GLOMERULAR DISEASES Flashcards
Glomerular diseases are the most common cause of
chronic kidney disease and dialysis-requiring
renal failure
The most common of these in the developed world is
diabetic nephropathy.
Most glomerular diseases are also called glomerulonephritis (GN) or inflammation of the
glomerulus
Glomerular diseases are often as the result of
1-autoimmune event,
2-circulating antibodies,
3-or vasculitis.
A few of Glomerular diseases are non-inflammatory and caused by other mechanisms, such as
1-hypertensive nephrosclerosis (prolonged high BP),
2-Alport syndrome (defective Type IV collagen in the glomerular basement membrane),
3-and hemolytic-uremic syndrome (microthrombi in renal small vessels).
GN may be classified as follows:
1-Primary disease without systemic illness (e.g., membranous GN, IgA nephropathy)
2-Secondary disease due to systemic illness (e.g., post-infectious GN, diabetic nephropathy, lupus nephritis)
Based on presentation, it may be further classified as follows:
1-Nephritic (sometimes called “acute GN”) with hematuria, RBC casts, edema, hypertension, and renal failure (e.g., post-infectious GN, Goodpasture syndrome)
2-Nephrotic with heavy proteinuria, hyperlipidemia, edema, and hypertension (e.g., minimal change disease, diabetic nephropathy)
3-Rapidly progressive GN: hematuria, usually nephritic, accompanied by sub-acute renal failure (over 1–2 weeks), often with crescents seen on biopsy.
Many glomerular diseases can be diagnosed using …………….. ……………..and …………………. ………………………….,
but the definitive diagnosis is usually made by …………… ……………., especially when there is heavy proteinuria or renal insufficiency. In these cases …………. is usually needed, since treatment varies depending on histology.
clinical evaluation and specific serologies,
renal biopsy
biopsy
Nephritic GN is characterized by
1-hematuria,
2-edema,
3-red cell casts,
4-hypertension.
The red cells often develop an abnormal shape (called “……………….”) which distinguishes them from non-glomerular hematuria due to
dysmorphic 1-stones, 2-bladder cancer, 3-infection. 4-Small or moderate proteinuria
• The edema of glomerular disease may be anywhere in the body, but is usually first seen in
dependent areas (ankles)
The edema of glomerular disease is caused by
avid renal sodium retention, so labs show a low urine sodium, with fractional excretion of sodium <1%.
• With the salt and water retention, ……………….. also develops.
• Nephritic diseases show modest amounts of ……………….in the urine, with a daily total ………. grams
per 24 hrs.
• The most important distinction between nephritic and nephrotic syndrome is the ………………(in nephritic) and degree of …………….(>………… gm/24 hrs in nephrotic).
hypertension protein 2 3.5 hematuria proteinuria 3.5
In nephritic diseases the single most important test for diagnosing GN is usually
the renal biopsy
Exceptions are post-infectious GN, where no biopsy is usually done, and systemic vasculitis, where ……….or …………. biopsy is easier and less risky. Biopsy is always done if the patient
is developing subacute renal failure (rapidly progressive GN).
skin or lung
Nephritic vascular diseases are
1-Granulomatosis with polyangiitis 2-Eosinophilic granulomatosis with polyangiitis 3-Henoch-Schönlein purpura (renal lesion = IgAN) 4-Polyarteritis nodosa 5-Cryoglobulinemia
Granulomatosis with polyangiitis (Wegener granulomatosis) is characterized by systemic …………… that most often involves :
vasculitis
1-the kidney,
2-lung,
3-and upper respiratory tract such as the sinuses or middle ear.
4-It can also involve the skin (50%), eyes (50%), joints, and GI tract.
If a patient with chronic upper and lower respiratory illness
does not respond to antibiotics and then develops renal failure or hematuria, consider
Granulomatosis with polyangiitis
