Renal Disease Flashcards
Define Glomerulonephritis
Sterile, inflammatory process that affects the glomerulus.
It is associated with blood protein, and casts in the urine specimen.
True or False: Glomerulonephritis does not process from one form to another.
False. Glomerulonephritis MAY progress from one form to another such as acute to chronic.
True or False: there is only one type of Glomerulonephritis.
False. There are many types of glomerulonephritis.
-Acute Poststreptococal (AGN)
-Rapidly Progressive GN
-Goodpasture, Wegener’s, Henoch-Schonlein
-Membranous GN
-Membranoproliferative GN
-Chronic GN
-IgA Nephropathy
-Nephrotic Synthrome (Minimal Change Disease, Focal Segmental Glomerulosclerosis, Alport syndrome, Diabetic Nephropathy)
Identify and describe: Acute Poststreptococal (AGN)
-significant UA findings
-differentiating tests
-disease process
-Sudden onset of symptoms consistent with damage to the glomerular membrane.
-Significant UA findings: BUN (blood urea nitrogen and ASO TITER (antistreptolysin O) serum are elevated
differentiating tests:
- light microscopy show increase inflammatory cells (neutrophils)
-immunofluorescence microscopy show immune complex deposits in capillary walls
-electron microscopy vs high magnification light microscopy allows us to see the damage of the glomerulus inflammation and the shift that allows neutrophils to squeeze through
disease process: Quickly happens after streptococcus group A
1. Immune complexes are formed from the Streptococcus antibodies and become deposited on the glomerular membrane
2. Management of complications until the immune complexes are cleared from the blood and the inflammation subsides. Usually there is no permanent kidney damage.
What are the symptoms of Acute Post-Streptococcal Glomerulonephritis?
Symptoms: fever, edema, fatigue, hypertension, oliguria, and hematuria
Symptoms usually occur in children and young adults following respiratory infections from Group A Streptococcus (contain M protein in the cell wall)
Identify and describe: Rapidly Progressive GN
-significant UA findings
-differentiating tests
-disease process
- Rapidly progressive glomerulonephritis is a more serious form of acute glomerular disease.
-Significant UA findings: similar to acute glomerulonephritis except clinical picture becomes more abnormal as disease progresses
- markedly elevated protein
- GFR decreases as disease progresses (loss of function due to glomerulosclerosis)
differentiating tests
-use light microscopy and immunofluorescence microscopy
disease process:
- symptoms initiated by deposition of immune complexes
- Macrophages on the capillary walls cause damage which allows cells and plasma to be released in to Bowman’s space.
- Crescentic formations are also produced containing macrophages, fibroblasts, and polymerized fibrin.
- This causes permanent damage to capillary tufts of the kidney.
Identify and describe: Goodpasture
-significant UA findings
-differentiating tests
-disease process
Goodpasture syndrome is a group of acute illnesses that affect the lungs and kidneys. It involves an autoimmune disorder. Morphologically similar to rapidly progressive glomerulonephritis. Condition can follow viral respiratory infections and damage the lungs
Significant UA findings:
- Proteinuria
- RBC
- RBC casts
differentiating tests:
-antiglomerular basement membrane antibody
-detectable in serum
-renal biopsy in anti-GBM Glomerulonephritis (abnormal crescent-shaped accumulation of cells in the urine surrounding a glomerulus (a crescent).
disease process:
- Syndrome results from cytotoxic autoantibody against the glomerular and alveolar basement membrane (damage to the lungs)
1. autoantibody attaches to the basement membrane
2. autoantibody initiates complement activation
3. autoantibody produces capillary destruction.
May process to chronic glomerulonephritis and end-stage renal failure.
Identify and describe: Vasculitis: Wegener’s granulmatosis
-significant UA findings
-differentiating tests
-disease process
Causes a granuloma producing inflammation of small blood vessels (primarily kidney and respiratory system)
significant UA findings:
- RBC
- RBC casts
- Proteinuria
- Elevated BUN
- Elevated Creatinine
differentiating tests:
- Antineutrophilic cytoplasmic antibody (ANCA) is found in the serum
disease process
-Overall inflammation of the blood vessels
1. Inflammation of the vessel wall (vasculitis) caused by white blood cells that have been stimulated by ANCA.
Identify and describe: Vasculitis: Henoch-Schonlein
and the disease process
Occurs primarily in children following upper respiratory infections. Renal involvement is the most serious complication (glomerulonephritis).
-Red patches appear on the skin.
Disease process: Kidney damage is due to-
1) Immune complex deposition
2) Autoantibodies binding to vascular structures
3) Immune mediated inflammation
What are the significant UA findings of Vasculitis: Henoch-Schonlein purpura?
Urinalysis findings:
- increase protein
- RBC and RBC casts
- platelet count MAY be raised (distinguishes if from diseases where low platelets are the cause of the purpura, but in this case its not.)
What are the differentiating tests of Vasculitis?
- For Wegner’s granulmatosis, the renal involvement includes RBC, RBC casts, proteinuria, elevated BUN and creatinine. WG has ANCA found in the serum!
-For Henoch-Schonlein purpura, red patches appear on the skin and there is an increase in protein, RBC, and RBC casts in the urine.
What is Membranous GN?
Membranous glomerulonephritis involves the basement membrane but not the mesangium.
-Thickening of the glomerular basement membrane and deposition of IgG immune complexes.
What are the significant UA finding of Membranous GN?
-Proteinuria
-RBC
-Tendency towards thrombosis (blood coagulation - blood clotting)
What is Membranoproliferative GN
Membranoproliferative glomerulonephritis involves the basement membrane and mesangium.
What conditions are included in Membranous Glomerulonephritis?
- SLE (Systemic lupus erythematous - autoimmune disease),
- Sjögren’s syndrome (immune system illness that mainly causes dry eyes and dry mouth)
- secondary syphilis (STI),
- hepatitis B (serious liver infection),
- gold and mercury treatments (mercury exposure)
- malignancy (malignant tumor/cancer)
