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Pathopharmacology I > Wk 3 Glomerular Disorders > Flashcards

Wk 3 Glomerular Disorders Flashcards

1
Q

What is glomerulonephritis?

A

Variety of conditions that cause inflammation of the glomeruli

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2
Q

Glomerulonephritis can be __ or __

A

focal or diffuse

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3
Q

Glomerulonephritis can be caused by…

A

Infection
Inflammatory condition

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4
Q

Glomerulonephritis affects..

A

both kidneys equally

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5
Q

Glomerulonephritis is the __ leading cause of kidney failure in the United States

A

third

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6
Q

About what percentage of ESRD patients have glomerulonephritis?

A

25%

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7
Q

Glomerulonephritis is primarily an __-mediated process

A

immune

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8
Q

What is the glomerulus?

A

A delicate network of arterioles within the bowman’s capsule

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9
Q

What is this structure?

A

Glomerulus (arterioles inside the Bowman’s capsule)

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10
Q

The tubules are a massive consumer of what?

A

Oxygen

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11
Q

What renal artery takes blood in?

A

Afferent

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12
Q

What renal artery takes blood away?

A

Efferent

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13
Q

What is the reason for the pressure difference in the arteries?

A

Helps push stuff out of the blood to the vessels to filter the blood, and then adds these particles to urine

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14
Q

What is needed to make urine?

A

A LOT of oxygen

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15
Q

What is needed to have the correct perfusion to the kidneys?

A

Adequate blood pressure and cardiac output

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16
Q

What pathway has high pressure?

A

Afferent

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17
Q

What pathway has the highest pressure?

A

Efferent

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18
Q

What type of cell helps with the production of urine?

A

podocytes

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19
Q

What are the three layers of the capillary membranes in the glomerulus?

A
  1. Endothelium
  2. Basement membrane
  3. Podocytes
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20
Q

What is primary glomerulonephritis?

A

Isolated to the kidneys

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21
Q

What is secondary glomerulonephritis?

A

Caused by systemic disease

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22
Q

If the damage to the glomeruli is diffuse, what does this mean?

A

It is affecting both kidneys

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23
Q

If the damage to the glomeruli is focal, what does this mean?

A

It is only affecting some of the glomeruli

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24
Q

If the damage to the glomeruli is local, what does this mean?

A

It is only an area of the glomerulus

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25
Q

Glomerulonephritis is a __ disease

A

progressive

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26
Q

How does a patient with glomerulonephritis present?

A

Systemic symptoms if secondary

Otherwise, maybe just some changes to the urine

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27
Q

What is an example of a type 2 hypersensitivity reaction?

A

Incompatible blood type - cytotoxic reaction

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28
Q

What type of hypersensitivity reaction is when the immune complexes are deposited into tissues and causes inflammation?

A

Type 3

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29
Q

What type of hypersensitivity reaction occurs on the surface of the cell and directly causes cell death?

A

Type 2

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30
Q

What type of hypersensitivity reaction do immune complexes deposit into the tissues?

A

Type 3

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31
Q

What type of hypersensitivity reaction is glomerulonephritis?

A

type 2 or 3

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32
Q

What type of hypersensitivity reaction is responsible for 90% of glomerulonephritis?

A

Type 3

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33
Q

What is the type 2 sensitivity responsible for glomerulonephritis?

A

Antibodies attach to antigens of the glomerular basement membrane (anti-GBM antibodies)

34
Q

What is the type 3 hypersensitivity reaction responsible for glomerulonephritis?

A

Antibodies react with circulating antigens and are deposited as immune complexes in the GBM

35
Q

What do both types of glomerulonephritis have in common? (2)

A

Accumulation of antigens, antibodies, and complement

Complement activation results in tissue injury

36
Q

What is acute gloemerulonephritis?

A

Abrupt onset of glomerulonephritis

37
Q

What is abrupt glomerulonephritis characterized by?

A

H.A.R.P.

38
Q

What does HARP stand for?

A

Hematuria

Azotemia

Retention

Proteinuria

39
Q

What is azotemia?

A

Buildup of waste products

40
Q

Someone with acute glomerulonephritis may present with what symptoms related to retention?

A

HTN and Edema becuase of sodium and water retention

41
Q

What does a patient with actue glomerulonephritis have proteinuria?

A

Protein spills over into the urine with damage to the GBM

42
Q

A patient with acute glomerulonephritis may become __ because of the water retention

A

oliguric

43
Q

When might a patient have acute glomerulonephritis?

