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Urinary System > Glomerular Pathology and Clinical Presentations of Kidney Disease > Flashcards

Glomerular Pathology and Clinical Presentations of Kidney Disease Flashcards

1
Q

What are the 4 renal cortical ‘compartments’?

A

Glomerular
Tubular
Interstitial
Vascular

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2
Q

What are the 3 parts of the filtering mechanism?

A

Podocytes
Basement membrane
Endothelium
(Pathology can occur in any one of these)

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3
Q

What are the effects if the filter gets blocked?

A

Decreased GFR

Renal failure

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4
Q

What is nephrotic syndrome?

A

Loss of significant amounts of protein
(Mainly albumin)
Decreased oncotic pressure - oedema

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5
Q

What is nephritic syndrome?

A

Blockage of the glomerulus
Decreased GFR - AKI
Go into renal failure
Often haematuria and hypertension

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6
Q

If a patient presents with nephrotic syndrome, what is the likely site of injury?

A 
Podocyte layer 
(Subepithelial)
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7
Q

What are the common primary causes of nephrotic syndrome?

A

Minimal change glomerulonephritis
Focal segmental glomerulosclerosis (FSGS)
Membranous glomerulonephritis

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8
Q

What are the common secondary causes of nephrotic syndrome?

A

Diabetes mellitus

Amyloidosis

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9
Q

Describe minimal change glomerulonephritis

A 
Childhood/adolescence 
Incidence reduces with increasing age 
Heavy proteinuria/nephrotic syndrome 
Responds to steroids 
May recur 
Usually no progression to renal failure 
Glomerulus looks normal under a microscope - need electron
An unknown circulating factor damages the podocytes
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10
Q

Describe FSGS

A 
Nephrotic 
Glomerulosclerosis (scarred) 
Adults
Less responsive to steroids 
Circulating factor damages podocytes 
Progressive to renal failure - dialysis needed
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11
Q

Describe membranous glomerulonephritis

A

Commonest cause of nephrotic syndrome in adults
Rule of thirds:
1/3 get better
1/3 stay the same
1/3 go onto end stage renal failure
Immune complex deposited - antigen attaches to podocytes then lots of IgG binds
Probably autoimmune but may be secondary

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12
Q

Describe the long term effects of diabetes mellitus on the kidneys

A

Kidneys get more and more leaky - progressive renal failure
Mesangial sclerosis - nodules that are easy to pick up histologically
Basement membrane thickening

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13
Q

Describe IgA nephropathy

A 
Commonest glomerulonephritis 
Can occur at any age 
Classically presents with haematuria 
Relationship with mucosal infections 
Variable histological features and course
\+/- proteinuria 
A significant proportion progress to renal failure 
No effective treatment
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14
Q

What are the 2 extremes of hereditary nephropathies?

A

Thin GBM nephropathy and benign familial nephropathy
To
Alport syndrome

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15
Q

Describe thin GBM nephropathy

A

Isolated haematuria
Thin GBM
Benign course

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16
Q

Describe Alport syndrome

A 
X linked 
Abnormal collage IV 
Associated with deafness
Abnormal appearing GBM 
Progresses to renal failure 
'Basket weaving' abnormally split
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17
Q

Describe Goodpasture syndrome

A

Anti GBM disease
Relatively uncommon but clinically important
Rapidly progressive - acute onset of severe nephritic syndrome
Difficult to reverse
Association with pulmonary haemorrhage (high BP)
Autoantibody to collage IV in BM

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18
Q

What is the treatment for Goodpasture syndrome?

A 
Immunosuppression 
Plasmaphoresis (give donor plasma to get rid of the autoantibody)
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19
Q

Describe vasculitis

A

Group of systemic disorders
No immune complex or antibody deposition
Association with anti-neutrophil cytoplasmic antibody (ANCA)
Nephritic presentation
Treatable if caught early
Urgent biopsy

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20
Q

Are kidney diseases painful?

A

Rarely

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21
Q

How do many kidney diseases present?

A

No symptoms

22
Q

What is acidotic breathing?

