Glomerular injury Flashcards
(32 cards)
What is the difference between a primary and secondary glomerular injury?
Primary: just affecting the glomerulus
Secondary: systemic disease that’s damaged the glomerulus
What are the 4 sites of glomerular injury?
- subepithelial/podocytes
- Within glomerular BM
- Subendothelial: inside the BM
- Mesangial/paramesangial: supporting capillary loop
What is the pathology of proteinuria?
Podocyte damage and widening of fenestration slits
What defines nephrotic syndrome? What is the likely site of injury?
> 3.5g of protein filtered in 24 hours.
Podocyte/ subepithelial damage
Name 3 primary causes of proteinuria/nephrotic syndrome
- Minimal change glomerulonephritis (GN)
- Focal segmental glomerulosclerosis (FSGS)
- Membranous glomerulonephritis
Define glomerulonephritis
Damage/inflammation of the glomerular BM
*resulting in altered function
How might a patient present with nephrotic/nephritic syndrome?
Nephrotic: low albumin, oedema, frothy urine
Nephritic: Increased BP, coca-cola urine, decreased urine output
How might you investigate a patient with glomerular disease (4)
Urine dip/microscopy, BP, Blood, Biopsy
When does minimal change glomerulonephritis usually present?
Childhood - adolescence
When and how does focal segmental glomerulosclerosis typically present?
Adulthood: Podocytes damaged/scarred (sclerosis), thickened BM
Briefly describe the pathophysiology of membranous glomerulonephritis, what histological features might be noticed?
Immune complex deposits in the sub-epithelial space
Histology: ‘speckly BM’, thickened capillary
*most common cause of nephrotic syndrome in adults
Briefly describe the pathophysiology of IgA nephropathy?
Deposits of IgA antibody in the glomerulus. (Visible/invisible hematuria, normal C3 complement levels)
*commonest glomerular nephropathy
Name the 2 hereditary nephropathies
Anti GBM and Alport syndrome
2 common secondary causes of proteinuria/nephrotic syndrome?
- Diabetes mellitus
2. Amyloidosis
What is goodpasture syndrome?
Rapidly progressing glomerular nephritis, autoantibody to collagen IV in BM (but only affects kidney)
What is HSP Henoch Schonlein Purpur? Describe its common presentation How and when can it commonly present?
IgA and IgG interact -> produce complexes -> activate immune response
3-10 years old,
What is post strep syndrome? What is a typical history and presentation?
Group A hemolytic streptococcus
Throat and skin infection, cokacola urine, swollen ankles or puffy eyes
What kind of general management would you offer to a patient with glomerular disease?
- BP control
- Fluid/hydration
- Immunosuppressive drugs
- Diuretics: fluid overload
- Control of hyperkalemia, uremia
- Dialysis
- ACE inhibitor
What does PHAROH stand for?
Nephritic syndrome:
P: Proteinuria
H: Hematuria
A; Azotemia: increased creatinine and urea
R: RBC casts (RBC gets a tubular skinny shape from squeezing through kidney tubles)
O: Oliguria
H: Hypertension
Where can a urinary tract malignancy occur?
Bladder, prostate, urethra, penis
5 red flags for UT malignancies?
Bone and abdo pain, weight or appetite loss, hematuria, ED
What is the ‘Triad’ Signs/symptoms of renal adenocarcinoma?
Have Fun Memorising…
Hematuria, flank pain, palpable flank mass
*majority of upper urinary tract tumours
How would you diagnose renal adenocarcinoma and what are some treatments?
MRI
Partial or radical nephrectomy
What is the cause of Wilm’s tumour? How do patient’s typically present?
Chromosome 11 mutation
Typically 2-5 years old; large abdo mass + pain, anemia, hypertension, hematuria, weight loss
