Glomerular Disorders

Question 1

Glomerulonephritis Definition

Answer 1

Variety of conditions that cause inflammation of the glomeruli

Question 2

Glomerulonephritis Overview

Answer 2

Can be focal or diffuse

Affects both kidneys equally

3rd leading cause of kidney failure in the US

-1/4 of all ESRD cases

Primarily an IMMUNE-mediated process

Question 3

Where does damage occur?

Answer 3

Glomerulus
-Delicate network of arterioles within the Bowman’s Capsule

Tubules
-Massive consumer of oxygen

Question 4

Capillary membranes of the glomerulus have 3 layers

Answer 4

1. Endothelium
2. Basement membrane
3. Podocytes (special epithelial cells)

Question 5

Types of Glomerulonephritis

Answer 5

Primary: Isolated to the kidney

Secondary: Caused by systemic disease

Question 6

Glomerulonephritis: Where can damage occur?

Answer 6

Diffuse: both kidneys
Focal: only some glomeruli
Local: an area of the glomerulus

Question 7

Glomerulonephritis is…

Answer 7

Progressive if inflammation isn’t treated

Question 8

Glomerulonephritis: 2 types of injury

Answer 8

1. Antibodies attach to antigens of the GBM (“anti-GBM antibodies”) 5% Type II
2. Antibodies react with circulating antigens and are deposited as immune complexes in the GBM 90% Type III

Question 9

Glomerulonephritis: What do the 2 types of injury have in common?

Answer 9

BOTH forms have this in common:

• Accumulation of antigens, antibodies, and complement
• Complement activation results in tissue injury

Question 10

Acute Glomerulonephritis is characterized by which symptoms

Answer 10

Characterized by H.A.R.P:

• Hematuria
• Azotemia
• Retention: sodium + water, Oliguria, leads to HTN and Edema
• Proteinuria

Question 11

Acute GN: Triggers

Answer 11

Post infectious:

• Poststreptococcal infection
• Nonstreptococcal infection (bacterial, viral, parasitic)

Primary Disease:
-Berger disease

Multisystem Disease:
-Goodpasture syndrome, systemic lupus, erythematosus (SLE), vasculitis

Question 12

Acute Glomerulonephritis Primary disease

Answer 12

Berger’s Disease

Question 13

Goodpasture Syndrome

Answer 13

Cause: anti-GBM antibodies (Type II)
-attack basement membrane of kidneys and lungs

S/S: Hemoptysis, respiratory and kidney problems

Question 14

Acute Glomerulonephritis: Steps of Pathogenesis

Answer 14

1. Trigger
2. Immune Complexes form
3. Compliment activated
4. Release of mediators (cause inflammation)
5. Tissue injury
6. Hematuria, Proteinuria, Decreased GFR

Question 15

Chronic Glomerulonephritis

Answer 15

Inflammation has been going on for months to a year.

Question 16

Prognosis for Chronic Glomerulonephritis

Answer 16

Start to get scar tissue
-Less and less kidney function

Prognosis:

• Slow progressive destruction
• End Stage Kidney Disease (ESKD)

Question 17

Chronic Glomerulonephritis Drugs

Answer 17

Corticosteroids:
-prednisone

Diuretics

Immunosuppressants

Anti-hypertensives:
-ARB or ACE

Other:

• Dialysis
• Diet (low Na, K+)

Question 18

Glomerulonephritis Proteinuria

Answer 18

The proteinuria associated with acute GN is accompanied by hypoproteinemia

-protein normally in circulation is able to slip through glomerular membrane and is lost in urine (albumin)

Question 19

Glomerulonephritis S/S

Answer 19

Hematuria:
-coffee/cola colored urine

Oliguria
-<400ml/day

Fluid retention
-generalized edema

Question 20

Glomerulonephritis Labs

Answer 20

• elevated BUN + creatinine
• > 20:1 Bun:Creatinine
• Increased Protein in urine
• Hypoproteinemia (lower levels of protein in body)

Question 21

Glomerulopathy: Diabetes + Hypertension

Answer 21

Diabetic Nephropathy

• Major complication
• Underlying Pathology: Gross thickening of GBM

Hypertensive Glomerular Disease
-Underlying Pathology: Decreased renal perfusion

-Sclerotic glomerular changes

Question 22

Nephrotic Syndrome

Answer 22

• The glomerulus is too permeable to plasma proteins

- Elimination of >3 grams of protein a day

Question 23

What can cause Nephrotic Syndrome

Answer 23

Etiology: most often seen in…

• Glomerulonephritis
• Diabetes Mellitus

Question 24

Nephrotic Syndrome Pathogenesis

Answer 24

1. Increased Glomerular Permeability
2. Proteinuria
3. Hypoalbuminemia

Question 25

Nephrotic Syndrome: Clinical Manifestations

Answer 25

1. Edema
   - lack of albumin + third spacing
2. Hypertension
   - kidney needs volume RASS
3. Liver Involvement
   - Hyperlipidemia
   - Hypercoagulation (loss of antithrombin III + plasminogen)

Question 26

Glomerulonephritis vs Nephrotic Syndrome

Answer 26

Biggest difference is the degree of proteinuria

-Nephrotic syndrome >3g loss per day of protein!