Inflammation in the Kidneys Flashcards
What is the name of the cell with lots of ‘legs’ which create the pores in the glomerulus and allow for the filtrate of protein but the retention of proteins?
Podocytes
What triggers the classical complement pathway?
Antigen antibody complexes
What triggers the alternative complement pathway?
Pathogen cell membranes
What is glomerulonephritis?
Inflammation of the glomeruli usually caused by immunological mediated injury to the glomeruli
What 2 mechanisms cause glomerulonephritis?
1) deposition of immune complexes (antibody:antigen complexes)
2) deposition of anti-glomerular basement membrane antibodies
How may glomerulonephritis present?
Hypertension
Microscopic haematuria
Proteinuria
Nephrotic Syndrome (proteinuria, low albumin, high lipids, oedema)
AKI (reduced GFR)
What are renal bruits and when are they heard?
Vascular sounds caused by turbulent flow, in this incidence caused most likely by renal artery stenosis
What is the most common type of glomerulonephritis?
Explain this disease.
Therefore, what type of hypersensitivity reaction is this disease?
IgA nephropathy (Berger disease) (type 3 hypersensitivity)
IgA (mucosal) immune complex accumulation and deposition in the kidneys
Name a condition similar to IgA nephropathy (Berger’s)?
Henoch-scholein purpura - a form of small vessel vasculitis
IgA immune complexes depositing in the vasculature giving an associated rashes
What are some differences between IgA nephropathy and HSP?
HSP
= systemic (therefore leucocytoclasic vasculitis rash and other signs)
= favours younger children
IgA nephropathy
= kidneys only
= favours young adults
What is a typical presentation of IgA nephropathy and HSP?
Hypertension
Haematuria
What symptom can nephrotic syndrome present with?
Why does it present with this?
Oedema due to a protein leak in the kidney
Proteins = main oncotic pressure maintainer
Water therefore moves into tissues where oncotic gradient is higher
What are the most common causes of nephrotic syndrome in children and by what %?
And in adults?
FSGS (focal segmental glomerulosclerosis) (35% in adults)
Minimal change disease (90% in kids, 10% in adults)
And in adults - membranous nephropathy (33% in adults) added into the Ddx, along with amyloid and diabetes
Differentiate between AL Amyloidosis and Multiple Myeloma.
AL Amyloidosis (light chain)
= proteins misfolded and lodged in extracellular tissue space
= can be systemic = multiple organs
= Ig light chain is the misfolded protein which is deposited
Multiple Myeloma
= Bone marrow produced too many light chains compared to heavy
= build up in tissues
= has bone breakdown (so calcium levels high)
What are some complications of nephrotic syndrome?
Hypovolaemia = as fluid is in tissues not circulating
VTE = risk higher
Infections as Ig are lost in urine
