Glomerulonephritis Flashcards
What are all conditions affecting the glomerulus known as?
All conditions affecting the glomerulus are called glomerulonephritis (glomerulopathy too)
What are the types of kidney diseases?
Tubulointerstitial diseases (diseases of tubules and interstitium)
Vascular diseases of the kidneys
Glomerulonephritis (not all inflammatory so some call it gomerulopathy)
What is a problem with separating the 3 diseases?
Sometimes all 3 compartments are affected and it is hard to tell where it started.
What is the second most common common cause of chronic renal failure requiring dialysis/renal transplantation?
Glomerulonephritis is the second most common cause of chronic renal failure.
(Diabetes is the most common cause of renal failure, hypertension third most common)
What is azotaemia?
Rise in creatinine/serum urea, this takes days or weeks typically. When it becomes symptomatic it is called ureamia.
When is chronic renal failure defined as end stage?
Chronic renal failure takes place over long time and is defined as end stage when eGFR is less than 5%
What is done to patients with chronic renal failure?
The idea is to maintain quality of life using dialysis for as long as possible after end stage renal failure
What are the symptoms of renal dysfunction?
Extensive list of symptoms and signs of renal dysfunction include primarily:
Lethargy
Anorexia
SOB
Peripheral neuropathy
Oedema
The actual symptoms include many more signs and symptoms that are systemic in nature due to systemic nature of kidney function
What are the prerenal factors that cause renal failure?
Factors that interfere with blood flow to kidney (example dehydration causing hypovolemia)
What are the renal factors that cause renal failure?
Damage to glomeruli, tubular or interstitium, glomerulonephritis, acute tubular necrosis, acute interstitial nephritis, tumor lysis syndrome, drug induced nephrotoxicity, contrast-induced nephropathy
What are the postrenal factors that cause renal failure?
Factors that affect urine outflow through obstruction (eg calculi)
What is nephritic syndrome?
Acute renal failure is similar
Azotemia/uraemia
Oliguria
Haematuria (often macroscopic but hard to tell by patients and urine starts to darken but doesn’t look like blood)
Mild to moderate proteinuria
Hypertension
Usually due to glomerulonephritis (until proven otherwise)
What is Rapidly Progressive Glomerulonephritis (RPGN)?
Subset of nephritic syndrome
Rapid rise in serum urea/creatinine
Usually due to crescenteric glomerulonephritis
What is nephrotic syndrome?
Nephrotic range proteinuria (>3.5g/24 hours) and low albumin in blood (caused by increased glomerular capillary permeability)
Hypoalbuminaemia (low serum protein due to losing it to the glomerulus)
Peripheral oedema (due to reduced serum oncotic pressure due to lower protein and albumin in blood causing fluid to be hypotonic to intracellular environment)
hyperlipidaemia (due to increase in hepatic lipid synthesis)
lipiduria
proteinuria
What is the primary cause of nephrotic syndrome?
Abnormal increase in permeability
What happens when the serum protein and albumin is low during nephrotic syndrome?
Liver compensates by producing more lipids causing hyperlipidaemia in response to loss of albumin and increase of water build up in the kidney due to change in oncotic pressure
What is the mesangial matrix?
Mesangial matrix is the scaffold of the glomerulus which holds the capillary loops together.
What causes the majority of glomerulonephritis syndromes?
Immune complex mediated glomerulonephritis
How can glomerulonephritis be diagnosed?
Glomerulonephritis can only be diagnosed via tissue biopsy using 3 diagnostic modalities: light microscopy, immunoflorscence (using fluorescent microscopy), and electron microscopy (extremely high magnification).
What are the types of glomerulonephritis and what causes them?
Primary no identifiable cause (idiopathic)
Secondary can be caused by drugs, infection, autoimmune disease, or malignancy
Who typically gets minimal change disease?
Usually in children
Who gets membranous nephropathy?
Membranous nephropathy is seen in middle aged males.
What happens in membranous nephropathy? What causes membranous nephropathy and what is the prognosis?
Autoantibodies to A2 receptor on the podocytes
Secondary causes: drugs, infections (HepB and syphilis), autoimmune diseases (Thyroiditis) and malignancy
40% spontaneous remission
What is focal segmental glomerulosclerosis?
Sclerosis means hardening and scarring
Fibrous adhesions to renal capsule
immunofluorescence shows segmental IgM and C3 because IgM has highest molecular heavy weight and this causes it to deposit in area of large amounts of IgM deposited passively NO IMMUNE COMPLEXES