Week 10 - Glomerular Pathology Flashcards
1
Q
What are the different sites of glomerular injury?
A
- Subepithelial
- — Anything that affects podocytes/podocyte side of BM
- Within glomerular basement membrane
- Subendothelial
- – Inside the BM
- Mesangial/paramesangial
- – Supporting capillary loop
2
Q
How can the glomerular filter cause injury?
A
- Filter can block
- – Renal failure
- – Decreased eGFR
- Filter can leak
- – Proteinuria
- – Haematuria
- Nephrotic syndrome
- Nephritic syndrome
3
Q
What are some causes of haematuria?
A
- IgA nephropathy (commonest cause)
- – Can occur at any age
- – Classically presents with visible/invisible haematuria
- – Relationship with mucosal infections
- – Variable histological features and course
- – +/- proteinuria
- – Significant proportion progress to renal failure
- – No effective treatment
- – Mesangial damage
- – Deposition of circulating IgA containing immune complexes in the mesangium
- Thin glomerular basement membrane disease
- – Hereditary nephropathy
- – Benign familial nephropathy
- – Isolated haematuria
- – Thin GBM
- – Benign course (i.e. doesn’t lead to renal failure)
- Alport syndrome
- – X-linked
- – Abnormal collagen IV
- – Associated with deafness
- – Abnormal appearing GBM
- – Progresses to renal failure
4
Q
What are the common symptoms of nephrotic syndrome?
A
- Lots of proteinuria
- Become oedemitis
- Hypoalbuminaemia
- Hypercholesterolaemia
5
Q
What is the likely site of injury in nephrotic syndrome?
A
Podocyte/subepithelial layer
6
Q
What are the common primary causes of nephrotic syndrome/proteinuria?
A
- Minimal change glomerulonephritis
— Seen in childhood/adolescence
— Heavy proteinuria or nephritic syndrome
— Responds to steroids
— May recur
— Usually no progression to renal failure
— Unknown circulating factors damage the podocytes
— No immune complex deposition (.: not immune) - Focal segmental glomerulosclerosis
— Nephrotic
— Adults
— Less responsive to steroids
— Glomerulosclerosis (glomerular scarring)
— Unknown circulating factor damaging podocytes
— Progressive to renal failure - Membranous glomerulonephritis
— Commonest cause of nephrotic syndrome in adults
— Immune complex deposits
— Autoimmune
— May be secondary (associated with other pathologies, e.g. lymphoma)
— Rule of thirds:
• 1/3rd get better
• 1/3rd “grumble along”
• 1/3rd progress to renal failure
7
Q
What are the common secondary causes of nephrotic syndrome/proteinuria?
A
- Diabetes mellitus
— Progressive proteinuria
— Progressive renal failure
— Microvascular condition
— Mesangial sclerosis leads to nodules
• These disrupt the glomerulus, causing proteinuria
— Basement membrane thickening - Amyloidosis
8
Q
What are the common symptoms of nephritic syndrome?
A
- Haematuria
- Hypertensive
- AKI
9
Q
What are some causes of nephritic syndrome?
A
- Goodpasture syndrome
- – Usually affects women
- – Autoimmune
- – Rapidly progressive
- – Relatively uncommon although clinically important
- – Acute onset of severe nephritic syndrome
- – Classically described association with pulmonary haemorrhage (but only occurs with smokers)
- – Autoantibody to collagen IV in basement membranes (may only affect the renal BM because the collagen may be slightly different)
- – Treatable by immunosuppression and plasmaphoresis if caught early
- – There is IgG deposition
- Vasculitis
- – Inflammation of blood vessels
- – Group of systemic disorders
- – No immune complex/antibody deposition
- – Nephritic presentation
- – Associated with anti-neutrophil cytoplasmic antibody
- – Treatable, if caught early
10
Q
Explain some immune complex mediated glomerular diseases
A
- Subepithelial deposits:
- – Antigen abnormally recognised on podocytes, circulating IgG binds to it forming immune complexes in the glomerulus
- – E.g. membranous glomerulonephritis
- Mesangial deposits:
- – Immune complexes can be deposited directly in the mesangium as there is no podocytes or basement membrane to act as a barrier
- – E.g. IgA nephropathy
11
Q
What are the risk factors for prostate cancer?
A
- Increasing age
- Family history
- – If one 1st degree relative is diagnosed with CaP before age 60, 4x greater risk
- BRCA2 gene mutation
- Ethnicity
12
Q
How does prostate cancer present?
A
- Usual presentation:
— Asymptomatic
— Urinary symptoms
• Benign enlargement of prostate
• Bladder overactivity
— Bone pain - Unusual presentation:
— Haematuria (in advanced CaP)
13
Q
How can you diagnose prostate cancer?
A
- Digital rectal examination and serum PSA (prostate specific antigen)
- – Used to assess whether or not a biopsy of the prostate is necessary
- – If a biopsy is required, it is carried out via a TRUS (transrectal ultrasound) guided biopsy of prostate
- Lower urinary tract symptoms are treated with a transurethral resection of prostate
14
Q
What factors influence prostate cancer treatment decisions?
A
- Age
- Digital rectal examination
- PSA level
- Biopsies
- MRI scan and bone scan
15
Q
How do you treat established prostate cancer?
A
- Surveillance – if the cancer is low risk it is appropriate just to watch the cancer, as treatment may do more damage than good
- Radical prostactectomy
- – Open, robotic or laparoscopic
- Radiotherapy
- –External beam or low dose brachytherapy
