Renal disease pt 1 Flashcards
Kidney major function
Blood filtration to remove waste products
3 types of renal diseases
- glomerular
- tubular
- interstitial
Major origin of glomerular disorders
- Immune origin
- Immune complexes circulate in bloodstream and deposit in glomerular membranes
Damage in glomerular disorders that cause disruption in normal glomerular filtration
- cellular proliferation
- leukocytic infiltration
- thickening of glomerular basement membrane
List non-immune causes of glomerular damage
- Exposure to chemicals/toxins
- Disruption of electrical membrane charges
- Deposition of amyloid material
- Basement membrane thickening associated with diabetic nephropathy
A normal capillary in a glomerulus keeps WBCs, RBCS, and proteins where?
In the blood (not filtered thru glomerulus). Only lets watery fluid into urine
Glomerulonephritis
- Sterile, inflammatory process that affects the glomerulus
- Associated with blood, protein, and casts in urine (sometimes WBCs)
List the types of glomerulonephritis
- Acute poststreptococcal (AGN)
- Rapidly progressive
- Goodpasture, Wegener’s, Henoch-Schonlein
- Membraneous GN
- Membranoproliferative GN
- Chronic GN
- IgA Nephropathy
- Nephrotic Syndrome
Types of nephrotic syndrome
- Minimal Change Disease
- Focal Segmental Glomerulosclerosis
- Alport Syndrome
- Diabetic Nephropathy
Acute Post-Streptococcal GN (AGN) usually occurs in
Kids and young adults following respiratory infections from Group A Strep (contain M protein in cell wall) S. pyogenes
AGN mechanism
- Immune complexes formed from Strep antibodies and become deposited in glomerular membranes
- Management of complications until immune complexes cleared from blood and inflammation stops
- Usually no permanent kidney damage
AGN urinalysis findings
- RBC (including dysmorphic)
- WBC
- Proteinuria
- Oliguria
- RBC casts
- Hyaline casts
- Granular casts
AGN serum findings
- Elevated BUN
- ASO (antistreptolysin) positive titer
Rapidly progressive glomerulonephritis (RPGN)
- More serious form of acute glomerular disease with poor prognosis, often terminating in renal failure
- SLE can cause RPGN
- Symptoms started by immune complex deposition
Which cell type causes capillary wall damage in RPGN?
Macrophages
What happens when macropohages destroy the capillary wall in RPGN?
- Cells and plasma release into Bowman’s space
- Crescentic formations containing macrophages, fibroblasts, and polymerized fibrin
- Permanent damage to capillary tufts of kidney
RPGN urinalysis findings
- Similar to acute GN except clinical pic becomes more abnormal as disease progresses
- Markedly elevated protein
- Reduced GFR and loss of function due to glomerulosclerosis
Goodpasture’s Syndrome morphologically similar to
RPGN
Goodpasture’s Syndrome can follow
Viral infections
Goodpasture’s Syndrome results from
- Cytotoxic auto-antibody against glomerular and alveolar basement. membrane
- Antiglomerular basement membrane antibody detectable in serum
What does antiglomerular basement membrane auto-Ab do?
- Attaches to basement membrane and initiates complement, which produces capillary destruction
- Attracts neutrophils, which come to attack the vessel wall -> inflammation, GN, alveolar capillaritis
Goodpasture’s Syndrome urinalysis findings
- Proteinuria
- RBC
- RBC casts
Vasculitis (blood vessel inflammation) can lead to what types of glomerular issues?
- Wegener’s granulomatosis
- Henoch-Schonlein purpura
Kidney damage due to vasculitis due to
- Immune complex deposition
- Auto-Ab binding vasculature
- Immune-mediated inflammation
Wegener’s granulomatosis causes
A granuloma producing inflammation of small blood vessels (mainly kidney + lungs)
Which antibody is found in Wegener’s granulomatosis?
Anti-neutrophilic cytoplasma antibody (ANCA) found in serum, which binds PMNs in the vascular walls
Lab findings in Wegener’s granulomatosis
- RBC
- RBC casts
- Proteinuria
- Elevated BUN/creatinine
Henoch-Schonlein purpura (red patches on skin) mainly occurs in
Children following upper resp infections
Lab findings of Henoch-Schonlein purpura
- Elevated protein
- RBC
- RBC casts
- Elevated plts
Difference between membranous GN and membranoproliferative GN
Membranous GN = basement membrane only
Membranoproliferative GN = both basement membrane + mesangium
Membranous GN pathology
- Thickening of glomerular basement membrane
- IgG immune complex deposition
Membranous GN lab findings
- Proteinuria
- RBC
- Thrombosis
Membranoproliferative GN Type 1
Thickening of capillary walls in Bowman’s capsule (increased cellularity)
Membranoproliferative GN Type 2
Dense deposits in glomerular basement membrane
Membranoproliferative GN affects
Children
Membranoproliferative GN lab findings
- Proteinuria
- RBC
- Decreased serum complement
IgA Nephropathy most commonly causes
Glomerulonephritis
Increased IgA in IgA nephropathy due to
Mucosal infection (genetic link to mutated IgA)
IgA Nephropathy found in
Kids and young adults
IgA Nephropathy pathology
IgA complexes deposited in glomerular membrane
IgA Nephropathy UA findings
Hematuria macroscopic (follows infection or hardcore exercise)
Chronic glomerulonephritis
Accumulation of damage due to the previously mentioned disorders can lead to the chronic version
Chronic glomerulonephritis lab findings
- Hematuria
- Proteinuria
- Glycosuria (tubular dysfunction)
- Decreased eGFR
- Increased BUN/creatinine
- Electrolyte imbalance