Lecture 13 - Glomerulonephritis And Histolgy Of Glomerulus Flashcards
What is glomerulonephritis?
Inflammation of the glomeruli
What are the 2 types of glomerulonephritis?
Nephritic
Nephrotic
What is the Renal corpuscle?
The Bowmanns capsule and the glomerulus
Go to the last slide (Image 1):
Identify the Renal corpuscle:
-glomerulus
-Bowmanns capsule
Identify:
PCT
DCT
Capilary lumens
Erase the pink on the image below to see
You can distinguish between the PCT and DCT since the PCT has a brush border which is blurry whereas the DCT has no brush border so it is clear near lumen
Go the last slide and look at histology slide 2:
Identify a:
Capillary lumen
Podocyte
PCT
Erase the pink on the image below to see
Go to the last slide, look at slide 3:
Identify the:
Bowmanns capsule
Afferent arteriole
DCT
Juxtaglomerular apparatus/macula densa cells
Peritubular capilaries
Remove the pink to reveal
The afferent arteriole could very well be the efferent arteriole it’s impossible to know without full depth image
Go to the last slide :
Look at slide 4
Label the structures:
What part of the kidney are we in and why?
1 = PCT (brush border visible)
2 = DCT (no brush border visible)
3 = peritubular capillary
Likely medulla not cortex since no renal corpuscles are visible
Not deep medulla since no loops of Henle visible
Look at the last slide:
Look at slide 5
Located the hairpin bend of the Loop Of Henle (remove pink to the right to reveal)
Label the structures 1 and 2
1 = thin descending limb of LoH
2 = thick ascending limb of LoH
What are the 4 structures of the glomerulus than can be inflammed/damaged in glomerulonephritis?
Capillary endothelium
Glomerular basement membrane
Mesangial cells
Podocytes
What is NephrItic syndrome?
Inflammation disrupting the basement membrane of the glomerulus
What is a key presentation of Nephritic syndrome?
Haematuria
Why does Haematuria occur in Nephritic syndrome?
Inflammation of basement membrane leads to the fenestrations of the basement membrane getting larger so RBCs can escape into urine
What colour does the urine appear in Nephritic syndrome?
Brown coloured
What is nephrotic syndrome?
Podocyte damage leading to the charged barrier of the glomerulus being lost
What is a key presentation of Nephrotic syndrome?
Due to Podocyte damage get massive Proteinuria
And therefore
Oedema
Albumin not repelled by the negatively charged footprocesses (they’re damaged)
How can you remember the difference between Nephritic and Nephrotic syndrome?
NephrItic has the I for Inflammation of basement membrane leading to Haematuria
NephrOtic syndrome has the O for Oedema caused by the damage of the Podocyte foot processes
What is the triad seen in nephrotic syndrome?
Proteinuria
Hypoalbuminaemia
Oedema
Why are cholesterol levels often high in nephrotic syndrome?
As a result of the body trying to make more albumin cholesterol levels increase
What is a key change in the urine of a patient with nephrotic syndrome?
Proteinuria
What are some Primary Renal Diseases that cause Nephrotic syndrome?
Minimal change disease (MCD)
Membranous glomerulonephritis
Focal Segmental GlomeruloSclerosis (FSGS)
What is meant by a primary renal disease?
Where the glomerulus itself is affected
What is the most common cause of nephrotic syndrome which is a type of secondary renal disease?
Diabetes
How does diabetic nephropathy lead to end stage renal disease (CKD)?
Chronic hyperglycaemia leads to hyperfiltration (lots of Na+ removed from filtrate)
This leads to activation of RAAS increasing GFR
This hypertension and increased RAAS damages glomerular capillaries
Leads to inflammation and fibrosis in the kidney as well as extracellular matrix accumulation in the glomeruli
Damage to filtration barrier
How is diabetic nephropathy treated?
Anti - Hypertensives
ACEi
Angiotensin receptor blockers
How does the fibrotic changes in the kidney further impair kidney function?
Blood vessels are scarred and stiff
Meaning the Myogenic response to hypertension not as effective
What is minimal change disease (MCD)?
Where theres no significant renal changes under light microscope
But the foot processes dissapear and basement membrane gaps get bigger
What is the most common cause of nephrotic syndrome in kids under 6?
Minimal Change Disease
What is Membranous Glomerulonephritis?
When there’s deposits of immune complexes in the basement membrane leading to thickening of the basement membrane
How do you treat membranous glomerulonephritis?
Immunosuppressants
Treating underlying cause
What is Focus Segmental GlomeruloSclerosis?(FSGS)
Podocytes get damaged leading to proteins building up in the glomerulus leading to Sclerosis
What part of the kidney is affected in Focal Segemented Glomerulosclerosis? (FSGS)
Some glomeruli
And glomeruli that are affected are only partially affected (not entire glomerulus)
How is Focal Segmental Glomerulosclerosis treated?
Steroids
What are the causes of FSGS?
Idiopathic
Sickle cell, HIV, heroin abuse and kidney hyper perfusion increases risk
How are nephrotic syndromes managed?
Diuretics for Oedema
Salt + fluid restriction for oedema
ACE inhibitor for the any inc in BP
Statins for Hypercholesterolaemia dye to albumin production
Treat underlying condition (e.g steroids for Minimal change disease)
What is the triad for Nephritic syndrome?
Haematuria
Reduced GFR (renal impairment/oliguria)
Hypertension
What are 4 common causes of Nephritic syndrome?
IgA Nephropathy (Bergers Disease)
Rapidly progressive Glomerularnephritis
Goodpastures
Post-streptococcal Glomerularnephritis
What occurs in IgA nephropathy/Bergers disease?
Hypertension and IgA levels raised
IgA deposited in mesangium leading to sclerosis
How is IgA nephropathy treated?
Control BP usin antihypertensives
Steroids
What is Rapidly progressive glomerulonephritis?
When theres a severe Glomerular injury leading to a huge mound response to that area
Leakage of fibrin macrophages and epithelial cells proliferate
What shape masses can be seen histologically with rapidly progressive glomerulonephritis?
Crescent shape
How is rapidly progressive glomerulonephritis treated?
High dose steroids
Immunosuppressants
Plasma exchange
What is Goodpastures syndrome?
Antibodies to type IV collagen in glomerular Basement membrane occurs causing inflammation
What does the antibodies to type IV collagen in Goodpastures syndrome cause on the kidney?
Rapidly progressive glomerulonephritis
Acute renal failure
(Lung haemorrhage)
How is Goodpastures syndrome treated?
Plasma exchanges (removes antibodies)
Corticosteroids (reduce inflammation)
What is post-streptococcal glomerulonephritis?
When the damage following a streptococcal infection spreads to the kidneys
What type of strep organism causes post-streptococcal glomerulonephritis?
B haemolytic streptococcal infection
(Tonsils, pharynx or skin)
How is post strep glomerulonephritis treated?
Antibiotics for remaining infection
How is Nephritic syndrome managed?
BP control which also helps reduce proteinuria/Haematuria (ACEi or Angiotensin receptor blockers)
Treat oedema if occurring
Disease specific treatments like immunosuppressants, plasma exchange
Cardiovascualr risk management
Dialysis (short term normally)
What is the key indication if its nephrotic or Nephritic?
Nephrotic = oedema (Podocyte damage)
Nephritic = inflammation of BM (Haematuria)
