Glomerular Pathology Flashcards

1
Q

What characterises nephrotic syndrome?

A
  • Proteinuria
  • Hypoalbumiaemia
  • Peripheral oedema
    (also hyperlipidaemia)
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2
Q

How does urine appear in a patient with nephrotic syndrome?

A

Frothy

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3
Q

Why does hypoalbuminaemia occur in a patient with nephrotic syndrome?

A

Albumin is lost in urine -> proteinuria

This is because gaps in podocytes allow proteins to leak

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4
Q

Why does a patient with nephrotic syndrome present with peripheral oedema?

A

Decreased intravascular oncotic pressure

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5
Q

Why does a patient with nephrotic syndrome present with hyperlipidaemia?

A

Liver tries to compensate for hypoalbuminaemia and increases production - the side effect is an increase in the production of lipids

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6
Q

What are the primary causes of nephrotic syndrome?

A
  • Minimal change glomerulonephritis
  • Focal segmental glomerulosclerosis
  • Membranous glomerulonephritis
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7
Q

What are some secondary causes of nephrotic syndrome?

A
  • SLE
  • Hep B and C
  • HIV
  • Diabetes
  • Malignancy
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8
Q

What kind of syndrome does minimal change glomerulonephritis lead to?

A

Nephrotic syndrome

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9
Q

How does minimal change glomerulonephritis appear under a microscope?

A

Under light microscope - normal

Under electron microscope - loss of foot processes on podocytes - widening of filtration slits

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10
Q

What do most patients with minimal change glomerulonephritis respond well to?

A

Steroids

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11
Q

What is the pathogenesis of minimal change glomerulonephritis?

A

Unknown circulating factor causing damage to podocytes

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12
Q

What is focal segmental glomerulosclerosis and what does it lead to?

A

Nephrotic syndrome

Like the adult version of minimal change

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13
Q

What is the commonest cause of primary nephrotic syndrome in adults?

A

Membranous glomerulonephritis

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14
Q

What is one difference between membranous glomerulonephritis and focal segmental glomerulosclerosis?

A

FSGM - no immune complexes deposited

MGN - immune complexes are deposited

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15
Q

What characterises nephritic syndrome?

A
  • Haematuria
  • Oligouria
  • Red cell casts (distinguishing feature)
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16
Q

What is the most common cause of primary nephritic syndrome?

A

Berger’s disease (IgA nephropathy)

17
Q

What are some causes of nephritic syndrome?

A
  • Post streptococcal glomerulonephritis
  • IgA nephropathy
  • Goodpasture’s syndrome
  • SLE
  • Hepatitis
  • Systemic vasculitis
18
Q

What is goodpasture’s syndrome?

A

An autoimmune disease in which antibodies attack the basement membrane in lungs and kidneys, leading to bleeding from the lungs and kidney failure

19
Q

In what syndrome are red cell casts present?

20
Q

What is Alport syndrome?

A

A genetic disease characterised by progressive chronic kidney disease with symptoms of haematuria, sensorineural deafness and ocular abnormalities

21
Q

How is Alport syndrome inherited?

A

X linked recessive

22
Q

What is the cause of Alport syndrome?

A

Mutation in the gene that codes for a5 chain of type IV collagen

23
Q

What class of drugs are known to slow the progression of renal disease?

A

ACE inhibitors

24
Q

What are the 3 layers of the glomerulus?

A

Endothelium, basement membrane (type IV collagen) and epithelial podocytes

25
What is the name of the spaces between the foot processes of podocytes?
Filtration slits
26
What is the commonest cause of end stage renal disease?
Diabetic nephropathy
27
Why isn't diabetic nephropathy seen in children?
It does not develop until a patient has had diabetes | (either type 1 or type 2) for around 8-15 years.
28
What is the earliest change seen in diabetic nephropathy?
Hyperfiltration and an increase in GFR
29
What histological changes are seen in diabetic nephropathy?
Glomerular BM thickening, mesangial expansion and glomerular sclerosis
30
What is diabetic nephropathy characterised by?
- Proteinuria - A gradual decline in GFR - Hypertension
31
Why does a thickened GBM allow more bigger molecules to get through?
Thickened GBM increases pore size, also high intraglomerular pressure increases chance of more bigger molecules getting through
32
What are the nodules seen in diabetic nephropathy called?
Kimmelstiel-wilson nodules
33
What is the first clinical sign of diabetic nephropathy?
Microalbuminuria
34
Why does GFR fall in the later stages of diabetic nephropathy?
Mesangial expansion/sclerosis -> reduced surface area for filtration Overt proteinuria
35
How long do most patients with diabetic nephropathy take to reach end stage kidney disease?
3-7 years
36
What are the risk factors for diabetic nephropathy?
- Genetics - Race (causasians have a lower risk) - Hypertension - Hyperglycaemia - High level of hyperfiltration - Older age - Smoking
37
How can you prevent diabetic nephropathy?
Tight glycaemic and BP control
38
What effect does angII have on glomerularly permeability to proteins?
Increases permeability
39
What histological changes are seen in hypertensive nephrosclerosis?
- Vascular changes tor renal arteries and arterioles - Fibroelastic intimal thickening - narrowing of lumen - Hyalinosis of afferent arteriolar walls