Wk 3 Glomerular Disorders Flashcards
What is glomerulonephritis?
Variety of conditions that cause inflammation of the glomeruli
Glomerulonephritis can be __ or __
focal or diffuse
Glomerulonephritis can be caused by…
Infection
Inflammatory condition
Glomerulonephritis affects..
both kidneys equally
Glomerulonephritis is the __ leading cause of kidney failure in the United States
third
About what percentage of ESRD patients have glomerulonephritis?
25%
Glomerulonephritis is primarily an __-mediated process
immune
What is the glomerulus?
A delicate network of arterioles within the bowman’s capsule
What is this structure?
Glomerulus (arterioles inside the Bowman’s capsule)
The tubules are a massive consumer of what?
Oxygen
What renal artery takes blood in?
Afferent
What renal artery takes blood away?
Efferent
What is the reason for the pressure difference in the arteries?
Helps push stuff out of the blood to the vessels to filter the blood, and then adds these particles to urine
What is needed to make urine?
A LOT of oxygen
What is needed to have the correct perfusion to the kidneys?
Adequate blood pressure and cardiac output
What pathway has high pressure?
Afferent
What pathway has the highest pressure?
Efferent
What type of cell helps with the production of urine?
podocytes
What are the three layers of the capillary membranes in the glomerulus?
- Endothelium
- Basement membrane
- Podocytes
What is primary glomerulonephritis?
Isolated to the kidneys
What is secondary glomerulonephritis?
Caused by systemic disease
If the damage to the glomeruli is diffuse, what does this mean?
It is affecting both kidneys
If the damage to the glomeruli is focal, what does this mean?
It is only affecting some of the glomeruli
If the damage to the glomeruli is local, what does this mean?
It is only an area of the glomerulus
Glomerulonephritis is a __ disease
progressive
How does a patient with glomerulonephritis present?
Systemic symptoms if secondary
Otherwise, maybe just some changes to the urine
What is an example of a type 2 hypersensitivity reaction?
Incompatible blood type - cytotoxic reaction
What type of hypersensitivity reaction is when the immune complexes are deposited into tissues and causes inflammation?
Type 3
What type of hypersensitivity reaction occurs on the surface of the cell and directly causes cell death?
Type 2
What type of hypersensitivity reaction do immune complexes deposit into the tissues?
Type 3
What type of hypersensitivity reaction is glomerulonephritis?
type 2 or 3
What type of hypersensitivity reaction is responsible for 90% of glomerulonephritis?
Type 3
What is the type 2 sensitivity responsible for glomerulonephritis?
Antibodies attach to antigens of the glomerular basement membrane (anti-GBM antibodies)
What is the type 3 hypersensitivity reaction responsible for glomerulonephritis?
Antibodies react with circulating antigens and are deposited as immune complexes in the GBM
What do both types of glomerulonephritis have in common? (2)
Accumulation of antigens, antibodies, and complement
Complement activation results in tissue injury
What is acute gloemerulonephritis?
Abrupt onset of glomerulonephritis
What is abrupt glomerulonephritis characterized by?
H.A.R.P.
What does HARP stand for?
Hematuria
Azotemia
Retention
Proteinuria
What is azotemia?
Buildup of waste products
Someone with acute glomerulonephritis may present with what symptoms related to retention?
HTN and Edema becuase of sodium and water retention
What does a patient with actue glomerulonephritis have proteinuria?
Protein spills over into the urine with damage to the GBM
A patient with acute glomerulonephritis may become __ because of the water retention
oliguric
When might a patient have acute glomerulonephritis?
Post-streptococcal infection
Bacterial, viral, or parasitic
What is post-infection a potential trigger for acute glomerulonephritis?
Antibodies mistake BGM as foreign and attack
What is the primary disease that can cause acute glomerulonephritis?
Berger disease
Berger disease is the __ disease that can cause acute glomerulonephritis
primary
What antibody casues the GBM damage in Berger disease?
IgA
What are autoimmune diseases that can cause actue glomerulonephritis?
Goodpasture syndrome
Systemic lupus erythematosus
Vasculitis
What is Goodpasture syndrome?
An autoimmune disease where a person has anti-GBM antibodies
What is a common presentation of Goodpasture syndrome?
Hemoptysis
Why do patients with Goodpasture syndrome often present with hemoptysis?
Because the GBM is very similar to the basement membrane of the lungs and the anti-GBM antibodies attack it too
What is chronic glomerulonephritis?
Long-term inflammation of the glomeruli that leads to a buildup of scar tissue
What is the prognosis of chronic glomerulonephritis?
Slow progressive destruction that leads to ESRD
What are 4 pharcotherapies for chornic glomerulonephritis?
Corticosteroids such as prednisone
Diuretics
Immunosuppressants
Anti-hypertensives
What 2 types of hypertensive meds are typically used for chronic glomerulonephritis?
ACE
ARB
What other treatments are important for chronic glomerulonephritis?
Dialysis
Diet -
What 3 diet restictions for chronic kidney disease?
Protein
Sodium
Potassium
What protein is specifically lost in the urine with glomerulonephritis?
Albumin
What color is the urine for a patient with glomerulonephritis?
Coffee/cola colored
Glomerulonephritis:
Why is the blood dark in the urine instead of bright red?
Because it starts at the Bowman’s capsule so it is old blood
What is oliguria defined by?
Less than 400 mls/day
What would the BUN look like for a patient with glomerulonephritis?
Elevated
What would the creatinine look like for a patient with glomerulonephritis?
Elevated
What would the BUN:Creatinine ratio look like for a patient with glomerulonephritis?
greater than 20:1
What are 2 types of glomerulopathy?
Diabetic neuropathy
Hypertensive glomerular disease
A thick glomerular basement membrane =
poor filtration!
What causes diabetic nephropathy?
Uncontrolled high glucose levels cause damage to the glomerulus
When do you see thickening of the glomerulus membrane?
with diabetic nephropathy
What causes the glomerulopahty in hypertensive type?
Increased pressure causes a buildup of scar tissue that doesn’t function
Hypertensive glomerulopathy results in… (2)
Decreased renal perfusion
Sclerotic glomerular changes
What is the definition of nephrotic syndrome?
The glomerulus is too permeable to plasma proteins
What is the defining amount of protein passing through for nephrotic syndrome?
Greater than 3 g of protein per day
How do we test for nephrotic syndrome?
We collect a 24 hour urine
What is the etiology for nephrotic syndrome?
Glomerulonephritis
Diabetes mellitus
Why do patients with nephrotic syndrome have edema?
Low albumin causes fluid to shift into interstitial space, causes third spacing
Why do patients with nephrotic syndrome have hypertension?
RAAS system increases because kidneys need more perfusion
Why do patients with nephrotic syndrome have hyperlipidemia?
Because they are losing protein, in response the liver will increase lipid production causing hyperlipidemia
Why do patients with nephrotic syndrome also have hypercoagulation?
Some of the proteins lost are antithrombin III and plasminogen
What does antithrombin III do?
Prevents thrombin which in turn inhibits blood clots
What does plasminogen do?
Precursor to plasmin which helps break down clots that form
