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3 - Urinary > deck_1662724 > Flashcards

deck_1662724 Flashcards

1
Q

What are the main foci of kidney disease?

A

• Glomerulus • PCT • Interstitium • Vascular supply

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2
Q

What is a primary glomerular injury?

A

• One which just effects the glomerulus

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3
Q

What is a secondary glomerula injury?

A

• A systemic illness which happens to effect the glomerulus

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4
Q

What are the four main sites of glomerular injury?

A

• Subepithelial ○ Anything that effects podocytes/podocyte side of glomerular basement membrane • Within glomerula basement membrane • Subendothelial ○ Inside the basement membrane • Mesangial/parameangial ○ Supporting capillary loop

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5
Q

Why can the nephron be termed a “functional unit”

A

• Same blood supply to glomerulus and nephron ○ Thus, ischaemic disease in glomerulus reduces blood supply to nephron, causing damage

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6
Q

What are the two main pathologies of the glomerulus?

A

• It can become blocked ○ “Renal Failure” ○ Decreased GFR ○ Haematuria • It can leak ○ Proteinuria ○ Haematuria ○ One, other or both

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7
Q

What is proteinuria?

A

• Presence of excess serum proteins in the urine (

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8
Q

What does proteinuria indicate?

A

• Podocyte damage, causing fenestration to widen and causing protein to be leaked when it would normally be filteredLess severe nephrotic syndrome

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9
Q

What is nephrotic syndrome?

A

• More than 3.5g of protein lost in urine per daySoon becomes hypoalbuminaemia

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10
Q

How does the body respond to hypoalbuminaemia as a result of nephrotic syndrome?

A

• Oedematous • Liver starts to pump out more albumin, along with more cholesterol!

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11
Q

What is nephritic syndrome?

A

• Glomerulus is blocked • GFR drops • Creatinine increases • Haematuria (glomerulus blood vessels ruptured) • Hypertensive

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12
Q

What are the four main areas in the glomerula capillary loop where damage can occur?

A

• Subepithelial • With GBM • Subendothelial • Mesangial

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13
Q

What is the difference between primary and secondary kidney disease?

A

• Primary kidney disease - Pathology soley affecting kidney • Secondary kidney disease - Systemic disease which affects kidney

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14
Q

What is the likely site of injury in proteinuria/nephrotic syndrome?

A

• Podocyte/subepithelial damage

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15
Q

Give three primary causes of proteinuria/nephrotic syndrome

A

• Minimal change glomerulonephritis • Focal segmental glomerulosclerosis • Membranous glomerulonephritis

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16
Q

Give two common secondary cuases of proteinuria/nephrotic syndrome

A

• Diabetes mellitus • Amyloidosis

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17
Q

When does minimal change glomerulnephritis occur?

A

• Occurs in childhood/adolescence • Incidence reduces with increasing age

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18
Q

What are the symptoms of glomerulonephritis?

A

• Heavy proteinuria or nephrotic syndrome • Responds to steroids • Usually no progression to renal failure

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19
Q

Why does minimal change glomerulonephritis occur?

A

• Podocytes destroyed, loss of filtration slits

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20
Q

What is the pathogenesis of minimal change glomerulonephritis?

A

• Unknown circulating factor damaging podocytes • No immune complex deposition

21
Q

Why is minimal change glomerulonephritis called thus?

A

• Normal golmeurli under a light microscope

22
Q

How can you detect minimal change glomerulonephritis?

A

• Electron microscope, damage to podocytes evident

23
Q

What is Focal segmental glomerulosclerosis

A

• Nephrotic syndrome which effects adults • Steroids minimally effective

24
Q

What does a patient with focal segmental glomerulosclerosis normal present with?

A

• Massive proteinuria • Haematuria • Hypertension • Renal failure

25
Q

Why is it called focal segmental glomerula sclerosis?

