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Urinary > Glomerular diseases > Flashcards

Glomerular diseases Flashcards

0
Q

Clinical presentation of glomerulonephritis

A
  • Asymptomatic proteinuria and/or non visible haematuria
  • Progressive CKD
  • Acute nephritic syndrome
  • Rapidly progressive glomerulonephritis
  • Nephrotic syndrome
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1
Q

Symptoms of nephrotic syndrome

A

Proteinurea Low albumin Oedema High cholesterol

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2
Q

Difference between nephrological and urological haematuria

A

Microscopy shows dysmorphic

RBCs in glomerular disease

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3
Q

Presentation of acute nephrotic syndrome

A

Haematuria (Non visible/ may be visible)

Proteinuria

Oliguria

Salt and water retention ( oedema, hypertension)

Uraemia

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4
Q

Common causes of glomerular nephritis

A

IgA nephropathy

Membrane proliferative nephropathy

Focal segmental sclerosis

Membranous

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6
Q

Difference between urological and nephrological haematuria

A

Haematuria can result from bleeding into the urinary tract or from the glomerulus into the urethra

UTIs are the most common cause of haematura. Assocaited with LUTS (dysuria, frequency)

Urological causes of haematuria include stones, renal cell carcinoma, transitional cell carcinoma

Glomerular causes are due to inflammation and bleeding

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7
Q

Features which suggest a nephrological cause of haematuria

A

abnormal renal function

proteinuria

oedema (salt and water retention)

hypertension

young age

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8
Q

Presentation of glomerulonephritis

A

Can present as:

Asymptomatic haematuria and proteinuria

Acute nephritic syndrome (haematuria, hypertension, oedema)

nephrotic syndrome (heavy proteinuria, hypoalbuminaemia and peripheral oedema)

Chronic kidney disease

Presentation can be acute or chronic, rapidly or slowly progressive.

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9
Q

Structures within the glomerulus prone to damage

A

Capillary endothelial lining

Glomerular basement membrane

Mesangium

Podocytes

When damage occurs to the glomerulus, it results in painless haematuria and proteinuria

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10
Q

Mechanisms of glomerular injury

A

Circulating immune complexes: Immune complexes from outside the kidney become trapped in the glomerulus and activate the complement pathway, leading to acute inflammation. This increases vascular permeability

Complex deposition: Ag-ab complexes form within the kidney and are deposited in the glomerulus. e.g. Goodpasture’s syndrome - antibodies form against teh basment membrane causing haemorrhage. Damage leads to progressive renal failure.

Cell mediated immunity: sensitised T cells mediates progression from acute to chornic damage.

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11
Q

Nephrotic syndrome

A

Proteinuria >3.5g in 2hrs

Hyperalbuminaemia

Oedema

Hyperlipidaema

Increased permeability of the glomerular filtration barrier as a result of damage to the basement membrane. Heavy proteinuria causes low plasma albumin and therefore tissue oedema.

Decreased circulating volume stimulates RAAS which increases Na+ and H2O retention, leading to further oedema

Management: blood pressure control, ACEi to reduce proteinuria, anticoagulants (low albumin increases risk of coagulation).

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12
Q

Acute Nephritic syndome

A

Haematuria

Hypertension

Oliguria

Proteinuria

Fluid retention (facial oedema)

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13
Q

Primary glomerular causes of nephrotic syndrome

A

Minimal change disease

Membranous glomerulonephropathy

Membranoproliferative glomerulonephritis

Focal segmental glomerulosclerosis

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14
Q

Minimal change disease

A

Most common cause of heavy proteinuria and nephrotic syndrome in children.

No changes seen on light microscope and immunofluorescence. EM shows damge to epithelial food processes

Treatment includes corticosteroids and ciclosporin.

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15
Q

Most common form of nephrotic syndrome in older patients

A

Membranous glomerulonephropathy

Chronic disease characterised by subepithelial depositions of immune complexes and thickening of the basement membrane.

Secondary causes: infection, melanoma, heroin, SLE

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16
Q

Focal segmental glomerulonephrosis

A

Caused by altered cellular immunity, IV heroin use, AIDS, idiopathic

Sclerosis of the glomeruli. Major histological characteristic of progressive renal damage.

Glomerular hypertophy results form haemodynamic changes that cause increased blood flow and glomerular hypertension. This causes endothelial and epithelial cell injury. Inflammation and proliferation in response to damage causes hyaline deposits. There is intraglomerular coagulation and sclerosis.

Most develop CKD within 10 years.

Treat with cyclosporin, corticosteroids.

17
Q

Common primary causes of nephritic syndrome

A

IgA nephropathy

Rapidly progressive (cresenteric) GN

Focal proliferative GN

Membranoproliferative GN

18
Q

IgA nephropathy

A

Most common primary glomerular disease.

Tends to occur due following URTI.

Present with haematuria, proteinuria, hypertension and renal impairment. Plasma IgA levels are raised.

IgA is deposited in the mesangium of the glomeruli, causing sclerosis of the damaged segment.

19
Q

Cresenteric glomerulonephritis

A

Rapidly progressive and results in severe glomerular injury.

Causes a leakage

20
Q

Causes of secondary glomerulonephritis

A

SLE: causes immune complex formation causes focal proliferative GN

Diabetes mellitus: causes glomerulosclerosis. Nephropathy causes proteinuria.

Infections: hepB, leprosy, malaria

Post-streptococcal - presents following groupA streptococcal infection of the tonsils. Causes nephritic syndrome

Good-pasture’s syndrome: autoantibodies to collagen develop causing inflammation. Present with cresenteric BM

21
Q

Investigations of haematuria

A

Urine microscopy - look for cell casts

Urine culture

Asessment of renal function (U+E, GFR)

Immunological tests

Imaging

Consider biopsy of cystoscopy

22
Q

Investigation of proteinuria

A

Assessment of renal function (urea, creatinine, clearance)

24hr protein (nephrotic syndrome is >3g)

Blood sugar, albumin, cholesterol

Immunological tests

Renal imaging

23
Q

Membranous glomerulonephritis

A

Increase in the thickness of the basement membrane. Subepithelial desposition of gives appearance of spikes on silver staining.

Little proliferation but sclerosis occurs. All glomeruli are involved.

24
Q

Secondary causes of nephrotic syndrome

A

Diabetes

Neoplasia

Drugs - Ax, NSAIDs, penicillins, cytotoxic drugs

Infections - HIV, Hep B, Hep C, malaria, schistosomaisis

SLE

25
Q
A

Urinary (19 decks)

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