S7 L2 Glomerulonephritis and Histology of the Glomerulus

Question 1

Label this histology image of the Cortex

Answer 1

Question 2

Histology of cortex - more pictures

Answer 2

Question 3

Histology of the cortex - label

Answer 3

Question 4

Histology of the cortex - label

Answer 4

Question 5

Histoloy - Between cortex and medulla

Answer 5

Question 6

Histology - Medulla

Answer 6

Question 7

ATN

• What is this?
• When does it occur?
• What happens?

Answer 7

Question 8

Glomerulonephritis (GN)

• What is this?
• Which structures can be damaged?
• What system is involved?

Answer 8

Question 9

2 types og glomerular nephritis

• State
• Explain the differences (in the kidney)
• Explain the differences in symptoms

Answer 9

Question 10

Nephrotic Syndrome

• Triad of…
• What other features occurs too?

Answer 10

Question 11

Causes of Nephrotic Syndrome

Answer 11

Question 12

Diabetic Nephropathy

• What is this?
• What happens?
• How is GFR affected?
• Treatment?

Answer 12

Thickening of BM
Thickening of wall of afferent arteriole

Question 13

Minimal Change Disease

• Common cause of nephrotic syndrome in which group of people?
• What happens?
• Prognosis?
• Presentation?

Answer 13

Question 14

Membranous Glomerulonephritis

• What is this?
• What happens?
• Treatment

Answer 14

Question 15

Focal Segmental Glomerulosclerosis

• What is this?
• Causes
• Treatment

Answer 15

Question 16

Histology:

• Diabetic Nephropathy
• Membranous Glomerulonephritis
• Focal Segmental Glomerulosclerosis

Answer 16

Question 17

Management of Nephrotic Syndrome

Answer 17

Question 18

Nephritic Syndrome

• Triad of…
• Other features

Common causes of Nephritic Syndrome

Answer 18

Nephritic Syndrome
• IgA Nephropathy (Berger’s Disease)
• Rapidly progressive GN
• Goodpasture’s (Anti GMB)
• Post-streptococcal GN

Question 19

IgA Nephropathy (Berger’s Disease)

• What is this?
• Symptoms?
• Treatment

Answer 19

Question 20

Rapidly Progressive Glomerulonephritis

• What is this?
• Loss of renal function in… (timeframe)
• Treatment

Answer 20

Question 21

Goodpasture’s Syndrome

• What is this?
• What happens?
• Treatment?
• Prognosis?

Answer 21

Question 22

Post-Streptococcal Glomerulonephritis

• What is this?
• Cause?
• Treatment?
• Prognosis?

Answer 22

Question 23

Management of Nephritic Syndorme
- 5…

Answer 23

Question 24

Differential diagnosis of glomerular disease
- Summary of all the diseases just covered - scale from: Nephrotic and Nephritic diseases

Answer 24

Question 25

GW:

• How do you classifiy or describe nephritic glomerulonephritis?
• What in the urine could case colouring?
• Use of a renal ultrasound?
• How would you treat someone with Post-Streptococcal GN?

Answer 25

• Nephritic - Haematouria and hypertension (specific symptoms associated with nephritic. Also has: proteinuria, hypertension, Haematouria, oedema

Blood in the urine

US: Looking for stones (will be normal in glomerulnephritis)

• Antibiotics - give something different to what she’s had before
• Fluid restriction
• Control hypertension and proteinuria - ACEi
• Treat oedema - diuretics e.g. furosemide, fluid restriction
• Analgesia
• Steroids (much, much later)

Question 26

GW:
- Nephitic syndrome vs Nephrotic syndrome

Answer 26

Nephrotic syndrome - triad of symptoms:
• Proteinuria • Hypoalbuminaemia • Oedema
Damage to the: podocytes More leaky capillaries
Don’t really see a drop in GFR, only see a drop in GFR if it is really bad Patients may have increased urination with this
Does not always caused a reduced kidney function

Nephritic syndrome -
• Inflammation, reactive cell proliferation, breaks in GBM
• Triad of: Haemotouria, hypertension, low GFR (might have proteinuria)
• Does not always case a reduced kidney function

Question 27

GW:

• What is the difference between a primary and secondary cause of glomerulonephritis?
• If creatinine is in normal range, is it definiatly normal?
• Process of what can happen in diabetic nephorpathy - starting stages…
• What happens to the processes in the tubule with advancing kidney disease?

Answer 27

• Primary - renal cause
• Secondary - systemic (kidney is one of many organs affected)

Always think - this creatinine is in the normal range, but is it normal for this patient? E.g. what is creatinine affected by: • Weight, height, muscle mass

—- lots of glucose in the blood
— glucose enter tubules
— Na is required for glucose to be reabosorbed
— Causes low Na+ in the DCT
— Macula densa cells notices the low Na+
— It then thinks the blood pressure is low
— Activates RAAS
— RAAS will increase filtration of the blood (leads to hyperfiltration)

With worse kidney disease:
• Mainly secretion affected • Filtration gets worse, filtration stays the same, so greater eGFR. (The eGFR is worse than it appears)
In advanced renal disease: Filtration is affected, reabsorption and secretion aren’t as much (at all)