A

• Focal - Involving less than 50% of glomeruli on light microscopy • Segmental - Involving part of the glomerular tuft • Glomerular • Sclerosis - Scarring

26
Q

What is the main pathology of Focal segmental glomerulosclerosis?

A

• Damage to glomerulus causing scarring • Circulating factor damages podocytes • Progressive renal failure

27
Q

What causes Focal segmental glomerular nephritis?

A

• A circulating factor

28
Q

What is membranous glomerulonephritis?

A

Commonest cause of nephrotic syndrome in adultsImmune complex depositsCapillary loop thickBasement membrane specley

29
Q

What causes membranous glomerulonephritis?

A

• Autoimmune response to podocytes • Immune complex deposits (IgG) ○ May also be secondary, as often associated with diseases such as lymphoma

30
Q

What is an immune complex?

A

• Äntigen complexed with multiple antibodies • IgG destroy antigen found on podocytes, destroying podocytes in process

31
Q

What is a distinguishing feature of kidney disease as a result of diabetes mellitus?

A

• Progressive proteinuriaProgressive renal failure

32
Q

How does the rule of thirds apply to membranous glomerulonephritis?

A

• 1/3 just get better • 1/3 grumble along, proteinuria but are fine • 1/3 progress to renal failure

33
Q

What is the pathology of kidney disease as a result of diabetes mellitus?

A

o Progressive proteinuriao Progressive renal failureo Microvascular (Damages glomerulus directly)o Mesangial sclerosis  noduleso Basement membrane thickening to 4-5x normal

34
Q

What is nephritic syndrome?

A

• Renal failure due to blocking of filter

35
Q

Give five causes of nephritic syndrome

A

• Good pasture syndrome • Vasculitis • IgA nephropathy • Thin GBM Nephropathy • Alport syndrome

36
Q

What is IgA nephropathy?

A

• Commonest glomerular nephropathy • Characterised by deposition of IgA antibody in the glomerulus

37
Q

How does IgA present?

A

• Will present with haematuria when get cold, due to relationship with mucosal infections • Significant proportion progress to renal failure • Some, not all, patients have proteinuria

38
Q

What is haematuria as a result of IgA nephropathy a result of?

A

• Mesangial damage and scarring - Significant proportion of patients progress to renal failure

39
Q

What happens to the mesangium in IgA nephropathy?

A

Mesangial proliferation and scarring

40
Q

Give two types of hereditatary nephropathy

A

• Thin GBM Nephropathy • Alport syndrome

41
Q

Outline thin GBM nephropathy

A

Isolated HaematuriaThin GBMBenign Course

42
Q

What is alport?

A

• X linked • Abnormal collagen IV • Associated with deafness • Abnormal appearing GBM • Progresses to renal failure

43
Q

What is Goodpasture Syndrome?

A

• Rapidly progressive glomerular nephritis • Acute onset of severe nephritic syndrome • Classically associated with pulmonary haemorrhage

44
Q

What is the pathology behind goodpasture syndrome?

A

• Autoantibody to collagen IV in basement membranes Characterised by IgG deposition but no extracellular matrix deposit

45
Q

How is goodpasture syndrome treated?

A

• Treatable by immunosupression • PlasmaphoresisTake patients blood out, remove plasma with IgG in and then exchange plasma

46
Q

What is vasculitis?

A

• Inflammation of blood vessels which attacks highly vascularised kidney • No immune complex/antibody deposition • Blood vessels directly attacked by anti neutrophil cytoplasmic antibody • Nephritic presentation • Urgent biopsy required

47
Q

What is a subepithelial deposit?

A

• Antigen abnormally recognised on podocytes, circulating IgG binds to it, forming immune complexes in the glomerulus ○ Membranous glomerulonephritis

48
Q

What is a mesangial deposit?

A

• Immune complexes can be deposited directly in the mesangium as there is no podocytes or basement membrane to act as a barrier

3 - Urinary (39 decks)

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