UG II - Glomerular Diseases Flashcards
ESKD Cx
- Electrolytes
- CPB
- Hematologic
Electrolytes
- Hyperkalemia
- Oedema from RAAS - hypertension
- Metab Acidosis
- less bicarb reabsorbed, and poor NH4+ excretion
CPB
- Kidney 1 alpha hydroxylase to make active Vit D
- Hypocalcaemia
- Hyperphosphataemia
- Secondary hyper PTH - but response is shit due to Vit D deficiency;
- – Osteodystrophy
GFR drops, PO4 increases, Osteocytes releases FGF23 to block vit D activation;
Blood
- Anaemia due to low EPO from kidneys
ESKD Histology [3]
- impt!
Chronic
- interstitial fibrosis
- glomerulosclerosis - scarring and fibrosis!!!
- tubular atrophy
Nephrotic Vs Nephritic Syndrome
Plus 3 unique presentations each
- think systemic also lmao
Nephrotic - leaky filter - proteinuria
Nephritic - damaged filter - 0 GFR + some leaky - oliguria + proteinuria
– INFLAMMATION - RBC, WBC
Nephrotic - hypoalbuminemia - generalized edema; hyperlipidemia lol 2 only
Nephritic - HYPERTENSION, Azotaemia, hematuria
– azotaemia - more nitrogen in blood
– can be due to decreased GFR leading to increased creatinine;
Whats the function of
- Macula Densa
- JGA
- DCT NaCl concentration - to stimulate renin from JGA + Vasodilate Afferent to increase GFR
- Sense BP of Afferent - to secrete renin
Whats the anatomy @ glomerular capsule
Lumen
Endothelial - Fenestrated (holes)
Basement Membrane
Podocytes Epithelial Layer - Slit Diaphragm - w foot processes;
Glomerulonephritis definition
Increased cellularity + Inflammation cells
3 AB-mediated Glomerular Injury
Examples and Staining properties
Antibody-Antigen complex deposition - Type III HS
- eg Lupus Nephritis; accumulation of IgA Nephropathy “glomerulonephritis”
- Post Strep GNP!!!!
- “granular staining”
Antibody- target self antigen - Type II HS
- forms in-situ complexes
- eg Anti-GBM disease - Goodpasture’s IgG staining - note systemic hence lung problems too; also GlomeruloNEPHRITIS
- “linear staining”
Anti-Neutrophil Cytoplasmic AB ANAC
Nephrotic Syndrome common causes
Without inflammation - hence glomerulopathy
- Podocyte diseases common
- Membranous Glomerulopathy - common in adults
- Basement membrane w immune complex; then MAC formation after Complement activation;
- narrowing of blood vessels, then leakage
- Focal Segmental Glomerulosclerosis - glomerular sclerosis and podocyte damage
Systemic Stuff that damages kidneys, seen w stain;
Which kidney syndrome
Amyloidosis
- accumulated fibrillary proteins forming Beta Pleated Sheets - oligomers of misfolded proteins which cannot be destroyed
- deposit in kidneys
- Congo Red stain, amorphous appearance
Present w Nephrotic Syndrome
Systemic Stuff thats hypertension lol
Hypertensive Nephrosclerosis
Benign
Renal arterioles - hyalinosis + muscular thickening
Malignant
- Fibrinoid Necrosis + Onion skinning lamination
Present w Nephrotic Syndrome
- wo blood, FSGS, then Glomeruli will collapse
- Glomerulosclerosis is hardening of the glomeruli in the kidney. It is a general term to describe scarring of the kidneys’ tiny blood vessels, the glomeruli, the functional units in the kidney that filter urea from the blood.
Whats top cause of nephrotic syndrome
Focal Segmental Glomerulosclerosis
- fibrosis at glomeruli
- leading cause of Nephrotic Syndrome
Systemic Stuff thats sweet
Pathophysiology and Presentation of all compartments
Histology [2]
Name 1 Cx
Diabetic Nephropathy
Hyperglycemia - Glycosylated Proteins and G. Collagen
and glycosylate glomerular proteins
- membranes now glycosylated - leakier, porous
- vascular atherosclerosis, hyalinosis; hypertension
- mesangial widening (increase in matrix and cells) - forming nodules - damage then hyaline materials then nodule
Histology: Nodular deposits, increased mesangial matrix
Nephrotic Syndrome; ESKD
Thickening of both Glomerular BM and Tubular BM
Hyalinosis (protein leakage)
Glomerular Sclerosis as end stage
Tubular BM also thicken
Tubular Atropy
Interstitial Fibrosis - note inflammation + RAAS both present
Cx: Pyelonephritis
