Lecture 13-Glomerular Pathology Flashcards
What are the symptoms of nephrotic syndrome?
- proteinuria > 3.5g a day
- oedema due to reduced oncotic pressure
- high cholesterol
What are the symptoms of nephritic syndrome?
- haematuria
- hypertension
- acute renal failure
Where is the likely site of injury in nephrotic syndrome?
Podocyte/subepithelium
What are the common primary causes of nephrotic syndrome?
- minimal change glomerulonephritis
- focal segmental glomerulosclerosis (FSGS)
- membranous glomerulonephritis
What are the common secondary causes of nephrotic syndrome?
- diabetes mellitus
- amyloidosis
True or false: minimal change glomerulonephritis is common in childhood
TRUE
What is the pathophysiology of minimal change disease?
Podocytes lose their processes and split diaphragm -> protein leakage
What is the treatment for minimal change disease?
Steroids
What is FSGS?
Same as minimal change but in adults, with scarring
Why doesn’t FSGS respond to steroids?
Scarring is permanent
True or false: FSGS can progress to renal failure
TRUE
What is membranous glomerulonephritis?
- commonest cause of nephrotic syndrome in adults
- immune complex deposits on podocytes
What is the antigen involved in membranous glomerulonephritis?
Phospholipase A2
What is the commonest cause of haematuria?
IgA nephropathy
What is the site of injury in nephritic syndrome?
Endothelium around capillary loops
Why can’t patients with IgA nephropathy fight infection?
Normally, IgA is secreted on mucosal membranes to stop bacteria entering so infection leads to more IgA production. In this condition, all the IgA is deposited in the nephron instead
What is the treatment for IgA nephropathy?
No effective treatment but ACEI can be used to slow progression
How can thin glomerular basement membrane nephropathy cause haematuria?
GBM is weak and can break -> bleeding
What is Alport syndrome?
X linked condition with abnormal collagen IV (used in basement membranes) -> haematuria and can lead to renal failure
What is Goodpasture syndrome?
- acute onset of severe nephritic syndrome
- associated with pulmonary haemorrhage (collagen IV in alveoli too)
- autoantibody to collagen IV
How can Goodpasture syndrome be treated?
Immunosuppression and plasmaphoresis
What is vasculitis?
Anti-neutrophil cytoplasmic antibody (ANCA) which activates neutrophils against blood vessels -> holes are punched through GBM