A

Post-streptococcal infection

Bacterial, viral, or parasitic

44
Q
A
45
Q

What is post-infection a potential trigger for acute glomerulonephritis?

A

Antibodies mistake BGM as foreign and attack

46
Q

What is the primary disease that can cause acute glomerulonephritis?

A

Berger disease

47
Q

Berger disease is the __ disease that can cause acute glomerulonephritis

A

primary

48
Q

What antibody casues the GBM damage in Berger disease?

A

IgA

49
Q

What are autoimmune diseases that can cause actue glomerulonephritis?

A

Goodpasture syndrome

Systemic lupus erythematosus

Vasculitis

50
Q

What is Goodpasture syndrome?

A

An autoimmune disease where a person has anti-GBM antibodies

51
Q

What is a common presentation of Goodpasture syndrome?

A

Hemoptysis

52
Q

Why do patients with Goodpasture syndrome often present with hemoptysis?

A

Because the GBM is very similar to the basement membrane of the lungs and the anti-GBM antibodies attack it too

53
Q

What is chronic glomerulonephritis?

A

Long-term inflammation of the glomeruli that leads to a buildup of scar tissue

54
Q

What is the prognosis of chronic glomerulonephritis?

A

Slow progressive destruction that leads to ESRD

55
Q

What are 4 pharcotherapies for chornic glomerulonephritis?

A

Corticosteroids such as prednisone

Diuretics

Immunosuppressants

Anti-hypertensives

56
Q

What 2 types of hypertensive meds are typically used for chronic glomerulonephritis?

A

ACE

ARB

57
Q

What other treatments are important for chronic glomerulonephritis?

A

Dialysis

Diet -

58
Q

What 3 diet restictions for chronic kidney disease?

A

Protein

Sodium

Potassium

59
Q

What protein is specifically lost in the urine with glomerulonephritis?

A

Albumin

60
Q

What color is the urine for a patient with glomerulonephritis?

A

Coffee/cola colored

61
Q

Glomerulonephritis:

Why is the blood dark in the urine instead of bright red?

A

Because it starts at the Bowman’s capsule so it is old blood

62
Q

What is oliguria defined by?

A

Less than 400 mls/day

63
Q

What would the BUN look like for a patient with glomerulonephritis?

A

Elevated

64
Q

What would the creatinine look like for a patient with glomerulonephritis?

A

Elevated

65
Q

What would the BUN:Creatinine ratio look like for a patient with glomerulonephritis?

A

greater than 20:1

66
Q

What are 2 types of glomerulopathy?

A

Diabetic neuropathy

Hypertensive glomerular disease

67
Q

A thick glomerular basement membrane =

A

poor filtration!

68
Q

What causes diabetic nephropathy?

A

Uncontrolled high glucose levels cause damage to the glomerulus

69
Q

When do you see thickening of the glomerulus membrane?

A

with diabetic nephropathy

70
Q

What causes the glomerulopahty in hypertensive type?

A

Increased pressure causes a buildup of scar tissue that doesn’t function

71
Q

Hypertensive glomerulopathy results in… (2)

A

Decreased renal perfusion

Sclerotic glomerular changes

72
Q

What is the definition of nephrotic syndrome?

A

The glomerulus is too permeable to plasma proteins

73
Q

What is the defining amount of protein passing through for nephrotic syndrome?

A

Greater than 3 g of protein per day

74
Q

How do we test for nephrotic syndrome?

A

We collect a 24 hour urine

75
Q

What is the etiology for nephrotic syndrome?

A

Glomerulonephritis

Diabetes mellitus

76
Q

Why do patients with nephrotic syndrome have edema?

A

Low albumin causes fluid to shift into interstitial space, causes third spacing

77
Q

Why do patients with nephrotic syndrome have hypertension?

A

RAAS system increases because kidneys need more perfusion

78
Q

Why do patients with nephrotic syndrome have hyperlipidemia?

A

Because they are losing protein, in response the liver will increase lipid production causing hyperlipidemia

79
Q

Why do patients with nephrotic syndrome also have hypercoagulation?

A

Some of the proteins lost are antithrombin III and plasminogen

80
Q

What does antithrombin III do?

A

Prevents thrombin which in turn inhibits blood clots

81
Q

What does plasminogen do?

A

Precursor to plasmin which helps break down clots that form

82
Q
A

Pathopharmacology I (33 decks)

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