glomerulonephritis principles Flashcards
what does the glomerular filtration barrier consist of ?
capillary endothelium
basement membrane
podocytes (epithelium)
what are the features of the basement membrane ?
negativley charged molecules
made up of type 4 collagen
heparan sulfate
repels negativley charged molecules like albumin
also a size barrier
why cant albumin go through the filtrate ?
filtered by the GBM charge barrier
what are the common pathological and non pathological causes of heamturia ?
can happen after exercise
can happen due to UTI and kidney stones
feared cause : bladder cancer
what is the hallmark of bleeding from the glomerulus ?
red cell casts
acanthocytes - spikey RBC
proteinuria
what is the gold standard for protein evaluation of urine ?
24 hour urine collection
what are the main 2 presentations associated with glomerular disease ?
nephritic or nephrotic syncrome
nephritic is associated with hte presence of red blood cell casts in the urine
mild proteinuria
nephrotic is associated with massive proteinuria and hyperlipidemia
what is the general pathology associated with nephrotic syndrome ?
filtration barrier to protein is lost , but barrier to RBS is still intact
what are the urine finidings associated with hyperlipidemia ?
fatty casts
oval fat bodies this is mainly seen with nephrotic syndrome due to the loivers compensatory mechanism
why is nephrotic syndrome considered a hypercoaguable state ?
due to the loss of ATIII causing thrombosis
why is there an increased risk of infection in association with nephrotic syndrome ?
due to loss of immunoglobulins
what is the appearance of oval fat bodies under the microscope ?
maltese cross appearance
what is the classic presentation associated with nephrotic syndrome ?
patient complains of frothy urine
edema , peri orbital edema
serum cholesterol is high
proteinuria
what is the general pathology associated with nephritic syndrome ?
inflammatory process that damages the entire glomeruli , both the barier to RBC and protein
what is the level of GFR in nephritic vs nephrotic ?
there is marked decrease associated with nephritic more than nephrotic
what are the mechanisms of edema associated with nephritic syndrome ?
a decrease in GFR causes an increase in hydrostatic pressure hence the edema
the mild proteinuria also plays a role in the edema ( loses the oncotic pressure)