A

Over-breathing

Trying to compensate for acidosis by blowing off more CO2

23
Q

If patients say they are tired all the time, what investigations should be done?

A

FBC

Kidney function tests

24
Q

What is uraemic syndrome?

A

Haemolytic anaemia
Acute kidney injury
Low platelet count
Very severe

25
How much extra water do you have to retain before getting peripheral oedema?
5L
26
What are some consequences of tubular dysfunction?
Impaired concentrating ability - increased frequency and nocturia Acidosis Glycosuria Hormonal complications - metabolic bone disease because cannot activates vit D, anaemia due to lack of EPO and hypertension due to increased renin
27
Why do we usually urinate less frequently at night?
Urine is diurnally regulated | Concentrated more at night
28
Why might glycosuria present with tubular dysfunction?
Tubular disease causes a lower tubular threshold for glucose Therefore may excrete glucose even when plasma glucose levels are normal
29
Who should be screened for kidney disease?
``` Hypertension Heart disease Diabetes Urinary tract obstruction Systemic disease (myeloma, lupus etc) ```
30
Give some causes of microscopic haematuria
``` UTIs Polycystic kidneys Renal stones Renal/bladder tumours Arteriovenous malformations Kidney/glomerular disease ```
31
What colour will blood be in from glomerular disease?
Brown/smoky in colour
32
Are clots in the blood in urine likely if from the kidneys?
No
33
Describe the blood in urine from glomerular disease
Brown/smoky in colour Blood throughout stream Painless Clots are very unusual
34
Give some other causes of discoloured urine (brownish)
Haemoglobinuria Myoglobinuria Consumption of food dyes
35
What is the commonest glomerular cause of haematuria?
IgA nephropathy
36
What are red cell casts?
Binding of RBCs to a tubular protein that is always present in the urine
37
Why are there often dysmorphic RBCs in the blood?
Squeezed through the filtration barrier
38
What does urine with protein in it look it?
Frothy
39
Why are people with proteinuria more susceptible to infections?
Loss of immunoglobulins
40
Why are people with proteinuria in a pro-thrombotic state?
Increased risk of clotting due to imbalance of regulators of coagulation cascade
41
What is the classic triad of findings with nephrotic syndrome?
Proteinuria Hypoalbuminaemia Oedema
42
Why might you get hyperlipidaemia with nephrotic syndrome?
Disturbances to liver function
43
What extra-urinary signs suggest nephrotic syndrome?
Muehrcke's bands - horizontal lines across the nails Xanthelasma Fat bodies in urine
44
Describe the manifestation of nephritic syndrome
``` Rapid onset Oliguria Hypertension Generalised oedema Haematuria Normal serum albumin Variable renal impairment Some proteinuria ```
45
What is required for a diagnosis of a nephritic syndrome?
Renal biopsy
46
How do nephritic and nephrotic syndromes different?
``` Nephrotic: More gradual onset More oedema Normal BP (raised in nephritic) Normal/low JVP More proteinuria Less haematuria Red cell casts usually absent Lower serum albumin ```
47
What is rapidly progressive glomerulonephritis?
Glomerular injury so severe that renal function deteriorates over days May present as uraemic emergency Associated with crescenteric glomerulonephritis Antineutrophil cytoplasmic antibodies Anti GBM antibodies Often associated with systemic vasculitis
48
How is the glomerulus damaged in vasculitis?
'Blown apart' by inflammation in the blood vessels Fibrin leaks out Profound effect on filtration and tubular function
49
What are the pulmonary manifestations of vasculitis?
Opacities | Cavitation lesions
50
With CKD, under what eGFR do you have to be before symptoms occur?
< 30 ml/min
51
At what eGFR would we start patients on dialysis?
8 - 10 ml/min
52
Give some of the many symptoms of CKD
``` Tired/lethargic Breathlessness Nausea/vomiting Aches and pains Sleep reversal Nocturia Restless legs Itching Chest pains Seizures and coma ```

Urinary System (14 decks)

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