Glomerular Disease

Question 1

Diseases that damage glomeruli are varied and include what types of disorders?

Answer 1

Immunologic, metabolic, and hereditary disorders.

Question 2

(T/F) Systemic disorders are technically secondary glomerular diseases.

Answer 2

True because they initially and principally involve other organs.

Question 3

Define glomerulonephritides (plural) or glomerulonephritis.

Answer 3

Nephrotic conditions characterized by damage to and inflammation of the glomeruli. Causes are varied and include immunologic, metabolic, and hereditary disorders.

Question 4

What four distinct morphologic changes of glomeruli occur during glomerular disease?

Answer 4

Cellular proliferation, leukocytic infiltration, glomerular basement membrane thickening, and hyalinization with sclerosis.

Question 5

Define cellular proliferation.

Answer 5

An increased number of endothelial cells (capillary endothelium), mesangial cells, and epithelial cells.

Question 6

Define leukocytic infiltration.

Answer 6

Leukocytes, particularly neutrophils and macrophages, can readily infiltrate glomeruli; may also be accompanied by cellular proliferation.

Question 7

Define glomerular basement membrane thickening.

Answer 7

Any process that results in enlargement of the basement membrane.

Question 8

Glomerular basement membrane thickening is commonly from the result of what?

Answer 8

The deposition of precipitated proteins (e.g. immune complexes, fibrin).

Question 9

Define glomeruli hyalinization.

Answer 9

The accumulation of a homogeneous, eosinophilic extracellular material in the glomeruli.

Question 10

What is the primary mode of glomerular injury?

Answer 10

Immune-mediated processes; circulating Ag/Ab complexes and complexes that result from Ag/Ab reactions within the glomerulus.

Question 11

Circulating immune complexes are created in response to ___ or ___ antigens.

Answer 11

Circulating immune complexes are created in response to endogenous or exogenous antigens.

Question 12

What becomes entrapped within the glomeruli and bind complement and causing glomerular damage?

Answer 12

Immune complexes.

Question 13

Glomerular injury does not result from the immune complexes but rather from the ___ ___ and ___ substances that they induce.

Answer 13

Glomerular injury does not result from the immune complexes but rather from the chemical mediators and toxic substances that they induce.

Question 14

What are the clinical features that indicate glomerular damage?

Answer 14

Hematuria, proteinuria, oliguria, azotemia, edema, and hypertension.

Question 15

What is an example of nephritic syndrome?

Answer 15

Acute poststreptococcal glomerulonephritis.

Question 16

Glomerular disease that manifest the nephritic or nephrotic syndrome have the potential to develop what?

Answer 16

Chronic renal failure.

Question 17

Define the group of clinical features indicative of nephrotic syndrome.

Answer 17

Increased permeability of the glomeruli to the passage of plasma proteins, most notably albumin; nephrotic syndrome is characterized by heavy proteinuria (3.5 g/day or more).

Question 18

Why is albumin the predominant protein lost during nephrotic syndrome?

Answer 18

Because of Albumin’s high plasma concentration.

Question 19

What would you expect to see on a patient’s physical and chemical exam with acute glomerulonephritis?

Answer 19

Protein: mild
Blood: positive (degree variable)

Question 20

What would you expect to see on a patient’s microscopic exam with acute glomerulonephritis?

Answer 20

↑ RBCs, often dysmorphic
↑ WBCs
↑ RTE cells
↑Casts: RBC, granular, WBC, renal cell casts

Question 21

What would you expect to see on a patient’s physical and chemical exam with chronic glomerulonephritis?

Answer 21

Protein: heavy
Blood: positive (usually small)
S.G.: low and fixed

Question 22

What would you expect to see on a patient’s microscopic exam with chronic glomerulonephritis?

Answer 22

↑ RBCs
↑ WBCs
↑ Casts: all types, particularly granular, waxy, and broad.
↑ Renal epithelial cells

Question 23

What would you expect to see on a patient’s physical and chemical exam with nephrotic syndrome?

Answer 23

Protein: severe
Blood: positive (usually small)

Question 24

What would you expect to see on a patient’s microscopic exam with nephrotic syndrome?

Answer 24

Lipiduria: oval fat bodies, free fat bodies
↑ Casts: all types, particularly fatty, waxy, and renal cell casts
↑ Renal epithelial cells
↑ RBCs

Question 25

What chemistry plasma levels are increased for someone with hyperlipidemia?

Answer 25

Triglycerides, cholesterol, phospholipids, and VLDL.

Question 26

The generalized edema present with the nephrotic syndrome is characteristically what?

Answer 26

Soft and pitting.

Question 27

The development of edema is primarily due to what?

Answer 27

The decreased excretion of sodium.

Question 28

What are the four glomerular diseases that account for about 90% of all nephrotic syndrome cases in children, and 75% in adults?

Answer 28

(1) minimal change disease (lipoid nephrosis), (2) membranous glomerulonephritis, (3) focal segmental glomerulosclerosis, and (4) membranoproliferative glomerulonephritis.

Question 29

Define acute poststreptococcal glomerulonephritis.

Answer 29

A type of glomerular inflammation that occurs 1 to 2 weeks after a group A beta-hemolytic streptococcal infection. Onset is sudden, and the glomerular damage is immune mediated.

Question 30

What glomerular morphological changes would occur with acute glomerulonephritis?

Answer 30

Cellular proliferation of the mesangium and endothelium, as well as leukocytic infiltration.

Question 31

What clinical symptoms would a patient have for acute glomerulonephritis?

Answer 31

Fever, malaise, nausea, oliguria, hematuria, and proteinuria.

Question 32

What would be the predicted results for a culture be for a patient suffering from acute glomerulonephritis?

Answer 32

Negative.

Question 33

What serum chemistry results would be predicted for a patient suffering from acute glomerulonephritis?

Answer 33

↓ Creat clearance
↑ BUN:Creat
Norm/↑ Alb levels depending on severity of proteinuria.

Question 34

Define rapidly progressive glomerulonephritis (or crescentic glomerulonephritis).

Answer 34

A type of glomerular inflammation characterized by cellular proliferation into Bowman’s space to form “crescents.” Numerous disease processes, including SLE, vasculitis, and infection, can lead to its development.

Question 35

What are the ways rapidly progressive glomerulonephritis can develop?

Answer 35

(1) Following an infection
(2) A systemic disease, i.e. SLE
(3) Idiopathically

Question 36

Define membranous glomerulonephritis.

Answer 36

A type of glomerular inflammation characterized by deposition of immunoglobulins and complement along the epithelial side (podocytes) of the basement membrane. The condition is associated with numerous immune-mediated diseases and is the major cause of nephrotic syndrome in adults.

Question 37

Define minimal change disease.

Answer 37

A type of glomerular inflammation characterized by loss of the podocyte foot process. An immune-mediated condition that is the major cause of nephrotic syndrome in children.

Question 38

Define focal segmental glomerulosclerosis.

Answer 38

A type of glomerular disease characterized by sclerosis of the glomeruli. Not all glomeruli are affected, hence the term focal, and of those that are, only certain portions become diseased, hence the term segmental.