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
