Glomerular Disease

Question 1

What are the 3 parts of the glomerular membrane?

Answer 1

Fenestrated endothelium
Basal Lamina
Foot processes of Podocytes

Question 2

What are mesangial cells?

Answer 2

“tree-like” groups of cells that support capillaries in the glomerulus

Question 3

Define glomerulonephritis?

Answer 3

Any disease of the glomerulonephritis, doesn’t have to be inflammatory

Question 4

What are the 4 main presentations of glomerular disease?

Answer 4

• Haematuria
• Heavy Proteinuria
• Slowly increasing proteinuria
• Acute renal failure

Question 5

What could cause haematuria?

Answer 5

Mainly:

• UTI
• UT Stone
• UT tumour
• Glomerulonephritis

Question 6

4 Main causes of glomerulonephritis?

Answer 6

Cases with immunoglobulin deposition:

• IgA Glomerulonephritis
• Membranous Glomerulonephritis

Without immunoglobulin deposition:

• Diabetic Glomerular disease
• Crescentic Glomerulonephritis

Question 7

Explain the pathology of IgA glomerulonephritis?

Answer 7

IgA gets stuck in the mesangium causing irritation which stimulates matrix and mesangium formation

This can lead to blood in the urine

Question 8

Prognosis for IgA glomerulonephritis

Answer 8

Mostly self limiting

Some can progress so far they cause chronic renal failure

Question 9

Explain the pathology of IgG glomerulonephritis?

Answer 9

IgG gets deposited between the basal lamina and podocytes causing thickening
It then activates complement C3 which punches holes in the filter, allowing albumin through –> Nephrotic syndrome

Question 10

Prognosis for IgG glomerulonephritis?

Answer 10

25% reach chronic renal failure within 10 yrs

Question 11

How does diabetic glomerular disease occur?

Answer 11

Glycalated molecules deposited in the basal lamina and mesangial matrix leading to a thick leaky basement membrane and compressed capillaries

Question 12

What is a kimmelsteil-wilson lesion?

Answer 12

A nodule of mesangial matrix formed during Diabetic glomerular disease

Question 13

Pathology of Crescentic Glomerulonephritis?

Answer 13

A number of conditions cause:
cellular proliferation and influx of macrophages, forming a crescent within the bowman’s space that crushes the glomerulus

Question 14

What can cause crescentic glomerulonephritis?

Answer 14

• ANCA (Wegener’s Granulomatosis)
• Microscopic polyarteritis
• Antiglomerular basement membrane disease

Others:

• IgA Vasculitis
• Post Infective
• Lupus

Question 15

What is wegener’s granulomatosis?

Answer 15

A form of vasculitis in kidneys, nose and lungs.

Question 16

How do you test for and treat wegener’s granulomatosis?

Answer 16

Serum ANCA (Anti-neutrophil cytoplasmic antibodies) test.

Treat with cyclophosphamide, untreated mean survival is 6 months

Question 17

What tests are relevant to glomerular disease?

Answer 17

• urine cultures to rule out infection
• Abdo US to rule out tumours/stones
• Dipstic for haematuria
• Clotting screen
• Renal biopsy