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12. Year 2: Urinary System > Glomerular Disease Pathology > Flashcards

Glomerular Disease Pathology Flashcards

1
Q

What is glomerulonephritis?

A

Inflammation of the tinu filters in your kidney (glomeruli)

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2
Q

What is inflammation of the glomeruli called?

A

Glomerulonephritis

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3
Q

How does blood enter the glomerulus?

A

Via afferent arteriole

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4
Q

What happens once blood enters the glomerulus?

A

Some of it is filtered across glomerular membrane

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5
Q

When blood enters the glomerulus, what happens to albumin and porteins that are equal in size or larger?

A

They are not filtered and will stay in plasma

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6
Q

What are the cells called in the Bowman’s capsule that wrap around the capillaries of the glomerulus?

A

Podocytes

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7
Q

What are podocytes observed to have?

A

Interdigitating fingers or foot processes

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8
Q

What can be seen if you took a secrtion through a capillary loop?

A

Filter barrier, which is a membrane composed of endothelial cell cytoplasm, basal lamina and podocyte

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9
Q

What are the 3 parts of the filter barrier?

A

Endothelial cell cytoplasm

Basal lamina

Podocyte

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10
Q

What are mesangial cells?

A

‘Tree like’ group of cells which support capillaries

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11
Q

What happens to filtrate after glomerulus?

A

Goes into Bowman’s space, then into proximal tubule

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12
Q

After the glomerulus, what do blood cells, some fluid and albumin and larger proteins exit via?

A

Efferent arteriole

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13
Q

What are the different kinds of glomerulonephritis?

A

Inflammatory or non-inflammatory

Primary (only affects glomerulus) or secondary (other body parts affected such as SLE or Wegener’s)

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14
Q
A
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15
Q

What is primary glomerulus?

A

Only affects glomerulus

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16
Q

What is secondary glomerulus?

A

Affects other parts of the body

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17
Q

What are examples of diseases causing secondary glomerulus?

A

SLE or Wegener’s

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18
Q

What is the aetiology of glomerulonephritis?

A

Some are due to immunoglobulin deposition, and some are diseases with no immunoglobulin deposition, such as diabetic glomerular disease

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19
Q

What are the 4 common presentations of glomerulonephritis?

A
  • Haematuria (blood in urine)
  • Heavy proteinuria (nephrotic syndrome)
  • Slowly increasing proteinuria
  • Acute renal failure
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20
Q

What is the medical term for blood in urine?

A

Haematuria

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21
Q

What is the medial term for excess proteins in the urine?

A

Proteinuria

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22
Q

What are different conditions that caue glomerulonephritis?

A

IgA glomerlonephritis

Membranous glomerulonephritis

Diabetic nephropathy

Crescentic glomerulonephritis

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23
Q

What does IgA glomerulonephritis often present with?

A

Often presents with discoloured urine, investigation would be dipstick urine which is positive for blood

24
Q

What are the main causes of IgA glomerulonephritis?

