Glomerular Diseases Flashcards
Renal disease is divided into diseases of?
- glomeruli
- tubules
- interstitium
- vessels
Glomerular diseases are caused mainly by?
immunologically mediated
Tubular and interstitial disorders are often due to?
toxins or infections
How do glomerular and tubular diseases affect each other?
- glomerular disease impairs the tubular blood supply and increases tubular toxins
- tubular disease causes increased intraglomerular pressure
Describe how vascular disorders affect glomerular function?
decreases the amount of filtrate
What is Azotemia?
Increased serum BUN (blood urea nitrogen) and creatinine, due to reduced glomerular filtration rate
- causes are pre-renal, renal and post-renal
What is uremia?
Azotemia plus clinical signs/symptoms
- gastroenteritis, peripheral neuropathy,
fibrinous pericarditis
What is acute renal failure?
Abrupt anuria or oliguria with rapidly progressive azotemia identified by increase in BUN or ammonia
- urine output < 400 ml/24 hr
What are the causes of acute renal failure?
- Vascular obstruction (polyarteritis nodosa, malignant hypertension, hemolytic-uremic syndrome)
- Rapidly progressive glomerulonephritis
- Acute tubular necrosis
- Acute tubulointerstitial nephritis
- Pyelonephritis with papillary necrosis
- DIC
- Urinary obstruction
What is chronic renal failure?
Azotemia progressing to uremia over a period of years
What are the stages of chronic renal failure?
- diminished renal reserve (GFR 50% normal) with normal BUN/Cr,
- renal insufficiency - azotemia, anemia, hypertension, polyuria, nocturia,
- renal failure: GFR < 20% normal, kidneys cannot regulate volume or solutes and patients develop edema, metabolic acidosis and hypocalcemia,
- end stage renal disease: GFR <5% normal, represents the end stage of various renal diseases
What is nephrotic syndrome?
Proteinuria > 3.5 g/day
- hypoalbuminemia (serum level <3 g/dl)
- hyperlipidemia
- lipiduria
- severe edema (anasarca)
What is the pathophysiology of nephrotic syndrome?
- Increased permeability to plasma proteins cause massive proteinuria, hypoalbuminemia and generalized edema (pitting, periorbital & dependent edema)
- Hyperlipidemia due to increased lipoprotein synthesis and decreased catabolism
- Lipiduria due to leakage of lipoproteins with albumin
What is nephritic syndrome?
Grossly visible hematuria, hypertension, variable proteinuria, azotemia, oliguria, edema, RBC casts
Name categories under Primary Diseases?
- Diseases associated with Nephrotic syndrome
2. Diseases associated with Nephritic syndrome
Name the diseases associated with nephrotic syndrome?
- Minimal change disease
- Focal segmental glomerulonephritis
- Membraneous glomerulonephritis
- Systemic disease (SLE, diabetes,
amyloidosis)
Name the disease associated with Nephritic syndrome?
- Acute diffuse proliferative glomerulonephritis (post-streptococcal or not)
- Rapidly progressive (crescentic) glomerulonephritis
- Membranoproliferative glomerulonephritis
Name secondary renal diseases?
Systemic lupus erythematosus (SLE), diabetes, amyloidosis, polyarteritis nodosa, Goodpasture syndrome, Wegener granulomatosis, Henoch-Schonlein purpura, bacterial endocarditis
Name hereditary glomerular diseases?
Alport syndrome, thin membrane disease, Fabry disease
What are the microscopic manifestations of kidney disease?
- hypercellularity
- basement membrane thickening
- hyalinization and sclerosis of glomeruli
Describe hypercellularity?
- cellular proliferation
- white blood cells (acute and chronic),
- crescents (white blood cells and epithelial cells)
Describe basement membrane thickening?
- highlighted by PAS stain and electron microscopy;
2. EM also shows electron-dense deposits (usually immune complexes) in or adjacent to basement membrane
What is hyalinization and sclerosis of glomeruli?
end result of glomerular damage Changes can be: - diffuse (all glomeruli) or focal; - global (entire glomerulus) - segmental (part of glomerulus) or mesangial
Describe the pathogenesis of glomerular injury?
Usually immune mediated via antibody deposition , or cell mediated injury
- Antibodies deposited are either to insitu
antigens or circulating immune complexes