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Eta 5 Renal > Glomerular injury > Flashcards

Glomerular injury Flashcards

1
Q

What is the difference between a primary and secondary glomerular injury?

A

Primary: just affecting the glomerulus

Secondary: systemic disease that’s damaged the glomerulus

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2
Q

What are the 4 sites of glomerular injury?

A
  1. subepithelial/podocytes
  2. Within glomerular BM
  3. Subendothelial: inside the BM
  4. Mesangial/paramesangial: supporting capillary loop
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3
Q

What is the pathology of proteinuria?

A

Podocyte damage and widening of fenestration slits

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4
Q

What defines nephrotic syndrome? What is the likely site of injury?

A

> 3.5g of protein filtered in 24 hours.

Podocyte/ subepithelial damage

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5
Q

Name 3 primary causes of proteinuria/nephrotic syndrome

A
  1. Minimal change glomerulonephritis (GN)
  2. Focal segmental glomerulosclerosis (FSGS)
  3. Membranous glomerulonephritis
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6
Q

Define glomerulonephritis

A

Damage/inflammation of the glomerular BM

*resulting in altered function

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7
Q

How might a patient present with nephrotic/nephritic syndrome?

A

Nephrotic: low albumin, oedema, frothy urine

Nephritic: Increased BP, coca-cola urine, decreased urine output

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8
Q

How might you investigate a patient with glomerular disease (4)

A

Urine dip/microscopy, BP, Blood, Biopsy

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9
Q

When does minimal change glomerulonephritis usually present?

A

Childhood - adolescence

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10
Q

When and how does focal segmental glomerulosclerosis typically present?

A

Adulthood: Podocytes damaged/scarred (sclerosis), thickened BM

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11
Q

Briefly describe the pathophysiology of membranous glomerulonephritis, what histological features might be noticed?

A

Immune complex deposits in the sub-epithelial space

Histology: ‘speckly BM’, thickened capillary

*most common cause of nephrotic syndrome in adults

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12
Q

Briefly describe the pathophysiology of IgA nephropathy?

A

Deposits of IgA antibody in the glomerulus. (Visible/invisible hematuria, normal C3 complement levels)

*commonest glomerular nephropathy

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13
Q

Name the 2 hereditary nephropathies

A

Anti GBM and Alport syndrome

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14
Q

2 common secondary causes of proteinuria/nephrotic syndrome?

A
  1. Diabetes mellitus

2. Amyloidosis

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15
Q

What is goodpasture syndrome?

A

Rapidly progressing glomerular nephritis, autoantibody to collagen IV in BM (but only affects kidney)

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16
Q

What is HSP Henoch Schonlein Purpur? Describe its common presentation How and when can it commonly present?

A

IgA and IgG interact -> produce complexes -> activate immune response

3-10 years old,

17
Q

What is post strep syndrome? What is a typical history and presentation?

A

Group A hemolytic streptococcus

Throat and skin infection, cokacola urine, swollen ankles or puffy eyes

18
Q

What kind of general management would you offer to a patient with glomerular disease?

A
  1. BP control
  2. Fluid/hydration
  3. Immunosuppressive drugs
  4. Diuretics: fluid overload
  5. Control of hyperkalemia, uremia
  6. Dialysis
  7. ACE inhibitor
19
Q

What does PHAROH stand for?

A

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

20
Q

Where can a urinary tract malignancy occur?

A

Bladder, prostate, urethra, penis

21
Q

5 red flags for UT malignancies?

A

Bone and abdo pain, weight or appetite loss, hematuria, ED

22
Q

What is the ‘Triad’ Signs/symptoms of renal adenocarcinoma?

A

Have Fun Memorising…
Hematuria, flank pain, palpable flank mass

*majority of upper urinary tract tumours

23
Q

How would you diagnose renal adenocarcinoma and what are some treatments?

A

MRI

Partial or radical nephrectomy

24
Q

What is the cause of Wilm’s tumour? How do patient’s typically present?

A

Chromosome 11 mutation

Typically 2-5 years old; large abdo mass + pain, anemia, hypertension, hematuria, weight loss

25
Q

What is the prevalence, risk factors, diagnosis and treatment for ureteric (urothelial cancer)?

A

Uncommon

Smoking, dyes/chemicals, HNPCC

Diagnosis: Ultrasound, ureteroscopy, biopsy, etc

Treatment: nephro-ureterectomy

26
Q

What are the 3 main risk factors for bladder cancer?

What is the prognosis and recurrence rate?

A

Smoking, aromatic amines (chemicals in dye), caucasians

High recurrence and bad prognosis (diagnosed at advanced stages)

27
Q

How could you diagnose and treat bladder cancer?

A

Urine culture and cytology with biopsy

Treat: transurethral resection of bladder tumour, radical cystectomy, radiotherapy

28
Q

5 RFs for prostate cancer

A

> 50, black, genetics, obesity, FH

29
Q

What is PSA Testing, is it reliable?

A

PSA (protein) produced via normal and cancerous prostate cells

*cancer can be present without raised PSA, non-cancerous causes of raised PSA; vigorous exercise, ejaculation, anal sex, DRE

30
Q

What is a major issue with diagnosing prostate cancer ?

A

No national screening (only DRE)

31
Q

What might you find on investigations of nephritic/nephrotic syndrome?

A

Urine: blood, frothy, protein

Blood: increased clotting, reduced albumin, infections, lipids

*hypoalbuminemia can trigger increased production of procoagulants and lipoproteins from the liver

32
Q

What signs indicate advanced prostate cancer?

A

Bone pain and hematuria

Eta 5 Renal (13 decks)

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