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Semester 3 - Urinary > Session 9 - Glomerular damage > Flashcards

Session 9 - Glomerular damage Flashcards

1
Q

What are the main foci of kidney disease?

A
  • Glomerulus
    • PCT
    • Interstitium
    • Vascular supply
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2
Q

What is a primary glomerular injury?

A

• One which just effects the glomerulus

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3
Q

What is a secondary glomerula injury?

A

• A systemic illness which happens to effect the glomerulus

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4
Q

What are the four main sites of glomerular injury?

A 
• Subepithelial 
		○ Anything that effects podocytes/podocyte side of glomerular basement membrane
	• Within glomerula basement membrane
	• Subendothelial 
		○ Inside the basement membrane
	• Mesangial/parameangial
		○ Supporting capillary loop
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5
Q

Why can the nephron be termed a “functional unit”

A

• Same blood supply to glomerulus and nephron

○ Thus, ischaemic disease in glomerulus reduces blood supply to nephron, causing damage

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6
Q

What are the two main pathologies of the glomerulus?

A 
• It can become blocked 
		○ "Renal Failure"
		○ Decreased GFR
		○ Haematuria
	• It can leak 
		○ Proteinuria
		○ Haematuria
		○ One, other or both
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7
Q

What is proteinuria?

A

• Presence of excess serum proteins in the urine (<3.5g filtered every 24 hours)

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8
Q

What does proteinuria indicate?

A

• Podocyte damage, causing fenestration to widen and causing protein to be leaked when it would normally be filtered
Less severe nephrotic syndrome

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9
Q

What is nephrotic syndrome?

A

• More than 3.5g of protein lost in urine per day

Soon becomes hypoalbuminaemia

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10
Q

How does the body respond to hypoalbuminaemia as a result of nephrotic syndrome?

A
  • Oedematous

* Liver starts to pump out more albumin, along with more cholesterol!

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11
Q

What is nephritic syndrome?

A
  • Glomerulus is blocked
    • GFR drops
    • Creatinine increases
    • Haematuria (glomerulus blood vessels ruptured)
    • Hypertensive
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12
Q

What are the four main areas in the glomerula capillary loop where damage can occur?

A
  • Subepithelial
    • With GBM
    • Subendothelial
    • Mesangial
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13
Q

What is the difference between primary and secondary kidney disease?

A
  • Primary kidney disease - Pathology soley affecting kidney

* Secondary kidney disease - Systemic disease which affects kidney

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14
Q

What is the likely site of injury in proteinuria/nephrotic syndrome?

A

• Podocyte/subepithelial damage

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15
Q

Give three primary causes of proteinuria/nephrotic syndrome

A
  • Minimal change glomerulonephritis
    • Focal segmental glomerulosclerosis
    • Membranous glomerulonephritis
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16
Q

Give two common secondary cuases of proteinuria/nephrotic syndrome

A
  • Diabetes mellitus

* Amyloidosis

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17
Q

When does minimal change glomerulnephritis occur?

A
  • Occurs in childhood/adolescence

* Incidence reduces with increasing age

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18
Q

What are the symptoms of glomerulonephritis?

A
  • Heavy proteinuria or nephrotic syndrome
    • Responds to steroids
    • Usually no progression to renal failure
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19
Q

Why does minimal change glomerulonephritis occur?

A

• Podocytes destroyed, loss of filtration slits

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20
Q

What is the pathogenesis of minimal change glomerulonephritis?

A
  • Unknown circulating factor damaging podocytes

* No immune complex deposition

21
Q

Why is minimal change glomerulonephritis called thus?

A

• Normal golmeurli under a light microscope

22
Q

How can you detect minimal change glomerulonephritis?

A

• Electron microscope, damage to podocytes evident

23
Q

What is Focal segmental glomerulosclerosis

A
  • Nephrotic syndrome which effects adults

* Steroids minimally effective

24
Q

What does a patient with focal segmental glomerulosclerosis normal present with?

