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GI/GU Illness > Glomerular Disease > Flashcards

Glomerular Disease Flashcards

1
Q

What are the ways that a glomerulus can fail? (4)

A
  1. focal barrier rupture - haematuria
  2. leakiness without rupture - proteinuria
  3. impaired filtration - azotaemia
  4. nephritic syndrome - rupture and impaired filtration
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2
Q

What are the potential fates of the glomerulus? (3)

A
  1. acute insult causes impairment - likely full recovery and return of function when insult removed
  2. permanently damaged (some sclerosis) and impaired but some function (likely to progress to full sclerosis in time)
  3. totally sclerotic, not contributing to renal function and never will again
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3
Q

What are the clinical manifestations of glomerular disease? (9)

A
  1. haematuria
  2. proteinuria
  3. uraemia
  4. oliguria/anuria
  5. acute renal failure
  6. chronic renal failure
  7. nephritic syndrome
  8. glomerulonephritis
  9. nephrotic syndrome
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4
Q

What is nephritic syndrome?

A

Inflammation

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5
Q

What is nephrotic syndrome?

A

loss of significant volume of protein via the kidneys

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6
Q

What investigations can be done for glomerular disease? (8)

A
  1. serum urea, creatinine and electrolytes
  2. urine dipstick
  3. urine osmolarity
  4. urine microscopy
  5. creatinine clearance
  6. 24 hour urine collection
  7. urine albumen:creatinine ratio
  8. renal biopsy
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7
Q

How are renal biopsies examined?

A
  1. light microscopy
  2. immunofluorescence
  3. electron microscopy
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8
Q

What does diffuse glomerular disease mean?

A

all glomeruli are affected

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9
Q

What does focal glomerular disease mean?

A

only some glomeruli are affected

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10
Q

What does global glomerular disease mean?

A

the whole glomerulus is affected

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11
Q

What does segmental glomerular disease mean?

A

only a portion of the glomerulus is affected

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12
Q

What does focal segmental glomerular disease mean?

A

only portions of some glomeruli are affected

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13
Q

What does nephropathy mean? (4)

A
  1. damage is not associated with increased cellularity or haematuria
  2. leaky to protein
  3. slow progression
  4. exception is IgA nephropathy
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14
Q

What does nephritis mean? (3)

A
  1. inflammation
  2. immune complex mediated
  3. associated with haematuria
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15
Q

What type of insults can happen to the glomerulus? (f

A
  1. immune
  2. toxic
  3. vascular
  4. physical
  5. tubular pathology
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16
Q

What is an example of immune insults to the glomerulus?

A

type III hypersensitivity

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17
Q

What is an example of a toxic insult to the glomerulus? (2)

A
  1. diabetes mellitus

2. amyloidosis

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18
Q

What is an example of vascular insult to the glomerulus?

A

hypertension and upstream vasculitis

19
Q

How do circulating immune complexes injure the glomerulus?

A

antibody binds to antigen in circulation outside the glomerulus, complexes then lodge in the glomerulus eg endocarditis, serum sickness

20
Q

How does in situ formation lead to immune injury of the glomerulus?

A
  1. antibody binds to planted antigen in the glomerulus

2. antibody binds to local antigen - autoimmune

21
Q

What are the consequences of immune complexes in the glomerulus?

A
  1. complement activation

2. cellular activation

22
Q

What are characteristics of nephritis?

A
  1. increased cellularity
  2. ruptured basement membrane
  3. leaky to blood cells and protein
  4. may have decreased GFR
23
Q

What are the clinical features of nephritic syndrome? (8)

A
  1. haematuria
  2. proteinuria
  3. oedema
  4. hypertension
  5. transient renal impairment
  6. lowered GFR
  7. azotaemia
  8. oliguria
24
Q

What is another name for IgA nephropathy?

A

Berger disease

25
Q

Who does IgA nephropathy usually occur in?

A

children and young adults

26
Q

What does IgA nephropathy present as? (3)

A
  1. recurrent post infectious haematuria
  2. flank pain
  3. fever
27
Q

What causes IgA nephropathy? (3)

A
  1. heritable abnormality in IgA1 impairs release and clearance
  2. deposits in glomerulus alone or as complexes with anti-IgA IgG
  3. often post resp infection
28
Q

What can be seen on light microscopy in IgA nephropathy? (2)

A
  1. may be normal

2. may show focal and segmental increased cellularity

29
Q

What is seen on electron microscopy in IgA nephropathy?

A

mesangial deposits

30
Q

What is seen in the bloods in IgA nephropathy?

A

serum complement is usually normal

31
Q

What is the prognosis of IgA nephropathy?

A
  1. majority microscopic haematuria only
  2. 5-10% nephritic syndrome
  3. 15-40% end stage renal failure in 20 years
32
Q

What is Henoch-Schonlein Purpura?

A

leucocytoclastic vasculitis

33
Q

How does Henoch-Schonlein Purpura present? (4)

A
  1. rash on buttocks and lower limbs
  2. abdominal symptoms
  3. athralgias in knees and ankles
  4. glomerular disease
34
Q

What is post-streptococcal glomerulonephritis?

A

nephritic syndrome that arises after group A Beta haemolutic streptococcus infection of the skin or pharynx

35
Q

When does post-streptococcal glomerulonephritis occur?

A

2-3 weeks post infection

36
Q

What does post-streptococcal glomerulonephritis present as?

A
  1. haematuria
  2. oligouria
  3. hypertension
  4. periorbital oedema
37
Q

What is seen on microscopy and H and E stain?

A
  1. hypercellular

2. inflammed glpmeruli

38
Q

What is is streptococcal glomerulonephritis mediated by?

A

immune complex deposition

39
Q

How is streptococcal glomerulonephritis treated?

A

supportive treatment

40
Q

What are the types of rapidly progressive glomerulonephritis (crescentic)?

A
  1. type I - anti glomerular basement membrane disease
  2. type II - immune complex
  3. type III - pauci-immune
41
Q

What is rapidly progressive glomerulonephritis?

A

nephritic syndrome that progresses to renal failure in weeks to months

42
Q

What is rapidly progressive glomerulonephritis characterised by?

A

crescents in Bowman space comprised of fibrin and macrophages

43
Q

What is goodpasture’s syndrome?

A

Glomerulonephritis which presents as an URTI like illness

44
Q

What is the presentation of goodpasture’s syndrome?

A
  1. haemoptysis

2. lethargy

GI/GU Illness (15 decks)

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