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Urinary > Glomerulonephritis + Histology Of Glomerulus > Flashcards

Glomerulonephritis + Histology Of Glomerulus Flashcards

1
Q

Differentiate between DCT and PCT on histology

A

DCT is hollow
PCT has brush border (fuzzy)

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2
Q

What is glomerulonephritis?

A

Inflammation of glomeruli

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3
Q

What can be damaged in glomerulonephritis?

A

Capillary endothelium
Glomerular basement membrane
Mesangial cells
Podocytes

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4
Q

What charge do podocytes have?
What does this do?

A

Negative charge
Repels albumin

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5
Q

Types of glomerularnephritis

A

Nephritic syndrome
Nephrotic syndrome

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6
Q

Outline nephritic syndrome

A

NeprItic - Inflmmation
- inflammation disrupts glomerular basement membrane

Triad of:
- haematuria (coke coloured urine)
- reduction in GFR
- hypertension

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7
Q

Outline nephrotic syndrome

A

NeprOtic - Oedema
- podocytes (foot processes) damage > glomerular charge barrier disruption > proteins can pass through

Triad of:
- proteinuria
- hypoalbuminaemia
- oedema

usually accompanied by hypercholesteroaemia

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8
Q

Causes of nephrotic syndrome

A
  • diabetes (most common cause)
  • minimal change disease (children)
  • membranous glomerulonephritis (adults)
  • focal segmental glomerulosclerosis
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9
Q

What is the leading cause of end stage renal disease?

A

Diabetic nephropathy

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10
Q

Treatment of membranous glomerulonephritis

A

Immunosuppressants
Treatment of underlying cause

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11
Q

What is minimal change disease?

A
  • Foot processes of podocytes bind together
  • Albumin + other proteins can pass through glomerulus > nephrotic syndrome (proteinuria, oedema + hypoalbuminaemia)
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12
Q

What is membranous glomerulonephritis?

A

Auto immune deposits within the basement membrane > thickening of basement membrane
(Cause of nephrotic syndrome)

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13
Q

What is focal segmental glomerulosclerosis?

A
  • ‘focal’: in some glomeruli (not all)
  • podocytes are damage
  • proteins build up in glomerulus
  • this leads to sclerosis
    (Cause of nephrotic syndrome)
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14
Q

Treatment of focal segmental glomerulosclerosis

A

Steroids

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15
Q

Management of nephrotic syndrome

A

Manage individuals symptoms
- diuretics, salt/fluid resection - oedema
- ACE inhibitor
- statin - hypercholestolaemia
- LMWH - due to hypercoagulable state

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16
Q

Causes of nephritic syndrome

A
  • IgA nephropathy
  • Rapidly progressive glomerulonephritis
  • Post streptococcal glomerulonephritis
  • Goodpasture’s syndrome (anti GMB)
17
Q

Outline IgA nephropathy

A
  • Hypertension
  • raised IgA levels > deposited in mesangium
  • this leads to sclerosis of damaged section
  • causes recurrent haematuria
    (Causes nephritic syndrome)
18
Q

Treatment of IgA nephropathy

A

Control BP
Antihypertensives
Steroids

19
Q

Outline rapidly progressive glomerulonephritis

A
  • severe glomerular injury > leakage of fibrin, macrophages + epithelial cells proliferate
  • crescent shape mass forms > decreased blood supply
  • loss of renal function
    (Causes nephritic syndrome)
20
Q

Treatment of rapidly progressive glomerulonephritis

A

High dose steroids
Immunosuppressants
Plasma exchange

21
Q

Outline Goodpasture’s syndrome/anti-GBM disease

A
  • antibodies to type IV collagen in glomerular basement membrane develop > inflamamtion
  • leads to rapidly progressive glomerulonephritis, acute renal failure + lung haemorrhage (causes haemoptysis)

(Causes nephritic syndrome)

22
Q

Treatment of Goodpasture’s syndrome

A

Plasma exchanges (to remove antibodies)
Corticosteroids (to reduce inflammation)

23
Q

Outline post-streptococcal glomerulonephritis

A
  • presents 1-3 weeks following streptococcal infection e.g. tonsillitis> spreads to kidneys

(Causes nephritic syndrome)

24
Q

Treatment of post streptococcal glomerulonephritis

A

Antibiotics to treat remaining infection

25
Q

Management of nephritic syndrome

A
  • ACE inhibitors
  • diuretics
  • immunosuppressants
  • stop smoking
  • statins
  • dialysis
26
Q

If a patient presents with coke coloured, are they more likely to have nephrotic or nephritic syndrome?

A

Nephritic syndrome
Coke coloured due to blood in urine

27
Q

Why do the kidneys get bigger in early diabetic nephropathy?

A
  • hyperglycaemia > hyper-filtration in kidneys
  • damages glomerular capillaries
  • release of inflammatory mediators + growth factors
  • inflammation + tissue remodelling of kidney triggers
  • this leads to fibrosis + reduced renal function
  • extracellular matrix accumulation in glomeruli > further impairing function
  • thickening of basement membrane
28
Q

Define nephrotic syndrome

A

Triad of:
- proteinuria
- hypoalbuminaemia
- oedema

29
Q

Define nephritic syndrome

A

Triad of:
- haematuria (coke coloured urine)
- reduction in GFR
- hypertension

30
Q

What part of the glomerular capillary wall is affected in nephrotic syndrome

A

Foot processes of the podocytes

31
Q

What are the mesangial cells?
What do they do?

A
  • smooth muscle like cells that contain actin + myosin
  • contraction of mesangial cells regulates the size of capillary lumen > regulates amount of glomerular blood flow
32
Q

Why does nephrotic syndrome present with oedema?

A
  • large amounts of albumin lost in urine > hypoalbuminaemia
  • reduces oncotic pressure in plasma
  • less water drawn in capillaries + remains in interstitum
  • oedema
33
Q

Why do you give LMWH during treatment of nephrotic syndrome?

A

Clotting factors are excreted in the urine so the patient is in a hypercoagulable state and at risk of clotting + VTE

34
Q

What could frothy/bubbly urine indicate?

A

Proteinuria

Urinary (24 decks)

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