urologic problems: glomerular disease

Question 1

azotemia

Answer 1

increase BUN and Cr in urine

Question 2

glomerular filtration rate (GFR)

Answer 2

blood test to check kidney function –> blood filtered per hour

calculated of blood metabolic panel

Question 3

glomerular disorders

Answer 3

glomerulonephritis

nephrotic syndrome

Question 4

glomerulonephritis

Answer 4

a variety of conditions that cause inflammation of glomeruli
-primarily an immune response
-focal or diffused
-affects BOTH kidneys equally

**3rd leading cause of kidney failure in US (25% of ESRD cases)

Question 5

where does the damage of glomerulonephritis occur?

Answer 5

glomerulus - delicate network of arterioles within the Bowman’s capsule

tubules - massive consumer of oxygen

Question 6

glomerular disorders

Answer 6

alterations in glomerular capillary

Question 7

glomerulus layers

Answer 7

capillary membranes have 3 layers:
1. endothelium
2. basement membrane
3. podocytes (special epithelial cells)

Question 8

primary vs. secondary glomerulonephritis

Answer 8

primary - isolated to kidneys
secondary - caused by systemic disease

Question 9

type II immune complex

Answer 9

reactions occur on the cell surface and result in direct cell death or malfunction

Question 10

type III immune complex

Answer 10

immune complexes are deposited into tissues and the resulting inflammation damages the tissues

Question 11

what are the 2 type of glomerulonephritis injuries?

Answer 11

1. antibodies attach to antigens of the glomerular basement membrane (“anti-GBM antibodies”) –> 5%
2. antibodies react with circulating antigens and are deposited as immune complex in the GBM –> 90%

Question 12

what do BOTH types of glomerulonephritis have in common?

Answer 12

-accumulation of antigens, antibodies, and complement

-complement activation results in tissue injury

Question 13

acute glomerulonephritis characterized by…

Answer 13

ABRUPT ONSET

HARP
H- hematuria
A- azotemia
R- retention (sodium & water retention; leads to oliguria, edema and HTN)
P- proteinuria

Question 14

triggers of acute glomerulonephritis

Answer 14

post-infectious:
-post-streptococcal infection
-non-streptococcal infection (bacterial, viral, parasitic)

primary disease
(ex: Berger disease)

multisystem disease:
(ex: goodpasture syndrome, systemic lupus erythematosus (SLE), vasculitis)

Question 15

anti-GBM antibodies

Question 16

acute glomerulonephritis patho

Answer 16

1. trigger
2. immune complexs form
3. complement activated
4. release of mediators
5. tissue injury
6. hematuria, proteinuria, decreased GFR

Question 17

chronic glomerulonephritis

Answer 17

longer term complication build up of scar tissue – scar tissue can’t filter/produce urine effectively
*inflammatory process
*can lasts months - years

Question 18

clinical manifestations of chronic glomerulonephritis

Answer 18

similar to acute –>

HARP
H- hematuria
A- azotemia
R- retention (sodium & water retention; leads to oliguria, edema and HTN)
P- proteinuria

*dependent of severity of damage to kidney’s

Question 19

prognosis of chronic glomerulonephritis

Answer 19

slow progressive destruction of glomerular tissue

ENDS with ESRD and REQUIRES dialysis

Question 20

pharmacotherapy for glomerulonephritis

Answer 20

corticosteroids (predisone) - reduce inflammation

diuretics - reduce swelling

immunosuppressants
anti-hypertensives (ACE or ARB)

Question 21

other treatment (aside from meds)

Answer 21

dialysis
diet (less PRO, salt, potassium)

Question 22

common S/S of glomerulonephritis

Answer 22

hematuria (coffee colored urine)
oliguria (<400mL/day)
fluid retention (edema, HTN)
labs
- elevated BUN, Cr (>20:1 BUN:Cr ratio)
-++proteinuria
-hypoproteinemia

Question 23

glomerulopathy: DM

Answer 23

diabetic neuropathy
-major complication
-underlying pathology (gross thickening of GBM–> poor filtration)
END RESULT:

Question 24

glomerulopathy: HTN

Answer 24

hypertensive glomerular disease
-decreased renal perfusion
-sclerotic glomerular changes

Question 25

nephrotic syndrome

Answer 25

the glomerulus is too permeable to plasma proteins
elimination > 3 grams of protein per day

Question 26

cause of nephrotic syndrome

Answer 26

glomerulonephritis
DM

Question 27

nephrotic syndrome PATHO

Answer 27

increased glomerular permeability –> proteinuria –> hypoalbuminemia

Question 28

clinical manifestations of nephrotic syndrome

Answer 28

edema
HTN
hyperlipidemia
hyper coagulation (DVT, PE) – loss of antithrombin III and plasminogen

Question 29

antithrombin III fxn

Answer 29

keeps balance between clots and free flowing blood

Question 30

plasminogen

Answer 30

percursor to plasmin which helps breakdown clots that do form