Glomerular Pathology Flashcards
What two things can the glomerulus leak?
Protein - proteinurea
Blood - haematuria
What is nephrotic syndrome?
Nephrotic syndrome is a collection of symptoms due to kidney damage.`
It is classified by the triad of: proteinuria, oedema and hypoalbuminaemia
What is nephritic syndrome?
Nephritic syndrome is also a collection fo symptoms due to kidney damage.
However, it is classified by haematuria, reduced GFR and hypertension
What different parts of the kidney are effected in nephrotic/ nephritic syndrome?
Nephrotic = podocytes or basement membrane
Nephritic = wrong with vessel or endothelium as blood not get through.
If it affects the mesangium, then it could be a picture of nephrotic and nephritic syndrome.
What are some common primary causes of nephrotic syndrome?
- Minimal Change Glomerulonephritis
- Focal segmental Glomerulosclerosis (FSGS)
- Membranous Glomerulonephritis
What are some common secondary causes of nephrotic syndrome?
Diabetes
Amyloidosis
SLE
What is minimal change glomerulonephritis?
Common in children / adolescence
Incidence reduces with increasing age
Heavy proteinuria or nephrotic syndrome
Responds to steroids
May reoccur
Usually no progression to renal failure.
What causes minimal change GN?
Damage to podocytes - so no foot processes on the podocytes so they cannot absorb protein properly.
But, don’’t know what circulates in the blood to cause the podocytes to change.
What is FSGS?
Nephrotic
Adults
Glomerulus starts to scar - glomerulosclerosis
Less responsive to steroids
Circulating factor damaging podocytes - know from transplant (different kidney will also leak protein)
Progressive to renal failure.
Don’t know if it is a separate condition to minimal change or if it is just different reaction as older?
What is membranous glomerulonephritis?
Commonest cause of nephrotic syndrome in adults
Rule of 1/3 (1/3 better, 1/3 same, 1/3 worse)
Immune complex deposits
Autoimmune condition
May be secondary (associated with other pathologies e.g. lymphoma)
What causes membranous glomerulonephritis?
It is caused by immune complexes binding to the podocytes and preventing filtration from occurring effectively.
The anti-PLA2R antibody is the most common cause.
How can diabetes cause renal failure?
Causes progressive proteinuria - occurs early on.
This then progresses to renal failure,
It affects the small blood vessels, causes mesangial sclerosis and thickening of the basement membrane.
What conditions can produce haematuria?
IgA Nephropathy
Thin glomerular basement membrane disease / Hereditary Nephropathy
What conditions can cause nephritic syndrome?
Goodpasture syndrome (Anti-GBM disease)
Vasculitis
What is IgA Nephropathy?
Commonest GN
Any age
Classically present eith visible / invisible haematuria
Relationship with mucosal (upper respiratory tract) infections
Variable histological features and course
+/- proteinurea
Significant proportion progress to renal failure
No effective treatment.
What causes IgA nephropathy?
Too many cells or too much cytoplasm in mesangium.
Immune complex deposition
What is thin GBM Nephropathy?
Hereditary Benign familial Nephropathy Isolated haematuria Thin GBM Benign course
What is Alport’s disease?
Hereditary X-linked Abnormal collagen IV Associated with deafness Abnormal appearing GBM Progress to renal failure.
What is goodpasture syndrome?
Anti-GBM disease
Relatively uncommon though clinically important
Rapidly progressive
Acute onset of severe nephritic syndrome - very unwell at presentation
Classically described association with pulmonary haemorrhage (smokers)
Autoantibody to collagen IV in basement membrane
Treatable by immunosuppressive and plasmapheresis if caught early.
Will probably need renal transplant
What is vasculitis?
Group of systemic diseases - inflammation of blood vessels.
No immune complex / antibody deposition
Association with anti neutrophil cytoplasmic antibody (ANCA)
Nephritic presentation (RPGN)
Treatable if caught early.
Urgent biopsy service
Blindness, stoke symptoms, renal failure
