Glomerular Disorders Flashcards
Glomerulonephritis Definition
Variety of conditions that cause inflammation of the glomeruli
Glomerulonephritis Overview
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
Where does damage occur?
Glomerulus
-Delicate network of arterioles within the Bowman’s Capsule
Tubules
-Massive consumer of oxygen
Capillary membranes of the glomerulus have 3 layers
- Endothelium
- Basement membrane
- Podocytes (special epithelial cells)
Types of Glomerulonephritis
Primary: Isolated to the kidney
Secondary: Caused by systemic disease
Glomerulonephritis: Where can damage occur?
Diffuse: both kidneys
Focal: only some glomeruli
Local: an area of the glomerulus
Glomerulonephritis is…
Progressive if inflammation isn’t treated
Glomerulonephritis: 2 types of injury
- Antibodies attach to antigens of the GBM (“anti-GBM antibodies”) 5% Type II
- Antibodies react with circulating antigens and are deposited as immune complexes in the GBM 90% Type III
Glomerulonephritis: What do the 2 types of injury have in common?
BOTH forms have this in common:
- Accumulation of antigens, antibodies, and complement
- Complement activation results in tissue injury
Acute Glomerulonephritis is characterized by which symptoms
Characterized by H.A.R.P:
- Hematuria
- Azotemia
- Retention: sodium + water, Oliguria, leads to HTN and Edema
- Proteinuria
Acute GN: Triggers
Post infectious:
- Poststreptococcal infection
- Nonstreptococcal infection (bacterial, viral, parasitic)
Primary Disease:
-Berger disease
Multisystem Disease:
-Goodpasture syndrome, systemic lupus, erythematosus (SLE), vasculitis
Acute Glomerulonephritis Primary disease
Berger’s Disease
Goodpasture Syndrome
Cause: anti-GBM antibodies (Type II)
-attack basement membrane of kidneys and lungs
S/S: Hemoptysis, respiratory and kidney problems
Acute Glomerulonephritis: Steps of Pathogenesis
- Trigger
- Immune Complexes form
- Compliment activated
- Release of mediators (cause inflammation)
- Tissue injury
- Hematuria, Proteinuria, Decreased GFR
Chronic Glomerulonephritis
Inflammation has been going on for months to a year.
Prognosis for Chronic Glomerulonephritis
Start to get scar tissue
-Less and less kidney function
Prognosis:
- Slow progressive destruction
- End Stage Kidney Disease (ESKD)
Chronic Glomerulonephritis Drugs
Corticosteroids:
-prednisone
Diuretics
Immunosuppressants
Anti-hypertensives:
-ARB or ACE
Other:
- Dialysis
- Diet (low Na, K+)
Glomerulonephritis Proteinuria
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)
Glomerulonephritis S/S
Hematuria:
-coffee/cola colored urine
Oliguria
-<400ml/day
Fluid retention
-generalized edema
Glomerulonephritis Labs
- elevated BUN + creatinine
- > 20:1 Bun:Creatinine
- Increased Protein in urine
- Hypoproteinemia (lower levels of protein in body)
Glomerulopathy: Diabetes + Hypertension
Diabetic Nephropathy
- Major complication
- Underlying Pathology: Gross thickening of GBM
Hypertensive Glomerular Disease
-Underlying Pathology: Decreased renal perfusion
-Sclerotic glomerular changes
Nephrotic Syndrome
- The glomerulus is too permeable to plasma proteins
- Elimination of >3 grams of protein a day
What can cause Nephrotic Syndrome
Etiology: most often seen in…
- Glomerulonephritis
- Diabetes Mellitus
Nephrotic Syndrome Pathogenesis
- Increased Glomerular Permeability
- Proteinuria
- Hypoalbuminemia
Nephrotic Syndrome: Clinical Manifestations
- Edema
- lack of albumin + third spacing - Hypertension
- kidney needs volume RASS - Liver Involvement
- Hyperlipidemia
- Hypercoagulation (loss of antithrombin III + plasminogen)
Glomerulonephritis vs Nephrotic Syndrome
Biggest difference is the degree of proteinuria
-Nephrotic syndrome >3g loss per day of protein!
