Glomerular Pathology Flashcards
What are renal cortical compartments?
Glomerular = site of filtration
Tubular = PCT, DCT
Interstitial = small space between tubules
Vascular = blood apply particular efferent/afferent arterioles
What is the role of mesangial cells?
Hold capillaries in place within bowmans capsule
Remove trapped residues and aggregated proteins from the basement mem = filter free of debris
Describe the layers of the glomerulus
Podocyte foot processes – slit processes reside
Layer of basement mem
Endothelium – fenestrated
What happens when the kidney filter blocks?
Lowers GFR
= renal failure
What happens when the kidney filter leaks?
Proteinuria
Haematuria
Define nephrotic syndrome
Proteinuria (mostly albumin)
> 3.5g of protein loss in 24hrs
Presents = proteinuria, oedema, high cholesterol (loss of cholesterol binding proteins), hypoalbuminaema
Define nephritic syndrome
Blood in urine (may have small amount of protein)
Injury to endothelium in capillary loops
In acute renal failure
Hypertensive = normal BP regulation by the kidney is lost
Renal injury can be classified as?
Primarily = kidney only
Secondary = effect whole body
What are the common causes of nephritic syndrome?
IgA
Anti-GBM
Post-infectious
Lupus
What are the primary and secondary causes of nephrotic disease?
Site of injury = podocyte/subepithelial
Primary causes =
1) minimal change glomerulonephritis
2) focal segmental glomerulosclerosis (FSGS)
3) membranous glomerulonephritis
Secondary causes =
1) DM
High protein loss = oedema
Outline minimal change glomerulonephritis
Young
Heavy proteinuria = damage to podocytes = cant selectively filter
Steroids
May recur
Glomerulus appears completely normal on H+E
What is the pathogenesis of minimal change glomerulonephritis?
Unknown circulating factor damaging podocytes
Outline focal segmental glomerulosclerosis FSGS
Nephrotic
Adult
Less steroid responsive due to scaring
Glomerulosclerosis = scaring of glomerulus
Unknown circulating factors damaging podocytes = loss of selectivity
Progressive to renal failure – but transplant will also get FSGS
Outline membranous glomerulonephritis
Adults
Third will get better
Third will not get worse
Third will progress to renal failure
Immune complex deposits in the glomerulus = loss of selectivity
Autoimmune
How does DM effect the kidney?
Proteinuria
Renal failure
Microvascular damage
Mesangial sclerosis = nodules
Basement membrane thickening (6-7x)
