Session 9 Flashcards
Which area of the kidney is most likely to be damaged first when there is a lack of O2?
Proximal Convoluted tubule
What are the 2 layers of the Bowman’s capsule?
Lamina rena externa Lamina rena interna (Make a net so physically filters too) Lamina densa (Gives charge to repel proteins)
What are some of the signs of the Glomerulus being blocked?
Renal failure
Decresed GFR
Increased Creatinine
What are some of the signs of the Glomerulus leaking?
Proteinuria
Haematuria
What is Nephrotic syndrome?
The Glomerulus becomes leaky so patient will have proteinuria and haematuria. There will also be increased cholesterol as the liver goes into overdrive to try and make albumin (To increase osmolarity of the blood)
What Nephritic syndrome?
The Glomerulus becomes blocked so there will be increased levels of creatinine and decreased GFR. Patient will be hypertensive and may have blood in the urine
What is a sign of damage to the Podocytes and subepithelial section of the Glomerulus?
Proteinuria
What are some of the Primary causes of Proteinuria?
Minimal change Glomerulonephritis
FSGS
Membranous Glomerulonephritis
What are some of the Secondary causes of Proteinuria?
Diabetes Mellitus
Amyloidosis (Rarer)
What are some of the signs of Minimal change Glomerulonephritis?
Generalised Oedema
Proteinuria or nephrotic syndrome
Histologically normal
Usually doesn’t progress to renal failure
What happens in Minimal change Glomerulonephritis?
There is de-differentiation of the Podocytes leading to them not having foot processes so the Glomerulus becomes leaky
How can you treat Minimal change Glomerulonephritis?
Treat with steroids (Stops the proteinuria)
What is FSGS spectrum?
The adult version of Minimal change Glomerulonephritis
Nephrotic
How can you treay FSGS spectrum?
Steroids, but it is less responsive
What is Glomerulosclerosis?
Loss of the architecture of the Glomerulus
Heals with scarring
An unknown circulating factor damages the podocytes.
Progresses to renal failure
What is membranous Glomerulonephritis?
Common cause of Nephrotic syndrome in adults
Primary cause is Autoimmune
Secondary cause is Lymphoma
Spikes occur on capillary loops (made of immune complexes eg IgG with antigen) They destroy the foot processes
How does Diabetes Mellitus cause proteinuria?
It effects the capillaries (Especially capillary dense areas)
Progressive renal failure
Effects mesangial cells (Specialised cells around blood vessels in the kidneys) leading to Sclerosis and nodules
Thickening of basement membrane so the Glomerular basement membrane is effected
What can cause Haematuria?
Damage to the endothelium of the blood vessel
A thin glomerular basement membrane
What can cause Nephritic syndrome?
Capillary loop vasculitis
How can IgA nephropathy cause Haematuria?
Causes inflammation to the mesangium leading to inflammation and scarring.
Abnormal glycosylated IgA circulates
Relationship with mucosal infections as increased IgA
What are some hereditary nephropathies?
Thin glomerular basement membrane nephropathy (Thin glomerular basement membrane, no renal failure.)
Alport (X linked disorder, abnormal collagen due to an abnormal gene leads to an abnormal glomerular basement membrane, progresses to renal failure)
What is Goodpasture syndrome?
Rapidly developing - destroys all glomerular cells in 48 hrs
Acute & Fast onset of severe nephritic syndrome
Autoantibody to collagen IV in the basement membrane
How can Goodpasture syndrome lead to pulmonary haemorrhage?
The membrane is the same as those in the Glomerulus
How can you treat Goodpasture syndrome?
Immunosuppression
Plasmaphoresis
Give plasma and remove theirs
What is Vasculitis?
Inflammation of the blood vessels. The neutrophils and antibodies damage the Glomerulus
Generally, what does isolated haematuria mean?
Mesengial/capillary loop damage
Generally, what does proteinuria mean?
Podocyte damage
What is PSA?
Prostate Specific Antigen
An enzyme that is used as a marker for cancer, but is also increased for enlargement or infection of the prostate
What are some of the risk factors for Prostate cancer?
Increasing age
BRCA2 gene
Family history of a first degree relative with Prostate cancer before 60
How does Prostate cancer usually present?
Asymptomatic mostly
Urinary symptoms due to enlargement/bladder
Haematuria in advanced Prostate cancer
How can you treat Prostate cancer?
Biopsy
MRI & Bone scans
Localised - Radiotherapy, Lose dose rate bracytherapy.
How does chemical castration work?
Gonadotrophin (usually released in a pulsatile way) contains LHRH. LH is released from the anterior pituitary gland. When LHRH is injected it is there all the time. This causes more LH and testosterone to be released, making the Pituitary gland exhausted. LH begins to drop making testosterone also drop.
What are bone metastases like in Prostaste cancer on xray?
Sclerotic - Brightness on xray
How can you get a positive dipstick for blood without there being blood in the urine?
Large spleen thats breaking down lots of haemoglobin
What are some of the urological causes of haematuria?
Cancer Stones Infection Inflammation Nephrological causes
What is the main type of bladder cancer?
Transitional cell carcinoma. Increased risk if working with rubber/plastics manufacturer
Where are renal cell carcinomas?
Parenchyma of the kidney. Can spread to perinephric, lymph node, IVC spreading to right atrium.
