Glomerular Diseases Flashcards
What is different about the basement membrane of the glomerulus?
It carries a strong negative electric charge to prevent the passage of proteins
What are the three cell types of the glomerulus?
endothelial, mesangial, epithelial (podocytes)
What is nephrotic syndrome?
a kidney disorder characterised by oedema, proteinuria, hypoalbuminamia and hyperlipidaemia - it is caused by a defect caused by the filter which allows protein into the urine - all other features follow on from the proteinuria - it is a clinical syndrome not a pathological process
What pathological processes cause nephrotic syndrome?
diabetes mellitus, some forms of glomerulonephritis, amyloidosis, inherited abnormalities
What keeps proteins in the glomerular capillaries?
the negative charge of the basement membrane, the physical structure of the basement membrane, the specialised proteins in the gaps between the foot processes
What is acute renal failure/injury?
an acute reduction in GFR reflected by a rise in serum creatinine
What are the causes of acute renal failure/injury?
pre renal, renal and post renal
What are the renal causes of acute renal failure?
acute tubular necrosis, acute glomerulonephritis, acute interstitial nephritis etc.
What is glomerulonephritis?
injury to the glomerulus that is almost always immune mediated - mostly deposition of immune complexes
What are the 3 groups of glomerulonephritis?
deposition of immune complexes, direct anti-glomerular basement membrane antibodies, pauci-immune (non immune mediated)
What is the progression of glomerulonephritis?
varies depending on the pathology - may be acute and reversible or may progress slowly and lead to chronic renal failure
What are crescents?
clumps of monocytes and epithelial cells and fibrin in severe glomerulonephritis with necrosis
What is acute post infectious glomerulonephritis?
due to an abhorrent immune response to a streptococci infection
What is the commonest form of glomerulonephritis in Australia?
IgA nephropathy
Do all glomerulonephritis have the same clinical presentation?
no
How do you diagnose glomerulonephritis?
light microscopy
What features may be seen in glomerulonephritis in light microscopy?
mesangial cell proliferation, endothelial cell proliferation, podocyte proliferation, neutrophils, lymphocytes and monocytes, basement layer proliferation
What is diffuse glomerulonephritis?
where every glomerulus is involved
What is global glomerulonephritis?
where the whole glomerulus is involved
What other tool is used to diagnose glomerulonephritis?
immunostains
How may the glomerulus become injured?
necrotising legions and sclerosing legions (where segments scar and contract)
What is the most common cause of end stage renal failure in Australia?
diabetic nephropathy
What is diabetic nephropathy due to?
chronic hyperglycaemia
What is a common early presentation of diabetic nephropathy?
proteinuria
What are the typical lesions in diabetic nephropathy?
spherical collagen nodules in mesangium, basement membrane thickening, hyaline arteiololsclerosis
