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Urinary clinical conditions > Glomerular Pathology > Flashcards

Glomerular Pathology Flashcards

1
Q

What constitutes the glomerular membrane?

A 
Endothelium 
Basal lamina (connective tissue) 
Podocyte foot processes
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2
Q

What cells support capillaries?

A

Mesangial cells

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3
Q

What is the difference between primary and secondary glomerulonephritis?

A

Primary - only affects the glomerulus

Secondary - affects other parts of the body e.g. SLE, Wegeners

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4
Q

What is the aetiology of glomerulonephritis?

A

Immunoglobulin deposition

Some diseases may have no Ig deposition e.g. Diabetic glomerular disease

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5
Q

What are the presentations of glomerulonephritis?

A

Haematuria
Heavy proteinuria
Slowly increasing proteinuria
Acute renal failure

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6
Q

What are the main causes of haematuria?

A

UTI
Urinary tract stone
Urinary tract tumour
Glomerulonephritis

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7
Q

What does biopsy show on IgA glomerulonephritis?

A

Deposition of IgA with prominent mesangial cells

IgA increase proliferation of mesangial cells

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8
Q

In IgA glomerulonephritis, does it present with IgA in the urine?

A

No, IgA isnt filtered it is stuck within the mesangium

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9
Q

What type of cells are present in the urine of someone with IgA glomerulonephroitis?

A

RBC

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10
Q

What is the prognosis of IgA nephropathy?

A

Usually self limiting

Small percentage go onto chronic renal failure via continued deposition of IgA in the matrix

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11
Q

If someone presents with low albumin, where is the pathology?

A

Glomerulus

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12
Q

What is the pathology of membranous glomerulonephritis?

A

Thickened glomerular basement membrane
(IgG deposits in the membrane between basal lamina and podocyte. This causes the basal lamina to spike in order to surround and move the deposit)

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13
Q

How does membranous glomerulonephritis result in low serum albumin ?

A

IgG is too big to be filtered into the urine
IgG activates complement (C3) cascade which punches holes into the filter = allows albumin to leak into the urine = nephrotic syndrome

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14
Q

What is the prognosis for membranous glomerulonephrosis?

A

1/4 in chronic renal failure by 10 years

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15
Q

What can sometimes be the underlying cause of membranous glomerulonephritis?

A

Malignancy

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16
Q

What can be the cause of albumin slowly increasing in the urine over years?

A

Poor glycaemic control in diabetes

17
Q

What is the pathology of diabetic nephropathy?

A

Glycated molecules are deposited in the basal lamina underlying the endothelium = thickened but leaky basement membrane
Glycated molecules are also deposited oin the mesangial matrix which causes compresses capillaries

18
Q

In what type of glomerulonephropathy is Kimmelsteil-wilson lesions found and what are they?

A

Gross excess of mesangial matrix forming nodules

Found in diabetic nephropathy

19
Q

What is the prognosis for diabetic nephropathy?

A

Inevitable decline if poor glycaemic control and its well established

20
Q

What is the pathology of crescentic glomerulonephritis?

A

Crushed glomerulus

Crescent of macrophages around glomerular tuft

21
Q

What are 3 causes of a crescentic glomerulonephritis?

A

Granulomatosis with polyangiitis (Wegener’s granulomatosis)
Microscopic polyarteritis
Antiglomerular basement membrane disease

22
Q

What is granulomatosis wut polyangiitis and what pattern of pathology does it cause?

A

also known as Wegener’s
Its a form of vasculitis (inflammation of the vessels) affecting the kidneys, nose and lungs
Shows a crescentic glomerulonephritis

23
Q

What further tests can you carry out if you suspect Wegeners?

A

ANCA

Anti neutrophil cytoplasmic antibodies

24
Q

What is the prognosis of Wegeners disease?

A

If left untreated = fatal

If treated = 75% remission

25
Q

What is the treatment for wegeners glomerulonephritis?

A

Cyclophosphamide

26
Q

what are the 4 main presentations of glomerular disease?

A

haematuria
heavy proteinuria
slowly progressing proteinuria
acute kidney injury

27
Q

what glomuerular disease presents with proteinuria?

A

membranous glomuerlonephritis

28
Q

what glomerular disease presents with haematuria?

A

IgA glomerulonephritis

29
Q

what glomerular disease causes acute kidney injury?

A

crescentic glomerulonephritis

This pattern of glomerular injury is caused by many diseases such as;

  • glomerulomatosis with polyangitis (Wegener’s disease)
  • microscopic polyarteritis
  • anti-glomerular basement membrane disease
30
Q

what is the prognosis for Wegener’s disease (granulomatosis with polyangitis)?

A

6 months if untreated
75% remission if treated
5 yr survival 80%

31
Q

what is the pathological cause of proteinuria?

A

podocyte damage in the glomerulus
podocytes surround capillaries and are a barrier for filtration
damage to the podocytes disrupts the barrier allowing large proteins such as albumin to be filtered

Urinary clinical conditions (17 decks)

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