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GI > Urinary Week 9 - glomerular injury > Flashcards

Urinary Week 9 - glomerular injury Flashcards

1
Q

What renal compartments can be damaged in renal disease

A

Glomerular
Tubular
Interstitial
Vascular

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2
Q

Sites of glomerular injury

A

Subepithelial
Glomerular basement membrane
Subendothelial
Mesangial

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3
Q

Secondary causes of glomerular injury

A

Diabetes

Hypertension

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4
Q

What occurs in blockage of the glomerulus

A

Renal failure (nephritic syndrome)
Low GFR
High stage AKI
Haematuria due to degradation of the glomerulus
Hypertension due to failure to control blood volume

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5
Q

What occurs in leakage of the glomerulus

A

Proteinuria including nephrotic syndrome

Haematuria

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6
Q

Criteria for nephrotic syndrome

A

> 3.5g filtered in 24 hours

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7
Q

Isolated proteinuria suggests what site of glomerular injury

A

Sub epithelial

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8
Q

Symptoms of nephrotic syndrome

A

Hypoalbuminaemia causes generalised oedema

Poor renal perfusion pressure leads to RAAS activation so more fluid retention

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9
Q

Primary causes of nephrotic syndrome/proteinuria

A

Minimal change glomerulonephritis
Focal segmental glomerulosclerosis
Membranous glomerulonephritis

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10
Q

Secondary causes of nephrotic syndrome/proteinuria

A 
Diabetes mellitus (causes microvascular damage, BM thickening, mesangial sclerosis, progressive proteinuria and progressive renal failure)
Amyloidoses
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11
Q

Describe minimal change glomerulonephritis - demographic, symptoms, treatment, outcome, histology

A

Presents in childhood/adolescence and incidence decreases with increasing age
Causes heavy proteinuria or nephrotic syndrome
Responds well to steroids
Usually doesn’t progress to renal failure
Under an EM, widened filtration slits are visible

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12
Q

Pathogenesis of minimal change glomerulonephritis

A

Unknown

Damage caused by a circulating factor that is not an immune complex

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13
Q

What does focal segmental glomerulosclerosis include

A

Focal - <50% glomerulus affected
Segmental - involves glomerular tuft
Glomerulosclerosis - patchy scarring of glomerulus

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14
Q

Describe focal segmental glomerulosclerosis - demographics, symptoms, treatment, outcome

A

Presents in adults
Causes nephrotic syndrome and glomerulosclerosis
Not very responsive to steroids
Can progress to renal failure

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15
Q

Pathogenesis of focal segmental glomerulosclerosis

A

Unknown

Damage is caused by a circuiting factor which is not an immune complex

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16
Q

What is an immune complex

A

Antigen-antibody complex that circulates and activates complement

17
Q

Describe membranous glomerulonephritis - demographics, symptoms, outcome, histology

A

Commonest cause of nephrotic syndrome in adults
Complement activation causes cell damage
1/3 recover, 1/3 don’t improve and 1/3 progress to renal failure
Capillary loop is thickened and BM appears spiky due to immune complex deposition

18
Q

Pathogenesis of membranous glomerulonephritis

A

Antigen and IgG are filtered and react in the sub epithelial space to produce immune complexes I.e it has an autoimmune basis
May also be secondary to malignancies likely lymphoma which triggers the immune system

19
Q

Causes of haematuria

A

IgA nephropathy

Hereditary nephropathy

20
Q

Causes of nephritic syndrome

A

Good pasture syndrome

Vasculitis

21
Q

Demographics of IgA nephropathy

A

Any age

22
Q

Presentation of IgA nephropathy

A

Haematuria
Triggered by mucosal infections (IgA secreted onto mucosa and activated in infection)
May be proteinuria

23
Q

Treatment and outcome of IgA nephropathy

A 
No treatment (can have transplant)
Significant number progress to renal failure
24
Q

Where is IgA usually deposited and why

A

Mesangium because there is no basement membrane between the mesangium and blood

25
Q

What are the types of hereditary neuropathies

A

Thin glomerular basement membrane neuropathy

Alport syndrome

26
Q

Describe thin glomerular basement membrane nephropathy

A

Isolated haematuria
Thin glomerular basement membrane
Benign

27
Q

Describe Alport syndrome

A 
X linked condition
Abnormal collagen IV production
Deafness
Abnormal glomerular basement membrane 
Progresses to renal failure
28
Q

Describe good pasture syndrome

A

Rapidly progressing glomerular nephritis

29
Q

What is common in smokers with good pastures syndrome

A

Haemoptysis

30
Q

Cause of good pasture syndrome

A

Autoantibody (IgG) against collagen IV glomerular basement membrane

31
Q

Outcome of untreated good pasture syndrome

A

Loss of kidney architecture (irreversible) so fibrosis occurs

32
Q

Treatment of good pasture syndrome

A

Immunosuppression

Plasmapheresis

33
Q

What is vasculitis

A

Group of systemic disorders causing inflammation of blood vessels

34
Q

Describe vasculitis

A

Blood vessels are attacked in the glomerulus by anti neutrophil cytoplasmic antibodies (ANCA) which damage endothelia by activating neutrophils

35
Q

What is required in suspected vasculitis

A

Urgent biopsy to confirm

36
Q

Histological appearance of vasculitis

A

Segmental necrosis and crescent formation on a light microscope

GI (19 decks)

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