Glomerular Disorders Flashcards
Functional unit of the kidney
Nephron
glomerulonephritis
Various conditions that cause inflammation of glomeruli
Can be focal or diffuse
Third leading cause of kidney failure in US
is glomerulonephritis a cell mediated or immune mediated process?
Immune mediated
glomerulus
Delicate network of arterials within Bowmans capsule
Tubules
Massive consumer of O2
Afferent renal artery
Takes blood in
efferent renal artery
Takes blood out
what is a glomerular disorder?
Alteration in glomerular capillary
Capillary membranes
Endothelial
Basement membrane
Podocytes
primary glomerulonephritis
Isolated in kidney
secondary glomerulonephritis
Caused by systemic disease
diffused damage to glomeruli
Both kidneys
focal damage to glomeruli
Only some of glomeruli
Local damage to glomeruli
Area of glomerulus
Type 2 reaction
occurs on cell surface
Results in direct cell death/malfunction
type 3 reaction
immune complexes are deposited into tissue and result in inflammation that destroys tissues
What type of reaction involves anti-GBM antibodies?
Type two
What type of reaction involves immune complexes in GBM?
Type three
what do both forms of injuries involve?
Accumulation of antigens, antibodies, complement
Complement Activation results in tissue injury
is acute glomerulonephritis rapid or slow onset?
Abrupt onset
s/sx of acute glomerulonephritis
HARP
Hematuria
Azotemia
Retention – sodium and water, oliguria – hypertension, and edema
Proteinuria – hypoproteinemia
post infectious
Post strep, and non-strep
Bacterial, viral, parasitic
primary disease
berger disease
IgA builds up in kidney
Multi system disease
Good posture syndrome
systemic lupus
Vasculitis
erythematosus
which multisystem disease is an auto immune?
Good posture syndrome
Anti-GBM antibodies, attack self
pathogenesis
Trigger
Immune complex forms
Complement activated – inflammation
Release of mediators
Tissue injury
Hematuria, proteinuria, decreased GFR
chronic glomerulonephritis
Long-term inflammation– months to years
Build up of scar tissue – can’t filter properly
s/sx chronic glomerulonephritis
Depends on the severity
Progression – renal failure
Slow and progressive destruction
what does chronic glomerulonephritis end with?
End stage renal disease – dialysis
pharm treatment for glomerulonephritis
corticosteroids – prednisone
Diuretics
Immuno suppressants
Antihypertensives – ACE/ARB
Dialysis, diet – less sodium, potassium, protein
s/sx glomerulonephritis
hematuria – coffee/cola, urine color
Oliguria – <400mL/day
Fluid retention – generalized edema, HTN
Labs – increased BUN and Cr (>20:1)
+ protein in urine – hypoproteinemia, low albumin
Diabetic neuropathy
Gross thickening of GBM
Uncontrolled blood sugar
Can’t filter out
Les urine – more toxins
hypertensive glomerular disease
Increased pressure
Decreased Renal perfusion
Sclerotic glomerular changes
thickening is associated with?
Diabetic neuropathy
scarring is associated with?
Hypertensive glomerular disease
nephrotic syndrome
Glomerulus is permeable to plasma membranes
Elimination >3g protein/day
how should urine be tested with nephrotic syndrome?
24 hour urine – measure proteins
Cause of nephrotic syndrome
glomerulonephritis
Diabetes
pathogenesis of nephrotic syndrome
Damage to glomerulus
Increased glomerular permeability
Proteinuria
Hypoalbuminemia
what happens when there is more protein in the urine?
Less in circulation
s/sx nephrotic syndrome
edema – loss of oncotic pressure, fluid into third space
HTN, HLD
Hypercoagulation – loss of antithrombin III and plasminogen
