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Renal > Glomerular Disease > Flashcards

Glomerular Disease Flashcards

1
Q

A young man develops macroscopic haematuria 1-2 days after URTI?

A

IgA nephropathy

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2
Q

Definition of Glomerulonephritis?

A

Immune mediated disease of the kidneys affecting the glomeruli. There is disruption somewhere in the 3 layered barrier of the glomerulus leading to haematuria/ and or proteinuria.

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3
Q

Damage to endothelial or mesangial cells results in a ___1_____ and ___2______
Damage to the podocytes leads to a ____3______ and _____4_____

A

1) proliferative lesion
2) haematuria
3) non-proliferative lesion
4) proteinuria

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4
Q

How can glomerulonephritis be classified?

A

By clinical syndrome
By histological classification
By cause

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5
Q

What are the 5 clinical syndromes glomerulonephritis can cause?

A

1) Asymptomatic proteinuria or haematuria
2) Acute glomerulonephritis/ acute nephritic syndrome
3) Chronic glomerulonephritis
4) Rapidly progressive glomerulonephritis
5) Nephrotic syndrome

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6
Q

GLOMERULONEPHRITIS CLINICAL SYNDROME

Asymptomatic proteinuria or haematuria?

A

Just have the proteinuria or haematuria and this signals mild glomerular damage

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7
Q

GLOMERULONEPHRITIS CLINICAL SYNDROME

Acute glomerulonephritis/ Nephritic Syndrome?

A

Haematuria, acute fall in GFR, Na+ and H2O retention and hypertension. Oedema but less so than nephrotic.

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8
Q

GLOMERULONEPHRITIS CLINICAL SYNDROME

Chronic Glomerulonephritis?

A

Slow progressive damage, proteinuria, haematuria, hypertension

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9
Q

GLOMERULONEPHRITIS CLINICAL SYNDROME

Rapidly progressive glomerulonephritis?

A

Very rapid renal failure, oliguria, haematuria, proteinuria, usually without other symptoms of nephritic syndrome (ie hypertension and oedema)

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10
Q

GLOMERULONEPHRITIS CLINICAL SYNDROME

Nephrotic syndrome?

A

Consists of heavy proteinuria leading to hypoalbuminaemia and oedema

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11
Q

4 histological classifications of glomerulonephritis explain?

A

1) Proliferative or Non-proliferative
- presence or absence of proliferation of mesangial cells
2) Focal or diffuse
- < or > 50% glomeruli affected
3) Global or segmental
> all or part of glomerulus affected
4) Crescenteric
> presence of crescents which are epithelial cell extra capillary proliferations

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12
Q

3 types of non-proliferative glomerulonephritis?

A

1) Minimal change glomerulonephritis
2) Focal segmental glomerulosclerosis
3) Membranous glomerulonephritis

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13
Q

4 types of proliferative glomerulonephritis?

A

1) IgA nephropathy
2) Post infectious Glomerulonephritis
3) Membranoproliferative glomerulonephritis
4) Rapidly progressive glomerulonephritis

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14
Q

Minimal change glomerulonephritis presents as ______

A

nephrotic syndrome

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15
Q

Minimal change glomerulonephritis accounts for ____ of all nephrotic syndrome in kids and ______

A

80% in children

20% in adults

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16
Q

Does minimal change glomerulonephritis cause progressive renal failure?

A

No

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17
Q

Describe histology of minimal change glomerulonephritis?

A

No abnormalities on light microscopy but electron microscopy reveals abnormal fused podocytes

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18
Q

No abnormalities on light microscopy but electron microscopy reveals abnormal fused podocytes

A

Minimal change glomerulonephritis

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19
Q

Focal segmental glomerulosclerosis presents as ____

A

nephrotic syndrome

20
Q

Non proliferative glomerulonephritis usually present as ____

A

nephrotic syndrome

21
Q

Focal segmental glomerulosclerosis is associated with ____

A

HIV, obesity, kidney reflux disease, heroin use and gene mutations

22
Q

_____ of focal segmental glomerulosclerosis progress to renal failure

A

50%

23
Q

Treatment of focal segmental glomerulosclerosis?

A

Prolonged steroids can help but 50% still progress to renal failure

24
Q

Membranous glomerulonephritis presents as _____

It is ____ progressive

A

nephrotic syndrome

slowly

25
Q

Membranous glomerulonephritis causes?

A

usually idiopathic but can be associated with heptatits B/ parasites, SLE, malignancies, penicillamine

26
Q

Describe microscopy of membranous glomerulonephritis?

A

Immune complex deposition and complement activation against the glomerular basement membrane proteins results in microscopically thickened glomerular basement membrane. Immunofluorescene shows IgG uptake

27
Q

_____ of membranous glomerulonephritis progresses to end stage renal disease

A

30%

28
Q

Treatment of membranous glomerulonephritis?

A

Steroids, alkylating agents, B cell monoclonal antibodies

29
Q

What is the most common glomerulonephritis?

A

IgA nephropathy (a sort of non-systemic form of HSP)

30
Q

IgA nephropathy presents as ______

A

nephritic syndrome

31
Q

IgA nephropathy often occurs ____

A

24-48hrs after an URTI

32
Q

IgA nephropathy on biopsy?

A

Mesangial cell proliferation and expansion of light microscopy with IgA deposits in mesangium on IF.

33
Q

Management of IgA nephropathy?

A

No specific management, lower BP with ACEi/ ARB potentially steroids, many people have recurrence even after transplant

34
Q

When does post infectious glomerulonephritis usually occur?

A

Typically occurs 2 weeks after an infection usually strep pyogenes

35
Q

Treatment of post infectitious glomerulonephritis?

A

Only need supportive treatment usually recovers

36
Q

Membranoproliferative glomerulonephritis presents with _____

A

combined nephritic and nephrotic syndrome

37
Q

What happens in membranoproliferative glomerulonephritis? Histology?

A

Subendothelial deposition of immune complexes

Thickened basement membrane and mesangium

38
Q

Causes of membranoproliferative glomerulonephritis?

A

SLE or hepatitis

39
Q

Treatment and prognosis of membranoproliferative glomerulonephritis?

A

Has poor prognosis need to treat underlying cause

40
Q

What conditions present as rapidly progressive glomerulonephritis?

A

All can present but
Vasculitis ANCA +ve GPA, EGPA and MPA
Goodpastures
only present as rapidly progressing

other common are SLE and HSP

41
Q

Rapidly progressive glomerulonephritis results in _____

A

rapid progression to renal failure over weeks

42
Q

Immune complexes can be a cause of glomerulonephritis but where can we get circulating immune complexes from?

A

Auto-immune diseases e.g. SLE
Infection- hepatitis, bacteria, HIV
Drugs- gold penicillamine
Cancer often lymphomas

43
Q

Complications of nephrotic syndrome?

A

Pulmonary emboli
Infection (loss of immunoglobulins)
Renal vein thrombosis (loss of clotting factors)
Hypovolaemia

44
Q

Treatment of nephrotic syndrome?

A

Fluid + salt restriction
Diuretic
ACE inhibitor
IV albumin if hypovolaemia

45
Q

Minimal change nephropathy can occur after _____ or ______

A

infection or allergic reaction

Renal (19 decks)

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