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ESA3 > Urinary 10 - Glomerular disease > Flashcards

Urinary 10 - Glomerular disease Flashcards

1
Q

What is the main problem in the kidney causing nephrotic syndrome?

A

Damaged glomerulus = increased permeability = LEAKS PROTEIN

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2
Q

Give 2 major symptoms in nephrotic syndrome:

A

1) Proteinuria > 3.5g/24hrs (+ oedema)

2) Foamy/frothy urine

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3
Q

Where is the most likely site of injury in the glomerulus causing glomerular disease?

A

Subepithelial layer (podocytes)

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4
Q

Name 3 common primary causes of Nephrotic syndromw:

A

1) Minimal change glomerulonephritis
2) Focal segmental glomerulosclerosis
3) Membranous glomerulonephritis

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5
Q

What is glomerulonephritis?

A

Any condition associated with inflammation of the glomerular tuft

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6
Q

At what age does Minimal Change Glomerulonephritis typically present?

A

Childhood/Adolescence

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7
Q

What is the main treatment for Minimal Change Gloerulonephritis?

A

Steroids

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8
Q

Does Minimal Change Glomerulonephritis typically progress to renal failure?

A

No

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9
Q

Describe the pathogenesis causing Minimal Change Glomerulonephritis:

A

Unknown circulating factor damaging podocytes, causing increased permeability of glomerulus

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10
Q

What is the name given to any condition associated with inflammation of the glomerular tuft?

A

Glomerulonephritis

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11
Q

What is the meaning of ‘focal’ when describing glomerular pathology?

A

Involving <50% of glomeruli on light microscopy

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12
Q

What is the meaning of ‘segmental’ when describing glomerular pathology?

A

Involving part of the glomerular tuft

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13
Q

What is the meaning of ‘glomerulosclerosis’ when describing glomerular pathology?

A

Segmental/global capillary collapse, presumed little/no filtration in hardened/sclerotic areas

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14
Q

At what age does Focal Segmental Glomerulosclerosis typically present?

A

~ 40-60 yrs

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15
Q

Does Focal Segmental Glomerulosclerosis typically progress to renal failure?

A

Yes

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16
Q

Describe the pathogenesis causing Focal Segmental Glomerulosclerosis:

A

Unknown circulating factor damaging podocytes

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17
Q

Name the 2 glomerular pathologies caused by unknown circulating factors damaging podocytes:

A

1) Minimal Change Glomerulonephritis

2) Focal Segmental Glomerulosclerosis

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18
Q

What is the meaning of ‘membranous’ when describing glomerular pathology?

A

Thickening of the glomerular capillary wall

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19
Q

Name the commonest cause of Nephrotic syndrome in adults:

A

Membranous glomerulonephritis

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20
Q

What age does membranous glomerulonephritis typically present?

A

Adulthood

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21
Q

Describe the outlook of a patient with membranous glomerulonephritis:

A

Rule of thirds:
1/3 = will get better
1/3 = will stay the same
1/3 = will progress to renal failure

22
Q

Describe the pathogenesis of membranous glomerulonephritis:

A

Deposition of immune complexes in the basement membrane under the podocyte layer
= Complement cascade activated
= Cellular injury to podocytes
(Often secondary to malignancies like Lymphoma)

23
Q

Name the antigen and antibody which forms the immune complexes deposited in membranous glomerulonephritis:

A 
Antigen = Phospholipase A2 receptor on podocyte
Antibody = IgG
24
Q

How does proteinuria in nephrotic syndrome lead to oedema?

A

Increased protein in urine
= decreased protein in blood
= water moves from blood into interstitial space
= oedema

25
Q

What is the most likely cause of persistently foamy urine?

A

Proteinuria

26
Q

Name 2 common secondary causes of nephrotic syndrome:

A

1) Diabetes mellitus

2) Amyloidosis

27
Q

Describe the pathogenesis of diabetes mellitus causing nephrotic syndrome:

A

Persistent high blood glucose injures all parts of the glomerulus:

  • Basement membrane thickens and becomes abnormal
  • Sclerotic nodules form in mesangium
28
Q

What is the main problem in the kidney causing nephritic syndrome?

A

Blocked glomerulus

29
Q

List the main features of nephritic syndrome:

A
  • Renal failure = oedema, oliguria, SOB
  • Haematuria (microscopic/macroscopic)
  • Decreased eGFR
  • Red cell casts in urine
30
Q

Where is the most likely site of injury of nephritic syndrome?

A

Endothelium

31
Q

Which glomerular syndrome describes the blocking of the glomerulus?

A

Nephritic syndrome

32
Q

Which glomerular syndrome describes protein leaking through the glomerulus?

A

Nephrotic syndrome

33
Q

Give 5 diseases associated with Nephritic syndrome:

A

1) IgA nephropathy
2) Thin GBM nephropathy
3) Alport syndrome
4) Goodpasture syndrome
5) Vasculitis

34
Q

Which glomerular syndrome is IgA nephropathy associated with?

A

Nephritic syndrome

35
Q

Which glomerular syndrome is Thin GBM nephropathy associated with?

A

Nephritic syndrome

36
Q

Which glomerular syndrome is Alport syndrome associated with?

A

Nephritic syndrome

37
Q

Which glomerular syndrome is Goodpasture syndrome associated with?

A

Nephritic syndrome

38
Q

Which glomerular syndrome is Vasculitis associated with?

A

Nephritic syndrome

39
Q

Which disease is the most common primary cause of glomerulonephritis?

A

IgA nephropathy

40
Q

Describe the presentation of IgA nephropathy:

A

Any age
Haematuria
Proteinuria (foamy urine)
Activated by URTI

41
Q

Describe the pathogenesis of IgA nephropathy:

A

IgA deposited anywhere in glomerulus

= Blocked filter (irreversible)

42
Q

Which nephropathy is typically activated by a URTI?

A

IgA nephropathy = Nephritic syndrome

43
Q

What is the treatment of IgA nephropathy?

A

No cure

  • IgA deposition = irreversible
  • Treat hypertension, dialysis, transplant
44
Q

What is the inheritance pattern of Thin GBM nephropathy?

A

Autosomal dominant

45
Q

What is the typical inheritance pattern of Alport syndrome?

A

X-linked recessive

46
Q

Why is Goodpasture’s syndrome called a ‘cresentic’ glomerulonephritis?

A

Causes accumulation of cells in Bowman’s capsule, which compresses the glomerulus forming a crescent shape

47
Q

Describe the pathogenesis of Goodpasture’s syndrome:

A

Autoimmune:
= IgG (anti-GBM autoantibody) attacks collagen IV in basement membrane
= Glomerulus becomes ball of inflammatory cells
= Heals by scarring therefore reduces filtration

48
Q

Why does Goodpasture’s syndrome sometimes present with haemoptysis?

A

Autoantibodies attack collagen IV, which is also present in alveoli membranes.
= More common when lungs are already damaged, ie in smokers

49
Q

What is the treatment of Goodpasture’s syndrome?

A

No cure, can prevent worsening via immunosuppresants and plasmaphoresis

50
Q

Name 2 crescentic glomerulonephritis’, and their associated glomerular syndromes:

A

1) Goodpasture’s syndrome
2) Vasculitis (ANCA)
Both cause nephritic syndrome

51
Q

Describe the pathogenesis of Vasculitis (nephropathy):

A

ANCA (Anti-Neutrophil Cytoplasmic Antibody) causes inflammation of blood vessels

ESA3 (48 decks)

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