Intro to Glomerular Disease

Question 1

3 layers of the glomerular filtration barrier

Answer 1

Fenestrated endothelial cells with basement membrane
Glomerular basement membrane
Podocytes with slit diaphragm

Question 2

Glomerularnephritis

Answer 2

Glomerular disease
Generic title meant to include a variety of disease with immune-mediate injury to the glomerulus
Require a kidney biopsy for definitive diagnosis
Most types have a high risk of progression to end stage renal disease
Treat with immunosuppression medications

Question 3

2 broad groups of GNs

Answer 3

Nephrotic syndrome: due to isolated injury of the filtration barrier
Nephritic syndrome: due to diffuse inflammation in the glomerulus

Question 4

Nephrotic syndrome

Answer 4

Loss of function of the glomerular filtration barrier
Proteinuria (>3.5), hypoalbuminemia, hypercholesterolemia, peripheral edema
Not a disease, it is a pattern of clinical presentation
Early on the GFR is normal, starts to decrease as scarring develops

Question 5

7 complications of nephrotic syndrome

Answer 5

Hypoalbuminemia
Periperhal edema (often severe)
Hypercholesterolemia
Hypercoagulability and VTE
Infection
Acute kidney injury
Lipiduria

Question 6

Minimal change disease

Answer 6

Diffuse foot process effacement on TEM (protein in urine)
Tends to present with sudden onset peripheral edema over several weeks
Younger children and older adults
Most respond to steroids

Question 7

Focal segmental glomerulosclerosis

Answer 7

Diffuse foot process effacement on TEM (protein in urine)
More common to present in adulthood
Rare variants can present in children
Worse prognosis than MCD

Question 8

Membranous nephropathy

Answer 8

Most common cause of nephrotic syndrome in Caucasians

Thickened capillary wall due to immune complex deposits under the podocytes and expansion of the GBM

Question 9

Nephritic syndrome

Answer 9

Glomerularnephritis due to diffuse glomerular inflammation
Influx of inflammatory cells into the capillaries and/or mesangium of the gomerulus
Proteinuria (less severe than nephrotic), dysmorphic RBCs, moderate edema, RBC casts

Question 10

ANCA vasculitis

Answer 10

Anti-neutrophil cytoplasmic antibodies
Multi-system disease
Results in GN
Severe presentation with rapid progression to kidney failure

Question 11

Lupus nephritis

Answer 11

SLE can affect any organ in the body

Immune complexes deposit in the glomeruli and induce glomerular damage

Question 12

IgA nephropathy

Answer 12

Most common type of GN
IgA immune complex deposits on the kidney biopsy
Rarely can have severe pathology features
Disease severity is highly variable