8 - glomerular pathology Flashcards
(14 cards)
what are the 4 renal cortical “compartments” of the kidney
1) glomerular
2) tubular
3) interstitial
4) vascular
Describe the histological structure of the kidney
podocyte foot processes (filtration) basement membrane (filtration) capillary endothelium
what is NEPHROTIC syndrome?
PODOCYTE DAMAGE LEADING TO GLOMERULAR CHARGE - BARRIER DISRUPTION
proteinuria, hypoalbuminaemia, oedematous
Usually with high cholesterol
protein lost is mostly albumin. the oncotic pressure in the blood drops. these patients do not need to have renal failure. BP and creatinine usually normal
what is NEPHRITIC syndrome?
INFLAMMATION DISRUPTING GLOMERULAR BM
haematuria, acute kidney failure, hypertensive
what is the likely site of injury in nephrotic syndrome?
podocytes foot processes (also called subepithelial damage)
what are the common primary and secondary causes of nephrotic syndrome?
PRIMARY
- minimal change glomerulonephritis
- focal segmented glomerulosclerosis (FSGS)
- membranous glomerulonephritis
SECONDARY
- diabetes mellitus
- SLE
- amyloid
What is minimal change glomerulonephritis and what is seen histologically?
- it occurs in children, common up to 21
- heavy proteinuria or nephrotic syndrome
- they respond well to steroids
- can recur (when stop steroids)
- usually no progression to renal failure
histology:
podocytes are missing
unknown circulating factor damages the podocytes
the glomerulus looks normal (hence minimal change)
what is FSGS and what is seen histologically?
focal segmented glomerulosclerosis
- nephrotic
- seen in adults
- not respond to steroids
- progresses to renal failure
histology:
glomerulus looks abnormal
circulating factor damaging podocytes
what is membranous glomerulonephritis?
- common common cause of nephrotic syndrome
- affects adults
- rule of thirds
- there are immune complex deposits
- probably autoimmune
- may be secondary to other pathologies like lymphoma
how does diabetes mellitus affect the kidney?
- progressive proteinuria
- progressive renal failure
- microvascular
- mesangial sclerosis –> nodules
- BM thickening
why is haematuria seen in nephritic syndrome:
where does haematuria effect and what causes it?
where does nephritic syndrome effect and what causes it?
haematuria affects the blood vessels, it occurs due to igA nephropathy
Nephritic syndrome affects the endothelium, causes include Goodpasture syndrome and vasculitis
What is IgA nephropathy?
- commonest cause of glomerular nephritis
- any age
- visible/ invisible haematuria
- relationship with mucosal infections
- variable histological features and course
- porteinuria may be seen
- significant proportion progress to renal failure
- no effective treatment
- igM deposits on the mesangial (no BM here)
what is goodpasture syndrome?
- a glomerulonephritis but not a vasculitis
- caused by production of anti-bodies to glomerular basement membrane
- trigger to antibody production is unknown
further explanation…
- uncommon
- rapidly progressive GN
- acute onset of severe nephritic syndrome
- association with pulmonary haemorrhage
- autoantibody to collagen IV in BM
- treatable if caught early
what is systemic vasculitis?
- group of auto-immune conditions
- cause inflammation and damage to the blood vessels
- classified according to whether they affect large, medium or small blood vessels
- if they affect small and medium arteries they can affect the kidneys
- causes nephritic syndrome
- can cause rapidly progressive renal disease
- fatal without treatment
further explanation …
- group of systemic disorders
- no immune complex/antibody deposition
- nephritic presentation
- treatable if caught early
