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Flashcards in glomerular disease Deck (20):
1

focal

some but not all the glomeruli contain the lesion

2

diffuse (global)

most of the glomeruli contain the lesion

3

segmental

only a part of the glomerulus is affected (most focal lesions are also segmental)

4

the presence of some form of glomerular disease, as opposed to tubulointerstitial or vascular disease is usually suspected from the hx and from one or more of the following findings:

urinary: haematuria, red cell casts, proteinuria
pt will likely have inc BP

5

symptoms nephrotic syndrome

massive proteinuria
hypoalbuminaemia
oedema
lipiduria
hyperlipidaemia

6

symptoms acute glomerulonephritis (acute nephritic syndrome)

abrupt onset of haematuria with casts or dysmorphic red cells
non nephrotic range proteinuria
oedema
HTN
transient renal impairment

7

symptoms rapidly progressive glomerulonephritis

features of acute nephritis
focal necrosis with or without crescents
rapidly progressive renal failure over weeks

8

what happens in nephrotic syndrome

there is massively increased filtration of macromolecules across the glomerular capillary wall due to structural and functional abnormalities of the glomerular podocytes

9

signs nephrotic syndrome

Loss of protein through the kidneys (proteinuria) leads to low protein levels in the blood (hypoalbuminemia), which causes water to be drawn into soft tissues (oedema).

10

investigations nephrotic syndrome

to monitor progress: eGFR, urinary protein, U+E, serum albumin
diagnosis: urine microscopy - red cell casts = glomerulonephritis
culture swan from throat/skin = diagnosis of recent strep infec
renal biopsy

11

management nephrotic syndrome - general

oedema - dietary salt restriction & thiazide diuretic e.g. bendroflumethiazide followed by furosemide
proteinuria - ACEi / angiotensin II receptor antagonists
prolonged bed rest avoided & LT prophylactiv anticoag due to thrombotic tendency

12

management nephrotic syndrome - specific

rx of underlying disease eg SLE
only severe cases receive specific rx as high rate of spontaneous recovery
rx is w cyclophosphamide - immunosuppressive therapy or chlorambicil w prednisolone

13

complications nephrotic syndrome

venous thrombosis - loss of clotting factors in the urine
sepsis - loss of immunoglobulin in the urine
AKI due to hypovolaemia (rather than the underlying renal disease)


(SAT- sepsis, AKI, thrombosis)

14

Aetiology acute glomerulonephritis (acute nephritic syndrome)

often caused by an immune response triggered by an infection or other disease. Diseases commonly associated:
post strep
staphylococcus, mumps, hep b/c
infective endocarditis
oliguria
uraemia
SLE

15

symptoms nephritic syndrome

AKI
acute and rapid deterioration in kidney function & an active dipstick - haematuria/proteinuria
HTN and fluid overload

16

investigations nephritic syndrome

As for nephrotic syndrome
to monitor progress: eGFR, urinary protein, U+E, serum albumin
diagnosis: urine microscopy - red cell casts = glomerulonephritis
culture swan from throat/skin = diagnosis of recent strep infec
renal biopsy

17

management nephritic syndrome

post strep glomerulonephritis = gd prog, just supportive rx
HTN rx w salt restriction & loop diuretics / vasodilators
in glomerulonephritis complicating SLE or the systemic vasculitides immunosuppression with prednisolone improved renal func

18

causes of rapidly progressive glomerulonephritis

acute nephritic syndrome
antiglomerular basement membrane disease
antineutrophilic cytoplasmic antibody associated vasculitis

(triple AAA!!!)

19

big difference nephrotic and nephritic syndrome

nephrotic syndrome involves the loss of a lot of protein, whereas nephritic syndrome involves the loss of a lot of blood.

20

IgA nephropathy

Abnormality in IgA glycosylation = mesangial deposition
can present as nephritic, nephrotic, asymptomatic or as progressive CKD
rx = supportive and immunosuppression if aggressive