Lecture 5: Nephritic and nephrotic conditions Flashcards
How can glomerular disease be classified?
- hereditary
- primary (most common): disease originates from glomerulus
- secondary to systemic diseases e.g. lupus, diabetes mellitus, bacterial endocarditis
What is glomerulonephritis?
Inflammation of the glomerulus
many of these can go on to form chronic kidney disease
What structures in the glomerulus are prone to damage?
- capillary endothelial cell lining
- glomerular basement membrane
- mesangium supporting the capillaries
- podocytes
What is nephrotic syndrome characterised by?
Proteinuria (>3g per day) because there is an increased permeability to albumin as a result of the glomerular basement membrane damage and increase in pore size
- causes hypoalbuminaemia, causing oedema
- because the body is losing lots of protein, the body stimulates lipid production= hyperlipidaemia
How do we manage nephrotic syndrome?
- blood pressure control
- ACE inhibitors (reduce BP in glomerulus)
- control hyperlipidaemia
- anticoagulation drugs (risk of thrombosis increases as albumin decreases)
- treatment of underlying cause when possible
What are some key nephrotic conditions? (lead to nephrotic syndrome)
Diabetic nephropathy
- excess glucose in blood binds to proteins, especially at efferent arteriole, obstructing flow (hyaline atherosclerosis), causing an increase in GFR
- over time mesangial cells secrete more structural membrane, thickening the basement membrane
- so over time we see a reduction in GFR
Minimal change disease
-no significant changes under light microscope
Membranous glomerulonephritis
- subepithelial deposition of immune complexes, causing thickening of basement membrane
- this causes it to become leaky as the pores get bigger
Focal segmental glomerulosclerosis (FSGS)
- only affects some of the glomeruli, and of them, only some of the glomerulus is affected
- podocytes damaged causing proteins to build up in glomerulus: hyalinosis: sclerosis
What is the leading cause of end stage renal disease?
Diabetic nephropathy
How do we treat diabetic nephropathy?
- keep watch on diabetic patient and their GFR
- treat hypertension
- have good glycemic control
- take ACE inhibitors
- take angiotensin receptor blockers
What is the most common cause of nephrotic syndrome in children under 6?
Minimal change disease
What are the causes of membranous glomerulonephritis?
85% idiopathic
Can be secondary to infections (syphilis/malaria/hep B), tumours, drugs (heroin/mercury), systemic illnesses (lupus)
How do you treat membranous glomerulonephritis?
Immunosuppressants
Treat underlying cause
What are the causes of FSGS?
- idiopathic
- secondary to sickle cell, HIV, heroin abuse, kidney hyperfusion
How do you treat FSGS?
Steroids
inconsistent results
What are some symptoms and signs of acute nephritic syndrome?
-oliguria/anuria (low or no urine output)
-hypertension
-hematuria
(sometimes proteinuria, uraemia (raised blood urea), fluid retention)
-loin pain, headaches, general malaise
How do you treat acute nephritic syndrome?
Steroids
What are some key nephritic conditions?
IgA Nephropathy (Berger's disease) -hypertension and high IgA levels: deposited in mesangium: sclerosis
Rapidly progressive glomerulonephritis
- severe glomerular injury cuasing leakage of fibrin, macrophages and epithelial cells to proliferate
- cresent shape mass forms reducing glomerular blood supply
- loss of renal function within days-weeks
Post-streptococcal glomerulonephritis
-1-3 weeks following group A beta-hemolytic streptococcal infection of tonsils/pharynx/skin
Goodpasture’s syndrome
- antibodies to type 4 collagen (strand of collagen that makes up the glomerular basement membrane) causing inflammation
- results in rapidly progressive glomerulonephritis, acute renal failure and lung haemorrhage
What is the most common primary glomerular disease worldwide?
IgA Nephropathy (Berger's disease) -causing recurrent hematuria
How do you treat IgA Nephropathy (Berger’s disease)?
-control BP
-antihypertensives
-steroids
(20% will develop CKD)
How do you treat rapidly progressive glomerulonephritis?
- high dose steroids
- immunosuppressants
- plasma exchange
How do you treat post-streptococcal glomerulonephritis?
Antibiotics to treat remaining infection
- good prognosis in children
- 60% recovery rate in adults, rest will develop hypertension/renal impairment
Why do you get lung haemorrhage in Goodpasture’s syndrome?
Similar type of collagen is found in the lungs
How do you treat Goodpasture’s syndrome?
Plasma exchange (to remove antibodies) Corticosteroids (remove inflammation)
What is loin pain?
Pain in area above belly button to the sides of the body, not usually at front of body
