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Genitourinary > Glomerular diseases > Flashcards

Glomerular diseases Flashcards

1
Q

What are glomerular diseases? What two types are there?

A

Diseases of the glomeruli

Glomerulonephritis: inflammation of the glomeruli
Glomerulopathies: non-inflammatory disease of glomeruli

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2
Q

What is a glomerulus?

Draw the structure of a nephron + glomerulus.

A

A network of capillaries located at the beginning of a nephron in the kidney, next to the Bowman’s capsule

http://www.ivyroses.com/HumanBody-Images/Urinary/Kidney_Nephron_cIvyRose.png

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3
Q

What is focal glomerular disease?

A

When some but not all the glomeruli are affected

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4
Q

What is diffuse glomerular disease?

A

When most of the glomeruli are affected

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5
Q

What is segmental glomerular disease?

A

When only part of each glomerulus is affected

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6
Q

What is proliferative glomerular disease?

A

There is hyperplasia of the glomerular cells (increase in cell numbers)

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7
Q

Describe the structure of a glomerulus?

A

Afferent arteriole gives rise to the capillary bundle, which gives rise to the efferent arteriole

The capillary bundle is next to/within the Bowman’s capsule

The capillary endothelium is specialised for filtration

Podocytes are cells that surround each capillary vessel

Between the capillaries is the mesangium

The macula densa is found between the afferent and efferent arterioles at the point they enter the Bowman’s capsule, adjacent to this is the ascending limb of the nephron

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8
Q

What is the mesangium?

What does it do?

A

The space between the cells of a glomerulus is occupied by mesangial cells.

They are not part of the filtration barrier

The cells participate indirectly in filtration by contracting and reducing the glomerular surface area, and therefore filtration rate, in response mainly to stretch

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9
Q

What do podocytes do?

A

They are an extra barrier to aid filtration

They have slits

They are able to contract and reduce the filtration rate by closing their slits

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10
Q

What is the macula densa?

What does it do?

A

It is found between to the ascending limb of the nephron and the afferent + efferent arterioles

It is a network of specialised cells

Which are sensitive to the concentration of NaCl in the thick ascending limb. Low NaCl indicates GFR is too low

A decrease in NaCl concentration initiates a signal from the macula densa

The signal causes dilation of the afferent arterioles resulting in increased blood flow through glomerulus, increasing the GFR

The signal also increases renin release from the juxtaglomerular cells of the afferent and efferent arterioles, which are the major storage sites for renin

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11
Q

What are the juxtaglomerular cells?

A

Cells that store renin and are found next to the afferent and efferent arterioles

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12
Q

What is the difference between the afferent and efferent arterioles?

A

Afferent: brings blood to the glomerulus
Efferent: takes blood away from the glomerulus

Remember the Latin: ex = from, ad = to

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13
Q

Pyelonephritis and glomerulonephritis can be easily confused. What is the difference?

A

Pyelonephritis: infection in the urinary system, can only affect one kidney

Glomerulonephritis: autoimmune disease, autoantibodies attack the glomerulus, always affects both kidneys since it’s a systemic disease

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14
Q

What evidence is there that glomerulonephritis is an immune condition?

A

Deposits of immunoglobulin are found in the kidneys

Inflammatory cells are found: macrophages, neutrophils

Positive response to immune system treatment

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15
Q

What two syndromes can glomerulonephritis result in?

A

Nephritic Syndrome

Nephrotic Syndrome

One or both

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16
Q

What can glomerulonephritis cause?

A

Leaky glomeruli: protein and haematuria

Hypertension

Deteriorating kidney function

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17
Q

Why does glomerulonephritis cause hypertension?

A

Because inflammation causes damage and thus reduced renal perfusion

The body compensates by raising blood pressure

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18
Q

What is acute nephritic syndrome?

A

A group of symptoms that occurs in some cases of glomerulonephritis

Destruction of epithelial barrier lining the glomeruli

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19
Q

What are the clinical features of acute nephritic syndrome?

A

Haematuria
Proteinuria

Hypertension, raised JVP

Oliguria

Oedema: peripheral + pulmonary

Uraemia

20
Q

What are some diseases associated with the development of acute nephritic syndrome?

A

ANCA associated vasculitis

Streptococcal infection

Goodpasture’s disease

SLE

Systemic Sclerosis

Henoch Schoenlein purpura

21
Q

How does ANCA associated vasculitis cause damage to the kidneys?

A

ANCA: anti-neutrophil cytoplasmic antibodies

Attack the small blood vessels including the glomeruli, cause necrosis of blood vessel walls

Inflammatory cells infiltrate

22
Q

How do you treat ANCA associated vasculitis?

A

Immunosuppression
Steroids
Rituximab

23
Q

What does ANCA stand for?

A

Anti-neutrophil cytoplasmic antibodies

24
Q

How does a streptococcal infection cause damage to kidneys?

