Glomerular Disease Pathology

Question 1

What is Glomerulonephritis?

Answer 1

An inflammatory or non-inflammatory disease of the glomerulus resulting in leak of protein into urine with possible blood in urine also.

Question 2

What tests are performed to investigate glomerulonephritis?

Answer 2

1) Bloods:

FBC

WCC

U+E’s

LFT’s

Creatinine

Urea

CRP

2) Urinalysis:

Blood

Protein

Glucose

Leucocytes

Bnece Jones Protein

3) Renal USS + Biopsy

Question 3

How does glomerulonephritis present?

Answer 3

1. Haematuria (blood in urine)
2. Heavy proteinuria (nephrotic syndrome)
3. Slowly increasing proteinuria
4. Acute renal failure

Question 4

What are the main causes of haematuria?

Answer 4

• Urinary tract infection
• Urinary tract stone
• Urinary tract tumour
• Glomerulonephritis

Question 5

What causes blood to appear in the urine in the case of glomerulonephritis?

Answer 5

1. IgA antibody is thought to ‘irritate’ the mesangial cells and cause them to proliferate and produce more matrix

Question 6

What is the pathology of Heavy proteinuria?

Answer 6

1. Caused by membranous glomerulonephritis (thickened glomerular basement membrane)
2. IgG antibodies get stuck in the basal lamina and activates C3 which ‘punches’ a hole in the basal membrane.
3. Now albumin can be filtered into the urine

Question 7

What is the pathology of slowly developing proteinuria?

Answer 7

1. Caused by poorly controlled diabetes
2. Similar pathophysiology to heavy proteinuria

Question 8

What is the pathology of acute renal failure?

Answer 8

1. Rapidly rising creatinine levels damages endothelium
2. Macrophages influx into Bowman’s space
3. Can result in granulomatosis (a form of vasculitis – inflammation in vessels which affects kidneys)