Glomerular diseases

Question 1

Glomerulonephritis

Answer 1

variety of conditions causing inflammation in the glomeruli
- focal or diffuse
- mostly an immune process
- often leads to dialysis
- 3rd leading cause of kid fail in U.S.

Question 2

Glomerulonephritis patho

Answer 2

Type 2 and 3 injury
- antibodies attach to antigens of GBM (anti-GBM antibodies) and cause direct cell death (type 2) OR react with circulating antigens and deposit in GBM as immune complexes that destroy tissues (type 3)

Question 3

Glomerulus

Answer 3

network of arterioles w/i Bowman’s capsule
- all blood flows thru it; in thru afferent artery, out thru efferent

Question 4

How does the glomerulus work?

Answer 4

Pressure difference of afferent and efferent arteries push toxins and fluids out vessels thru capillaries in the GBM to filter and add them to urine

Question 5

What gases are needed for the glomerulus to work?

Answer 5

20% of the body’s CO of oxygen

Question 6

Podocytes

Answer 6

help with urine production

Question 7

Layers of the capillary membranes

Answer 7

• endothelium
• basement membrane
• podocytes (special epithelial cells)
  Fluid travels thru the nephron and particles are excreted and reabsorbed to get final concentration of urine

Question 8

Similarity in type 2 and 3 hypersensitivity reaction

Answer 8

Both accumulate antigens, antibodies, and complement (inflammatory process) - complement activation causes injury to the GBM

Question 9

Acute glomerulonephritis CM

Answer 9

SUDDEN ONSET - HARP
- Hematuria
- Azotemia (high waste products in the blood)
- Retention of Na and water (oliguria, edema, HTN)
- Proteinuria from damaged GBM

Question 10

Acute glomerulonephritis

Answer 10

Abrupt onset; often hospital patients

Question 11

Triggers of Acute glomerulonephritis

Answer 11

• after strep and infection - bodily antibodies attack GBM bc think it is a foreign antigen?
• Primary Berger disease
• multisystem disease like Goodpasture sx, lupus, vasculitis

Question 12

Berger disease

Answer 12

antibody IgA builds up kidney, inflames glom

Question 13

Goodpasture sx

Answer 13

anti-GBM antibodies (type 2) attack lungs and GBM (bc of similar structure) causing hemoptysis (major sign), respiratory probs, renal problems

Question 14

Acute glom patho

Answer 14

Trigger - immune complex forms - complement activated (inflammatory process)- release mediators - GBM (tissue) injury - sx (hemoptysis and proteinuria) and dec GFR

Question 15

Chronic glom

Answer 15

Develop scar tissue over months and years–kidneys fxn less
- sx depend on severity but are similar to acute
- slow progressive destruction to ESRD

Question 16

Nephrotic syndrome

Answer 16

glomerulus too permeable to plasma proteins causing spills of protein (often albumin) into blood that start to pass thru as tissue weakens into urine (proteinuria) then get 3rd spacing from lack of protein

Question 17

Causes of nephrotic syndrome

Answer 17

uncontrolled DM, GLOMERULONEPHRITIS

Question 18

How to diagnose nephrotic syndrome

Answer 18

24h urine - over 3g/day protein

Question 19

CM of nephrotic syndrome

Answer 19

Edema, HTN (RAS activated to get more volume–HTN and inc kidney perfusion), liver problems, HLD, hypercoag (PE & DVT), proteinuria and hematuria

Question 20

Why does nephrotic syndrome cause hypercoag?

Answer 20

antithrombin 3 and plasminogen are some of the proteins lost in the blood, can’t b/d clots w/o plasminogen

Question 21

DM complication of nephropathy

Answer 21

Diabetic nephropathy specific to glomerulus; gross thickening of GBM causes build up toxins and less urine and ESRD

Question 22

HTN and glomerular disease

Answer 22

inc pressure on BVs causes dec renal perfusion and sclerotic glomerular changes (scarring)

Question 23

Where does damage occur with glomerulonephritis?

Answer 23

Glomerulus and tubules (big consumer of oxygen)

Question 24

Which hypersensitivity is more common with glomerulonephritis?

Answer 24

Type 3

Question 25

Glomerulopathy

Answer 25

Diabetic and HTN complications of glomerulonephritis

Question 26

Glomerulopathy CM

Answer 26

Hematuria, oliguria (<400 mL/day), fluid retention, inc BUN:Cr ratio, proteinuria, low albumin (hypoproteinemia)