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Year 3 Renal & Urology > Renal damage > Flashcards

Renal damage Flashcards

1
Q

What is glomerulonephritis?

A

Immune-mediated inflammation of renal glomeruli affecting the capillaries and basement membrane.

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2
Q

What is the aetiology of glomerulonephritis? (x7)

A
  • Commonly idiopathic • !!! BERGER’S DISEASE: IgA nephropathy; deposition of IgA antibodies in glomerulus
  • INFECTION: BACTERIAL: group A beta-haemolytic Streptococcus, staphylococci, gonococci, Salmonella, syphilis; VIRAL: Hep B/C, HIV, measles, mumps, EBV; PROTAZOAL: Plasmodium malariae, schistosomiasis
  • SYSTEMIC INFLAMMATORY: SLE, systemic vasculitis
  • DRUGS: penicillamine, gold
  • MALIGNANCY
  • HEREDITARY: Fabry’s disease, Alport’s syndrome
  • DEPOSITION: amyloidosis and light-chain nephropathy
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3
Q

What is the pathophysiology of glomerulonephritis?

A

Arises from glomerular injury which may be caused by inflammation due to leukocyte infiltration, antibody deposition or antigen-antibody complex deposition, leading to inflammation and complement activation.

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4
Q

What are the types of glomerulonephritis? (x10)

A
  • MINIMAL-CHANGE: normal appearance on light microscopy. Loss of epithelial foot processes on electron microscopy
  • MEMBRANOUS: thickening of GBM from immune complex deposition
  • MEMBRANOPROLIFERATIVE: thickening of GBM, mesangial cell proliferation
  • FOCAL SEGMENTAL GLOMERULOSCLEROSIS: glomerular scarring. Focal refers to involvement of some glomeruli. Segmental refers to involvement of parts of individual glomeruli
  • FOCAL SEGMENTAL PROLIFERATIVE: mesangial and endothelial cell proliferation
  • DIFFUSE PROLIFERATIVE: same as above but affects all glomeruli
  • CRESCENTRIC: crescent formation by macrophages and epithelial cells (fill Bowman’s space)
  • FOCAL SEGMENTAL NECROTISING: peripheral capillary loop necrosis, microscopic polyarteritis and other vasculitides
  • TYPE 1: Subendothelial immune complex deposition and reduplication of GBM
  • TYPE 2: Dense intermembranous immune complex deposits
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5
Q

What are the signs and symptoms of glomerulonephritis? (x7)

A
  • Symptoms of aetiology esp. infectious
  • Nephrotic syndrome
  • Nephritic syndrome
  • Symptoms of uraemia (N&V, itching, anorexia, tiredness)
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6
Q

!!! What is nephrotic and nephritic syndrome? Difference in symptoms?

A

Nephrotic syndrome develops as a result of damage to glomeruli, characterised by massive proteinuria (over 3.5g/day), oedema, hypoalbuminemia (less than 30g/L; secondary to protein loss in urine) and hyperlipidaemia. Nephritic syndrome is inflammation of the glomeruli, characterised by haematuria, mild proteinuria, hypertension, oliguria and red cell CASTS in urine (! implying direct bleeding from glomeruli).

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7
Q

What does haematuria look like?

A

Coca-Cola

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8
Q

What does proteinuria look like?

A

Foamy

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9
Q

What are the blood investigations for glomerulonephritis? (x7)

A

U&Es – renal failure, hypoalbuminemia, deranged LFTs in hepatitis, anaemia (associated with systemic disease aetiologies), hyperlipidaemia, complement studies (low in immune-complex disease due to exhaustion of supplies), serology (ANA, anti-dsDNA, ANCA, anti-GBM; for aetiology)

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10
Q

What are the urine investigations for glomerulonephritis? (x5)

A

Haematuria, proteinuria, RBC casts, dysmorphic RBCs, normal/elevated albumin:creatinine ratio.

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11
Q

What are dysmorphic RBCs?

A

Distortion of RBC cytoskeleton when passing through GBM.

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12
Q

What are the other investigations for glomerulonephritis?

A
  • RENAL USS: exclude other pathology
  • RENAL BIOPSY: definitive diagnosis; immunofluorescence microscopic and identify proliferation in certain glomerulonephritis types
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13
Q

How do you differentiate between IgA and post-Strep glomerulonephritis?

A

IgA presents a few days after non-specific URTI, while post-Strep presents a few weeks after Strep (usually throat) infection.

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14
Q

What is nephrotic syndrome?

A

Characterised by the following SYMPTOMS: proteinuria (over 3g/day), hypoalbuminemia (less than 30g/L), oedema and hypercholesterolaemia.

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15
Q

What is the aetiology of nephrotic syndrome? (x8) God DDAAM SH

A
  • G DDAAM SH
  • GLOMERULONEPHRITIS (primary cause): Minimal change glomerulonephritis in children. Other forms of glomerulonephritis also cause the disease
  • SECONDARY CAUSES:
  • Diabetes mellitus
  • Drugs such as NSAIDs
  • Amyloidosis
  • Alport’s syndrome
  • Malignancies
  • Sickle cell disease
  • HIV
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16
Q

! What is the pathophysiology of nephrotic syndrome? (x5)

A
  • Structural damage to the basement membrane or reduction in the negatively charged components within it reduces the filtration of large protein molecules by the glomerulus, causing proteinuria and hypoalbuminemia.
  • The liver tries to compensate for this protein loss by increasing the synthesis of albumin, as well as other molecules including LDL and VLDL and lipoprotein(a), contributing to the development of lipid abnormalities including hypercholesterolaemia
  • Oedema is secondary to hypoalbuminemia and renal sodium retention.
  • There is also hypercoagulability from loss of inhibitors of coagulation in the urine and increased synthesis in liver
  • Patients with nephrotic syndrome are at risk of infection due to loss of Igs and complement in the urine
17
Q

What is the epidemiology of nephrotic syndrome: Most common cause in children?

A

Most common cause in children is minimal change glomerulonephritis.

18
Q

What are the signs and symptoms of nephrotic syndrome? (x4)

A

Proteinuria, oedema, symptoms of complications (renal vein thrombosis: loin pain and haematuria), ascites.

19
Q

What are the investigations for nephrotic syndrome? (x4)

A
  • BLOODS: FBC, U&Es, LFTs (hypoalbuminemia), lipid profile, immunoglobulins, complement (lost in urine), serology (aetiology)
  • URINE: urinalysis (proteinuria and microscopic haematuria), microscopy, 24-hour collection (needed to measure protein loss), albumin:creatinine ratio
  • RENAL USS: exclude other pathologies
  • RENAL BIOPSY
20
Q

How does hyperlipidaemia manifest in the urine? (x4)

A

Lipid sediment, fatty casts, oval fat bodies, or free fat droplets in the urine (which appear as Maltese crosses under polarised light).

Year 3 Renal & Urology (10 decks)

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