Lecture 16 - Glomerular disease

Question 1

Management of nephrotic syndrome

Answer 1

Oedema:

• Diuretics - furosemide
• Salt and fluid restriction

Proteinuria:
- ACE inhibitors - not if volume deplete

Hypercholesterolaemia - statin

Treat underlying cause - Steroids for MCG

Question 2

Management of nephritic syndrome

Answer 2

Oedema:

• diuretic
• Restrict salt and fluid intake

Proteinuria and hypertension:

• ACE inhibitor
• Angiotensin II receptor blocker

Treat underlying disease:

• Immunosuppresents - prednisolone
• Plasmaphoresis

CVS risk manangement:
- Statin

Dialysis

Question 3

Symptoms of ANCA vasculitis

Answer 3

Fatigue
Arthralgia - pain in joints
Myalgia
Weight loss

Question 4

SLE

Answer 4

Systemic lupus erythematosus
Autoimmune systemic disease
Can cause nephritic and nephrotic syndrome

Nephritic:
- Immune deposits and mesangial hypercellulitis

Nephrotic: Podocyte damage

Question 5

How does hyperglycaemia stimulate RAAS?

Answer 5

1. Increased reabsorption of glucose via SGLT 2 therefore increased sodium absorption.
2. Less sodium reached macula densa which is interpreted as decreased perfusion and low BP
3. RAAS stimulated as renin releases from JGA
4. Vasoconstriction of efferent arteriole increasing GFR

Question 6

How does thickened GBM affect selectivity?

Answer 6

Increased pore size decreases selectivity

Question 7

How does diabetes affect the glomerular filtration barrier?

Answer 7

Damaged podocytes

Thickened GBM and increases pore size

Mesangial expansion

Increased intraglomerular pressure

Kimmel wilson nodules

[In diabetics if normal GFR and have proteinuria not mild kidney disease]

Question 8

Albustix

Answer 8

Specialised dipstick to detect albumin at low concentrations

Question 9

Urine creatinine in women and men

Answer 9

0 - 3.5 mg/mmol

0- 2.5 mg/mmol

Question 10

Diabetic nephropathy risk factors

Answer 10

Genetic susceptibility
Race 
Hypertension
Uncontrolled hyperglycaemia
Increasing age
Smoking
Duration of diabetes 
High level of hyperfilitration

Question 11

Management of diabetic neuropathy

Answer 11

Tight glycaemic control
SGLT 2 inhibitor
Stop smoking
Statin therapy and CVS risk management

Blood pressure control - inhibit RAAS

Question 12

Angiotensin II

Answer 12

1. Increases glomerular permeability to proteins
2. Mesangial expansion
3. Increased mesangial matrix
4. Vasoconstriction of efferent arteriole