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Kidneys and Hormones > Glomerular disease > Flashcards

Glomerular disease Flashcards

1
Q

What are the 3 different cell types of the glomerulus?

A

Lining - endothelial cells

Outside contains podocytes

Mesangial cells

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2
Q

What is the role of the endothelial cells?

A

Specialised

Gaps allow water and molecules to passs through

Sit on the basement membrane

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3
Q

What is the role of the podocytes?

A

Form filtration barrier

Prevent large molecules from entering the filtrate

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4
Q

What is the role of the mesangial cells?

A

Hold down the capillary loop

Prevent the capillary loop from moving

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5
Q

What is glomerulonephritis?

A

Inflammation to the glomerulus

Leads to rapid deterioration of renal function

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6
Q

What are the symptoms of glomerulonephritis?

A

Different symptoms which depend on the part of the glomerulus affected and the effectors involved

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7
Q

What are the two types of glomerulonephritis?

A

Nephrotic syndrome

Nephritic syndrome

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8
Q

Which diseases cause glomerulonephritis?

A

Different infections

Can be caused by

Systemic infections - SLE

Kidney-specific infections - IgA disease

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9
Q

What is nephrotic syndrome?

A

Epithelial patterns of injury to the glomerulus

Large concentration of proteins leak out

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10
Q

What are the symptoms of nephrotic syndrome?

A

Oedema

Hypoalbuminunemia

Proteinuria - 3.5 g/day

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11
Q

What is nephritic syndrome?

A

Endothelial pattern of injury to the glomerulus

Global damage to the glomerulus

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12
Q

What are the symptoms of nephritic syndrome?

A

Blood and protein leakage to the urine

Salt and water retention - reduction to the urine formed

Hypertension and high blood pressure

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13
Q

What is another name for low volume of urine formed?

A

Oliguria

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14
Q

How does a urine dipstick test for glomerular disease?

A

It’s an early pointer to renal inflammation

Can be used to tell how functional the glomerular filtration barrier is

Normal - little protein and RBC escapes the tight filtration barrier

Abnormal - high concentration of albumin and low mass proteins

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15
Q

What is another way to test for glumorular disease?

A

Microscope urine to see if blood cells have been released into it

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16
Q

What is the most common cause of glomerulonephritis?

A

Post-infectious glomerulonephritis

Immune complexes deposit in the kidneys

Antigens and antibodies accumulate in the glomerulus and

Complement activation

17
Q

Which features of the immune complexes affect the disease features?

A

Location

Size

Charge

18
Q

What type of GN happens if antibodies get stuck in the podocytes?

A

Neprhotic syndrome

Proteins leak out

19
Q

What type of GN happens if antibodies get stuck under endothelial cells?

A

Nephritic syndrome

Stimulates WBC in capillary loop - activates WBC and causes damage by release of their contents

20
Q

How do autoantibodies cause GN?

A

Autoantibodies are dysfunctional and make antibodies towards self proteins

Antigen-antibody complex is presented to WBC

This triggers complement cascade

Immune complexes travel around the circulation and get stuck in compartments

Kidney is susceptible to blockages as it filters a large amount of blood

Deposition of immune complexes leads to glomerular disease

21
Q

Where may antigens come from?

A

Foreign antigens - infection

Endogenous antigens - autoimmunity

Formed in-situ - anti-glomerular basement

Formed in circulation - SLE

22
Q

What mechanism prevents autoimmunity?

A

Tolerance

Prevents T cells from reacting to self antigens

23
Q

How does the body normally get rid of dead or dying cells?

A

Under normal circumstances the body gets rid of dead and dying cells via apoptosis

Phagocytes ingest and clear them, recycling their contents

24
Q

What process leads to autoimmunity?

A

Defects in handling apoptosis in dead or dying cells leads to presentation of self-antigens to the immune system

Apoptotic cells undergo necrosis and contents of the cells are presented to the IS

If chromatin and DNA are in sufficient quantity, an immune response is triggered

25
Q

What type of GN does mesangial injury induce?

A

Nephritic syndrome

26
Q

What type of GN does endothelial injury induce?

A

Nephritic syndrome

27
Q

What type of GN does epithelial injury induce?

A

Nephrotic syndrome

28
Q

Pathogenesis of lupus

A

Intracellular contents released when apoptosis goes wrong

DNA, nucleoproteins and cytoplasmic ribonuclear proteins are released

These are expressed on the CSM during apoptosis - antigens form against these

29
Q

How many antibodies must accumulate for lupus to develop?

A

2 or 3

30
Q

What type of GN is present in lupus?

A

Mesangial injury
Endothelial injury
Epithelial injury

Both nephrotic and nephritic syndrome is present

31
Q

How does lupus lead to GN?

A

Deposition of antibodies underneath the podocytes and blood vessel wall

Both nephrotic and nephritic syndrome

32
Q

Treatments for GN in lupus patients

A

Remove the antibodies

Remove the infection

Suppress antibodies from being made

33
Q

What is Goodpasture’s disease?

A

Autoimmune disease

Caused by circulating anti glomerular basement membrane antibodies

34
Q

What conditions develop in Goodpasture’s disease?

A

Acute GN

Pulmonary alveolar haemorrhage

35
Q

What are the treatments of Goodpasture’s disease?

A

Glucocorticoids

Cyclophosphamide - suppresses leukocytes

Plasma exchange - remove abnormal antibodies from the circulation

36
Q

Which side effects arise from the treamtents of Goodpasture’s disease?

A

Infections

Malignancies - cataracts and melanoma

Metabolic complications

Drug toxicities - bone disease (glucocorticoids), bladder tumour (cyclophosphamide) and avascular necrosis

37
Q

What are the side effects of glucocorticoids?

A

Bone disease

38
Q

What are the side effects of cyclophosphamide?

A

Bladder tumour

Kidneys and Hormones (39 decks)

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