A
  • Massive proteinuria
    • Haematuria
    • Hypertension
    • Renal failure
25
Why is it called focal segmental glomerula sclerosis?
* Focal - Involving less than 50% of glomeruli on light microscopy * Segmental - Involving part of the glomerular tuft * Glomerular * Sclerosis - Scarring
26
What is the main pathology of Focal segmental glomerulosclerosis?
* Damage to glomerulus causing scarring * Circulating factor damages podocytes * Progressive renal failure
27
What causes Focal segmental glomerular nephritis?
• A circulating factor
28
What is membranous glomerulonephritis?
Commonest cause of nephrotic syndrome in adults Immune complex deposits Capillary loop thick Basement membrane specley
29
What causes membranous glomerulonephritis?
• Autoimmune response to podocytes • Immune complex deposits (IgG) ○ May also be secondary, as often associated with diseases such as lymphoma
30
What is an immune complex?
* Äntigen complexed with multiple antibodies | * IgG destroy antigen found on podocytes, destroying podocytes in process
31
What is a distinguishing feature of kidney disease as a result of diabetes mellitus?
• Progressive proteinuria Progressive renal failure
32
How does the rule of thirds apply to membranous glomerulonephritis?
* 1/3 just get better * 1/3 grumble along, proteinuria but are fine * 1/3 progress to renal failure
33
What is the pathology of kidney disease as a result of diabetes mellitus?
o Progressive proteinuria o Progressive renal failure o Microvascular (Damages glomerulus directly) o Mesangial sclerosis  nodules o Basement membrane thickening to 4-5x normal
34
What is nephritic syndrome?
• Renal failure due to blocking of filter
35
Give five causes of nephritic syndrome
* Good pasture syndrome * Vasculitis * IgA nephropathy * Thin GBM Nephropathy * Alport syndrome
36
What is IgA nephropathy?
* Commonest glomerular nephropathy | * Characterised by deposition of IgA antibody in the glomerulus
37
How does IgA present?
* Will present with haematuria when get cold, due to relationship with mucosal infections * Significant proportion progress to renal failure * Some, not all, patients have proteinuria
38
What is haematuria as a result of IgA nephropathy a result of?
• Mesangial damage and scarring | - Significant proportion of patients progress to renal failure
39
What happens to the mesangium in IgA nephropathy?
Mesangial proliferation and scarring
40
Give two types of hereditatary nephropathy
* Thin GBM Nephropathy | * Alport syndrome
41
Outline thin GBM nephropathy
Isolated Haematuria Thin GBM Benign Course
42
What is alport?
* X linked * Abnormal collagen IV * Associated with deafness * Abnormal appearing GBM * Progresses to renal failure
43
What is Goodpasture Syndrome?
* Rapidly progressive glomerular nephritis * Acute onset of severe nephritic syndrome * Classically associated with pulmonary haemorrhage
44
What is the pathology behind goodpasture syndrome?
• Autoantibody to collagen IV in basement membranes Characterised by IgG deposition but no extracellular matrix deposit
45
How is goodpasture syndrome treated?
* Treatable by immunosupression * Plasmaphoresis Take patients blood out, remove plasma with IgG in and then exchange plasma
46
What is vasculitis?
* Inflammation of blood vessels which attacks highly vascularised kidney * No immune complex/antibody deposition * Blood vessels directly attacked by anti neutrophil cytoplasmic antibody * Nephritic presentation * Urgent biopsy required
47
What is a subepithelial deposit?
• Antigen abnormally recognised on podocytes, circulating IgG binds to it, forming immune complexes in the glomerulus ○ Membranous glomerulonephritis
48
What is a mesangial deposit?
• Immune complexes can be deposited directly in the mesangium as there is no podocytes or basement membrane to act as a barrier

Semester 3 - Urinary (33 decks)

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