Glomerular Disease Flashcards Preview

Renal > Glomerular Disease > Flashcards

Flashcards in Glomerular Disease Deck (11):
1

mesangial cells

smooth muscle-like cells that sit between the capillary loops

produce matrix and are required for support of the capillary loop structure

2

slit diaphragm

an extracellular structure that its in the 25-60 nm wide filtration slits created by the podocyte foot processes

3

glomerular endothelial cells

cells that line the inner surface of the glomerular capillaries and form an anticoagulant barrier between blood and tissues

glomerular ECs have a large fenestrated area constituting 20-50% of the entire endothelial surface

4

glomerular endothelial fenestrae

plasma membrane lined trans-cellular pores 60-100

5

NPHS1 (nephrin) mutation

leads to congenital nephropathy of the Finnish Variety (presents in infants)

6

NPHS2 (podocin) mutation

autosomal dominant steroid resistant focal segmental glomerulosclerosis (present in infants)

7

ACTN4 (alpha actinin 4) mutation

autosomal dominant focal segmental glomerulosclerosis (presents in adults)

8

Why is it important to know when kidney failure is caused by a genetic mutation?

mutations in architectural proteins will not respond well to systemic therapies

however, the same disease will not occur after kidney transplantation

occasionally patients will develop antibodies to the "wildtyp, normal" protein expressed by the transplanted kidney such as anti-nephrin antibodies

9

What is the role of VEGF A in podocyte development?

factor secreted by podocytes and acts on receptors expressed by adjacent glomerular endothelial cells

promotes endothelial cell survival, fenestration, and proliferation

when VEGF levels are reduced, this may lead to endothelial cell swelling and cell death

this in turn promotes the formation of microscopic thrombi int he glomerular capillaries which can clog the glomerulus and lead to kidney failure

10

What are some of the side effects of anti-VEGF therapies?

reduction of podocyte VEGF leads to thrombotic microangiopathy

can also happen in pregnant patients with preeclampsia, where the placenta makes large quanities of FLT1, which is a naturally occurring anti-VEGF molecule

11

Nephrin

a very large protein with an extracellular domain that interacts with protein on adjacent podocytes

interacts with a protein called Nck to promote actin polymeraization and podocyte foot process formation

Nck proteins link slit diaphragm to cytoskeleton of podocyte