Glomerular Diseases Flashcards
Diseases that damage glomeruli are varied and include what types of disorders?
Immunologic, metabolic, and hereditary disorders.
T/F) Systemic disorders are technically secondary glomerular diseases.
True because they initially and principally involve other organs.
Define glomerulonephritides (plural) or glomerulonephritis.
Nephrotic conditions characterized by damage to and inflammation of the glomeruli. Causes are varied and include immunologic, metabolic, and hereditary disorders.
What four distinct morphologic changes of glomeruli occur during glomerular disease?
Cellular proliferation, leukocytic infiltration, glomerular basement membrane thickening, and hyalinization with sclerosis.
Define cellular proliferation.
An increased number of endothelial cells (capillary endothelium), mesangial cells, and epithelial cells.
Define leukocytic infiltration.
Leukocytes, particularly neutrophils and macrophages, can readily infiltrate glomeruli; may also be accompanied by cellular proliferation.
Define glomerular basement membrane thickening.
Any process that results in enlargement of the basement membrane.
Glomerular basement membrane thickening is commonly from the result of what?
The deposition of precipitated proteins (e.g. immune complexes, fibrin).
Define glomeruli hyalinization.
The accumulation of a homogeneous, eosinophilic extracellular material in the glomeruli.
What is the primary mode of glomerular injury?
Immune-mediated processes; circulating Ag/Ab complexes and complexes that result from Ag/Ab reactions within the glomerulus.
Circulating immune complexes are created in response to ___ or ___ antigens.
Circulating immune complexes are created in response to endogenous or exogenous antigens.
What becomes entrapped within the glomeruli and bind complement and causing glomerular damage?
Immune complexes.
Glomerular injury does not result from the immune complexes but rather from the ___ ___ and ___ substances that they induce.
Glomerular injury does not result from the immune complexes but rather from the chemical mediators and toxic substances that they induce.
What are the clinical features that indicate glomerular damage?
Hematuria, proteinuria, oliguria, azotemia, edema, and hypertension.
What is an example of nephritic syndrome?
Acute poststreptococcal glomerulonephritis.
Glomerular disease that manifest the nephritic or nephrotic syndrome have the potential to develop what?
Chronic renal failure.
Define the group of clinical features indicative of nephrotic syndrome.
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).
Why is albumin the predominant protein lost during nephrotic syndrome?
Because of Albumin’s high plasma concentration.
What would you expect to see on a patient’s physical and chemical exam with acute glomerulonephritis?
Protein: mild
Blood: positive (degree variable)
What would you expect to see on a patient’s microscopic exam with acute glomerulonephritis?
↑ RBCs, often dysmorphic
↑ WBCs
↑ RTE cells
↑Casts: RBC, granular, WBC, renal cell casts
What would you expect to see on a patient’s physical and chemical exam with chronic glomerulonephritis?
Protein: heavy
Blood: positive (usually small)
S.G.: low and fixed
What would you expect to see on a patient’s microscopic exam with chronic glomerulonephritis?
↑ RBCs
↑ WBCs
↑ Casts: all types, particularly granular, waxy, and broad.
↑ Renal epithelial cells
What would you expect to see on a patient’s physical and chemical exam with nephrotic syndrome?
Protein: severe
Blood: positive (usually small)
What would you expect to see on a patient’s microscopic exam with nephrotic syndrome?
Lipiduria: oval fat bodies, free fat bodies
↑ Casts: all types, particularly fatty, waxy, and renal cell casts
↑ Renal epithelial cells
↑ RBCs
What chemistry plasma levels are increased for someone with hyperlipidemia?
Triglycerides, cholesterol, phospholipids, and VLDL.
The generalized edema present with the nephrotic syndrome is characteristically what?
Soft and pitting.
The development of edema is primarily due to what?
The decreased excretion of sodium.
What are the four glomerular diseases that account for about 90% of all nephrotic syndrome cases in children, and 75% in adults?
(1) minimal change disease (lipoid nephrosis), (2) membranous glomerulonephritis, (3) focal segmental glomerulosclerosis, and (4) membranoproliferative glomerulonephritis.
Define acute poststreptococcal glomerulonephritis.
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.
What glomerular morphological changes would occur with acute glomerulonephritis?
Cellular proliferation of the mesangium and endothelium, as well as leukocytic infiltration.
What clinical symptoms would a patient have for acute glomerulonephritis?
Fever, malaise, nausea, oliguria, hematuria, and proteinuria.
What would be the predicted results for a culture be for a patient suffering from acute glomerulonephritis?
Negative.
What serum chemistry results would be predicted for a patient suffering from acute glomerulonephritis?
↓ Creat clearance
↑ BUN:Creat
Norm/↑ Alb levels depending on severity of proteinuria.
Define rapidly progressive glomerulonephritis (or crescentic glomerulonephritis).
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.
What are the ways rapidly progressive glomerulonephritis can develop?
(1) Following an infection
(2) A systemic disease, i.e. SLE
(3) Idiopathically
Define membranous glomerulonephritis.
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.
Define minimal change disease.
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.
Define focal segmental glomerulosclerosis.
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.
