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Flashcards in deck_1662724 Deck (48):

What are the main foci of kidney disease?

• Glomerulus • PCT • Interstitium • Vascular supply


What is a primary glomerular injury?

• One which just effects the glomerulus


What is a secondary glomerula injury?

• A systemic illness which happens to effect the glomerulus


What are the four main sites of glomerular injury?

• Subepithelial ○ Anything that effects podocytes/podocyte side of glomerular basement membrane • Within glomerula basement membrane • Subendothelial ○ Inside the basement membrane • Mesangial/parameangial ○ Supporting capillary loop


Why can the nephron be termed a "functional unit"

• Same blood supply to glomerulus and nephron ○ Thus, ischaemic disease in glomerulus reduces blood supply to nephron, causing damage


What are the two main pathologies of the glomerulus?

• It can become blocked ○ "Renal Failure" ○ Decreased GFR ○ Haematuria • It can leak ○ Proteinuria ○ Haematuria ○ One, other or both


What is proteinuria?

• Presence of excess serum proteins in the urine (


What does proteinuria indicate?

• Podocyte damage, causing fenestration to widen and causing protein to be leaked when it would normally be filteredLess severe nephrotic syndrome


What is nephrotic syndrome?

• More than 3.5g of protein lost in urine per daySoon becomes hypoalbuminaemia


How does the body respond to hypoalbuminaemia as a result of nephrotic syndrome?

• Oedematous • Liver starts to pump out more albumin, along with more cholesterol!


What is nephritic syndrome?

• Glomerulus is blocked • GFR drops • Creatinine increases • Haematuria (glomerulus blood vessels ruptured) • Hypertensive


What are the four main areas in the glomerula capillary loop where damage can occur?

• Subepithelial • With GBM • Subendothelial • Mesangial


What is the difference between primary and secondary kidney disease?

• Primary kidney disease - Pathology soley affecting kidney • Secondary kidney disease - Systemic disease which affects kidney


What is the likely site of injury in proteinuria/nephrotic syndrome?

• Podocyte/subepithelial damage


Give three primary causes of proteinuria/nephrotic syndrome

• Minimal change glomerulonephritis • Focal segmental glomerulosclerosis • Membranous glomerulonephritis


Give two common secondary cuases of proteinuria/nephrotic syndrome

• Diabetes mellitus • Amyloidosis


When does minimal change glomerulnephritis occur?

• Occurs in childhood/adolescence • Incidence reduces with increasing age


What are the symptoms of glomerulonephritis?

• Heavy proteinuria or nephrotic syndrome • Responds to steroids • Usually no progression to renal failure


Why does minimal change glomerulonephritis occur?

• Podocytes destroyed, loss of filtration slits


What is the pathogenesis of minimal change glomerulonephritis?

• Unknown circulating factor damaging podocytes • No immune complex deposition


Why is minimal change glomerulonephritis called thus?

• Normal golmeurli under a light microscope


How can you detect minimal change glomerulonephritis?

• Electron microscope, damage to podocytes evident


What is Focal segmental glomerulosclerosis

• Nephrotic syndrome which effects adults • Steroids minimally effective


What does a patient with focal segmental glomerulosclerosis normal present with?

• Massive proteinuria • Haematuria • Hypertension • Renal failure


Why is it called focal segmental glomerula sclerosis?

• Focal - Involving less than 50% of glomeruli on light microscopy • Segmental - Involving part of the glomerular tuft • Glomerular • Sclerosis - Scarring


What is the main pathology of Focal segmental glomerulosclerosis?

• Damage to glomerulus causing scarring • Circulating factor damages podocytes • Progressive renal failure


What causes Focal segmental glomerular nephritis?

• A circulating factor


What is membranous glomerulonephritis?

Commonest cause of nephrotic syndrome in adultsImmune complex depositsCapillary loop thickBasement membrane specley


What causes membranous glomerulonephritis?

• Autoimmune response to podocytes • Immune complex deposits (IgG) ○ May also be secondary, as often associated with diseases such as lymphoma


What is an immune complex?

• Äntigen complexed with multiple antibodies • IgG destroy antigen found on podocytes, destroying podocytes in process


What is a distinguishing feature of kidney disease as a result of diabetes mellitus?

• Progressive proteinuriaProgressive renal failure


How does the rule of thirds apply to membranous glomerulonephritis?

• 1/3 just get better • 1/3 grumble along, proteinuria but are fine • 1/3 progress to renal failure


What is the pathology of kidney disease as a result of diabetes mellitus?

o Progressive proteinuriao Progressive renal failureo Microvascular (Damages glomerulus directly)o Mesangial sclerosis  noduleso Basement membrane thickening to 4-5x normal


What is nephritic syndrome?

• Renal failure due to blocking of filter


Give five causes of nephritic syndrome

• Good pasture syndrome • Vasculitis • IgA nephropathy • Thin GBM Nephropathy • Alport syndrome


What is IgA nephropathy?

• Commonest glomerular nephropathy • Characterised by deposition of IgA antibody in the glomerulus


How does IgA present?

• Will present with haematuria when get cold, due to relationship with mucosal infections • Significant proportion progress to renal failure • Some, not all, patients have proteinuria


What is haematuria as a result of IgA nephropathy a result of?

• Mesangial damage and scarring - Significant proportion of patients progress to renal failure


What happens to the mesangium in IgA nephropathy?

Mesangial proliferation and scarring


Give two types of hereditatary nephropathy

• Thin GBM Nephropathy • Alport syndrome


Outline thin GBM nephropathy

Isolated HaematuriaThin GBMBenign Course


What is alport?

• X linked • Abnormal collagen IV • Associated with deafness • Abnormal appearing GBM • Progresses to renal failure


What is Goodpasture Syndrome?

• Rapidly progressive glomerular nephritis • Acute onset of severe nephritic syndrome • Classically associated with pulmonary haemorrhage


What is the pathology behind goodpasture syndrome?

• Autoantibody to collagen IV in basement membranes Characterised by IgG deposition but no extracellular matrix deposit


How is goodpasture syndrome treated?

• Treatable by immunosupression • PlasmaphoresisTake patients blood out, remove plasma with IgG in and then exchange plasma


What is vasculitis?

• Inflammation of blood vessels which attacks highly vascularised kidney • No immune complex/antibody deposition • Blood vessels directly attacked by anti neutrophil cytoplasmic antibody • Nephritic presentation • Urgent biopsy required


What is a subepithelial deposit?

• Antigen abnormally recognised on podocytes, circulating IgG binds to it, forming immune complexes in the glomerulus ○ Membranous glomerulonephritis


What is a mesangial deposit?

• Immune complexes can be deposited directly in the mesangium as there is no podocytes or basement membrane to act as a barrier