A
  • Urinary tract infection
  • Urinary tract stone
  • Urinary tract tumour
  • Glomerulonephritis
25
What investigations are done for IgA glomerulonephritis?
Dipstick urine Urine culture Ultrasound scan If all normal, renal biopsy
26
If all typical investigations are normal for IgA glomerulonephritis, what investigation would be done?
Renal biopsy
27
What is immunofluorescence?
Method in biology that relies on the use of antibodies chemically labeled with fluorescent dyes to visualize molecules under a light microscope
28
What can be done with urinary biopsy in IgA glomerulonephritis?
29
What is seen in a renal biopsy and immunofluorscence for IgA glomerulonephritis?
* Reveals immunoglobulin (of IgA type) and complement component of C3 in mesangial area of all glomeruli
30
What is the aetiology of IgA glomerulonephritis?
Aetiology of IgA glomerulonephritis is unknown: * Excess antibody (IgA) sometimes present in serum, but this is also true of some people who do not have IgA glomerulonephritis
31
What is the pathogenesis of IgA glomerulonephritis?
IgA also does not get filtered into urine, it is “stuck” within the mesangium This causes mesangium, not the filter membrane to become clogged with antibody – causing red blood cells to escape into urine: * IgA irritates mesangial cells and causes them to proliferate and produce more matrix
32
What is the prognosis of IgA glomerulonephritis?
* Usually self-limiting, ie return to normal * Small percentage go onto chronic renal failure (via continued deposition of matrix)
33
What is the typical presentation of membranous glomerulonephritis?
Could present with feeling unwell and swollen legs
34
What investigations are done for membranous glomerulonephritis?
* Check clotting screen then do renal biopsy
35
What is seen in a dipstick of urine for membranous glomerulonephritis?
Proteinuria
36
What is seen in blood biochemistry for membranous glomerulonephritis?
Serum albumin low
37
What is the pathogenesis of membranous glomerulonephritis?
In membranous glomerulonephritis IgG is stuck in the membrane: * IgG deposits itself between basal lamina and podocyte but cannot go further and is not filtered into urine * IgG is too big to be filtered into urine, but activates complement (C3) which punches holes in filter * This leaky filter now allows albumin to be filtered into urine, causing nephrotic syndrome
38
What does renal biopsy reveal for membranous glomerulonephritis?
Thickened glomerular basement membrane Deposits of IgG Basal lamina spikes (matrix which tries to surround the deposit)
39
What is deposited on the membrane in membranous glomerulonephritis?
IgG
40
What is the prognosis of membranous glomerulonephritis?
* 1/4 will get chronic renal failure within 10 years
41
What is the aetiology of membranous glomerulonephritis?
* Unknown but ca sometimes have underlying malignancy * In many patients antigen is phospholipase A2 receptor
42
What investigations are done for diabetic nephropathy?
Dipstick urine Clotting screen Renal biopsy
43
What can be seen in the biopsy for diabetic nephropathy?
44
What is the pathogenesis of diabetic nephropathy?
45
What kind of lesion does diabetic nephropathy cause?
Diabetic nephropathy causes nodules of mesangial matrix to form, known as Kimmelsteil-Wilson lesion: * Is gross excess of mesangial matrix forming nodules
46
What is the prognosis of diabetic nephropathy?
* Inevitable decline if established diabetic nephropathy ad if continued poor diabetic control
47
What is a sign of acute renal failure?
Rapidly rising creatinine
48
What are the typical investigations for renal disease?
Urine dipstick Clotting screen Renal biopsy
49
What is seen in the biopsy for crescentic glomerulonephritis?
Early endothelial damage with fibrin deposition Crush glomerular tuft Cellular proliferation and influx of macrophages (is the crescent) around glomerular tuft, within Bowman's space
50
What are some causes for the crescentic glomerulonephritis pattern of injury?
* Granulomatosis with polyangiitis (also known as Wegener’s granulomatosis) * Form of vasculitis (inflammation in vessels) which affects vessels in kidneys, nose and lungs * Microscopic polyarteritis (a disease very like Wegener) * Antiglomerular basement membrane disease * Many other forms of glomerulonephritis
51
What is granulomatosis with polyangitis also known as?
Wegener's granulomatosis
52
What is Wegener's granulomatotis?
* Form of vasculitis (inflammation in vessels) which affects vessels in kidneys, nose and lungs
53
What further tests can be done for Wegener's?
* Serum test shows presence of anti-neutrophil cytoplasmic antibodies (ANCA) * These are not deposited in the kidneys * Antibodies directed against proteinase 3 and myeloperoxidase, 2 enzymes in primary granules of neutrophils * Antibodies produce tissue damaged via interactions with primed neutrophils and endothelial cells
54
What do serum tests reveal in Wegener's?
Presence of anti-neutrophil cytoplasmic antibodies (ANCA)
55
What does ANCA stand for?
Anti-neutrophil cytoplasmic antibodies
56
What is ACNA a form of?
Autoimmunity
57
What is the prognosis of Wegener's?
* Fatal (mean survival time is 6 months) if left untreated * Cyclophosphamide * 75% complete remission

12. Year 2: Urinary System (29 decks)

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