glomerular problems (W3)

Question 1

what is the functional unit of the kidney?

Answer 1

the nephron

Question 2

glomerulonephritis

Answer 2

a variety of conditions that cause the inflammation of glomeruli
can be focal or diffuse
affects both/either or
3rd leading cause of kidney failure, about 1/4 of ESRD cases
primarily an immune-mediated response

Question 3

where does damage occur?

Answer 3

glomerulus- delicate network of arterioles within bowmans capsule
tubules- massive oxygen consumer

Question 4

glomerular d/o

Answer 4

alterations in glomerular capillary

Question 5

glomerulus (3 layers of the capillary membrane)

Answer 5

1. endothelium layer
2. basement membrane
3. podocytes (special epithelial cells)

Question 6

how to classify glomerulonephritis

Answer 6

etiology:
primary- isolated to kidneys
secondary- caused by systemic disease

damage to glomeruli:
focal- only some glomeruli
local- an area of glomeruli

disease progression

clinical presentation

Question 7

type 2

Answer 7

occurs on the cell surface and results in direct cell death/malfunction

Question 8

type 3

Answer 8

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

Question 9

type 2 and 3- what do they have in common?

Answer 9

immune complexes

Question 10

two types of injury

Answer 10

1. AB attack to antigens of the glomerular basement membrane, direct attack via “anti-GBM AB” (> 5%)
2. antibodies react with circulating antigens that are deposited in the GBM (> 90%)

Question 11

both types of injury- what do they have in common?

Answer 11

1. accumulation of antigens, AB, complement
2. complement activation results in tissue injury
3. inflammation

Question 12

acute glomerulonephritis

Answer 12

abrupt onset
“HARP”
H- hematuria, blood in urine
A- azotemia, buildup of wast products
R- retention, sodium/water/oliguria/leads to htn and edema
P- proteinuria, protein in urine

Question 13

AG triggers

Answer 13

post-infection: strep/non-strep/bacterial/viral/parasitic
primary disease: berger disease
multisystem disease: good pasture syndrome, systemic lupus (SLE), vasculititis

Question 14

anti-GBM AB

Answer 14

think about the disease good pasture syndrome
similar to lungs
hemoptysis
results in renal and respiratory problems

Question 15

acute glomerulonephritis pathogenesis

Answer 15

1. trigger
2. immune complex formation
3. complement activation
4. release mediators
5. tissue injury
6. hematuria, proteinuria, decreaed GFR

Question 16

chronic glomerulonephritis

Answer 16

LT inflammaton- weeks to months
buildup of scar tissue, results in non-functional kidney
similar s/s of acute
progression- s/s renal failure
slow
eventually ESRD- dialysis

Question 17

pharm

Answer 17

corticosteroids
diuretics
immunosuppressants
anti-hypertensives

Question 18

other treatment

Answer 18

dialysis
diet (< protein, salt, potassium)

Question 19

S/S of glomerular problems

Answer 19

hematuria- coffee/cola-colored
oliguria
fluid retention
labs (increased BUN/creatinine- ratio 20:1, positive protein in the urine, hypoproteinemia, low albumin)

Question 20

loss of albumin

Answer 20

hypoproteinemia

Question 21

glomerulopathy

Answer 21

diabetes
hypertension

Question 22

diabetic glomerulopathy

Answer 22

major complication
gross thickening of GBM

Question 23

hypertension glomerulopathy

Answer 23

decreased renal perfussion
scarring
sclerotic glomerular changes

Question 24

nephrotic syndrome

Answer 24

damage causes glomeruli to be too permeable to plasma proteins, eliminates > 3 grams of protein each day

etiology:
1. glomerulonephritis
2. diabetes

Question 25

patho of nephrotic syndrome

Answer 25

increased glomeruli permeability
proteinuria
hypo-abluminemia

Question 26

nephrotic syndrome- clinical manifestations

Answer 26

edema (decreased albumin)
hypertension (compensates)
liver (hyperlipidemia, hypercoagulation because of loss of antithrombin 3 and plasminogen)

Question 27

why does edema occur in nephrotic syndrome?

Answer 27

due to decrease in serum osmotic pressure caused by loss of serum albumin