A

Sometimes, after a Strep infection immune complexes (antigen-antibody) are deposited in the kidney

Classically it’s a tonsillitis infection

25
Q

How does Goodpastures disease cause kidney damage?

A

Deposits of autoantibodies along basement membrane of glomerulus

They cause in immune response there, damaging the glomerulus

26
Q

How would you diagnose Goodpasture’s disease?

A

Anti-glomerular basement membrane antibodies

Lung involvement as well: haemoptysis

27
Q

How would you treat Goodpasture’s disease?

A

Remove the antibody
Plasma exchange
Immunosuppression

28
Q

How does SLE damage the kidneys?

A

Systemic Lupus Erythematosus

Systemic condition where body attacks its own cells, including renal cells

29
Q

What is Henoch Schoenlein purpura?

A

A condition in which blood vessels become inflamed

Causing rash, abdominal pain, AKI

30
Q

What is Nephrotic syndrome?

A

A group of symptoms that sometimes occurs as a result of glomerulonephritis

Massively increased filtration of large molecules across the glomerular capillary wall (out of blood into urine)
Due to damaged podocytes

31
Q

What are the clinical features of nephrotic syndrome?

A

Heavy proteinuria

Hypoalbuminaemia

Oedema

Hyperlipidaemia

32
Q

Why does nephrotic syndrome cause heavy proteinuria and hypoalbuminaemia?

A

Because damage to the glomerular filtration system, especially the podocytes, means proteins can leave the bloodstream and enter the tubules

Leaving protein in the urine
And less albumin is left in the blood

33
Q

Why does nephrotic syndrome cause oedema?

A

Hypoproteinaemia

Fluid leaves the blood stream and enters tissues due to a decrease in oncotic pressure

34
Q

What is oncotic pressure?

Describe its link with oedema.

A

Pressure exerted by proteins, notably albumin

In a blood vessel’s plasma it pulls water into the circulatory system

So reduced oncotic pressure means no pull into circulatory system
Fluid enters tissues and causes oedema

35
Q

Why does nephrotic syndrome cause hyperlipidaemia?

A

Hypoproteinaemia stimulates the liver to make more protein, including lipoproteins

Catabolism of lipids is reduced due to reduced levels of lipases

36
Q

What is anasarca?

A

Widespread oedema throughout the body, particularly the face

37
Q

What are the primary causes of nephrotic syndrome?

A

Minimal Change Disease: a renal disease of children

Membranous glomerulonephritis: inflammation of glomerular membrane, impaired filtration

Focal Segmental Glomerulsclerosis: scarring of glomerular tissue

38
Q

What are some secondary causes of nephrotic syndrome?

A 
Diabetes
Amyloidosis
Infections
SLE
Malignancy
Drugs
39
Q

What are the key differences between nephritic and nephrotic syndrome?

A

Nephritic:

  • oliguria
  • haematuria
  • hypertension

Nephrotic:

  • oedema
  • proteinuria
  • hypoalbuminaemia
  • hyperlipidaemia
40
Q

Investigation of glomerulonephritis?

A

Aim is to find the cause!

Blood:

  • FBC, U+E
  • ESR/CRP: is it inflammatory
  • Serology: autoantibodies, ANCA

Urinalysis:

  • Look for RBC casts
  • Proteinuria

USS: look for visible damage

CXR: look for pulmonary oedema

Renal biopsy:

  • will show what part is damaged, podocytes, mesangium, basement membrane
  • will show if focal or diffuse, segmental or global
41
Q

Management of glomerulonephritis in general?

A

Refer to a nephrologist!

Treat the underlying cause if you know it

Maintain BP

Prescribe an ACEi or ARB, these can help reduce proteinuria and preserve renal function

42
Q

Management of nephritic syndrome?

A

Treat hypertension: diuretics, vasodilators, salt restriction

Treat oedema: diuretics

Fluid restriction in patients with fluid overload + oliguria

Treat causes: antibiotics, immunosupression

Manage life threatening complications: encephalopathy

43
Q

Management of nephrotic syndrome?

A

Treat oedema: diuretics

Treat proteinuria: ACEi or ARBs

Treat underlying cause: immunosuppression, cessation of offending drug

44
Q

What is minimal change disease?

Why is it named this?

A

A disease that causes nephrotic syndrome, it affects children

For many years doctors couldn’t see any abnormalities on biopsies

45
Q

What are the 3 hallmarks of minimal change disease?

A
  1. Diffuse loss of podocytes foot processes
  2. Vacuolation (formation of vacuoles)
  3. Growth of microvilli on the visceral epithelial cells
46
Q

How can you treat minimal change disease?

A

Steroid: immunosuppressant, prednisolone

ACEi to help with proteinuria

47
Q

What is Focal Segmental Glomerulsclerosis (FSG)?

A

Scarring of the glomerulus
Focal: only affects some of the glomeruli
Segmental: part of each glomeruli affected

Genitourinary (13 decks)

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