms: Name 2-3 (Consider acute C. P.)
- Other features: Cause Compensatory _________ of remaining glomeruli
- Treatment: ________ therapy
Consider Chronic Pyelonephritis
- Causes: Vesico-ureteric reflux, Obstruction by stones
- Symptoms: Recurrent high fever, recurrent shaking chills, recurrent loin pain
- Other features: Cause Compensatory hypertrophy of remaining glomeruli
- Treatment: Antibiotic therapy
Consider Light Chain Cast Nephropathy
- Prevalence:
- Presentations (name 2)
- Treatment: Stem cell…
Consider Light Chain Cast Nephropathy
- Prevalence: 90% of cases are greater than 50 years old
- Presentations (name 2): Acute Renal Failure, Proteinuria
- Treatment: Hematopoietic Stem Cell Transplantation
Consider Vascular Disease- Blood Vessel damages
Hypertensive Nephrosclerosis
- Disease associated:
- Features (name 2)
Consider Vascular Disease- Blood Vessel damages
Hypertensive Nephrosclerosis
- Disease associated: Hypertension
- Features:
Hyalinization of Arteriolar Wall,
Intimal fibrosis and medical thickening of interlobar and arcuate arteries
Consider Vascular Disease- Blood Vessel damages
Malignant Nephrosclerosis
- Disease associated:
- Definition with relation to the blood pressure:
- Histology:
- Treatment:
Consider Vascular Disease- Blood Vessel damages
Malignant Nephrosclerosis
- Disease associated: Malignant hypertension
- Definition with relation to the blood pressure: Systolic pressure greater than 200 mmHg, Diastolic pressure greater than 120 mmHg
- Histology: Fibrinoid Necrosis of arterioles
- Treatment: Antihypertensive medication
Consider Vascular Disease- Blood Vessel damages
Diabetic Nephropathy
- Disease associated
- Features: Name 2-4
Consider Vascular Disease- Blood Vessel damages
Diabetic Nephropathy
- Disease associated: Type I and II Diabetes
- Features: Thickened GBM, Diffuse increase in mesangial matrix, Kimmelstiel-Wilson nodules, Hyalinosis of both afferent and efferent arterioles
