Glomerular Diseases

Question 1

What is different about the basement membrane of the glomerulus?

Answer 1

It carries a strong negative electric charge to prevent the passage of proteins

Question 2

What are the three cell types of the glomerulus?

Answer 2

endothelial, mesangial, epithelial (podocytes)

Question 3

What is nephrotic syndrome?

Answer 3

a kidney disorder characterised by oedema, proteinuria, hypoalbuminamia and hyperlipidaemia - it is caused by a defect caused by the filter which allows protein into the urine - all other features follow on from the proteinuria - it is a clinical syndrome not a pathological process

Question 4

What pathological processes cause nephrotic syndrome?

Answer 4

diabetes mellitus, some forms of glomerulonephritis, amyloidosis, inherited abnormalities

Question 5

What keeps proteins in the glomerular capillaries?

Answer 5

the negative charge of the basement membrane, the physical structure of the basement membrane, the specialised proteins in the gaps between the foot processes

Question 6

What is acute renal failure/injury?

Answer 6

an acute reduction in GFR reflected by a rise in serum creatinine

Question 7

What are the causes of acute renal failure/injury?

Answer 7

pre renal, renal and post renal

Question 8

What are the renal causes of acute renal failure?

Answer 8

acute tubular necrosis, acute glomerulonephritis, acute interstitial nephritis etc.

Question 9

What is glomerulonephritis?

Answer 9

injury to the glomerulus that is almost always immune mediated - mostly deposition of immune complexes

Question 10

What are the 3 groups of glomerulonephritis?

Answer 10

deposition of immune complexes, direct anti-glomerular basement membrane antibodies, pauci-immune (non immune mediated)

Question 11

What is the progression of glomerulonephritis?

Answer 11

varies depending on the pathology - may be acute and reversible or may progress slowly and lead to chronic renal failure

Question 12

What are crescents?

Answer 12

clumps of monocytes and epithelial cells and fibrin in severe glomerulonephritis with necrosis

Question 13

What is acute post infectious glomerulonephritis?

Answer 13

due to an abhorrent immune response to a streptococci infection

Question 14

What is the commonest form of glomerulonephritis in Australia?

Answer 14

IgA nephropathy

Question 15

Do all glomerulonephritis have the same clinical presentation?

Answer 15

no

Question 16

How do you diagnose glomerulonephritis?

Answer 16

light microscopy

Question 17

What features may be seen in glomerulonephritis in light microscopy?

Answer 17

mesangial cell proliferation, endothelial cell proliferation, podocyte proliferation, neutrophils, lymphocytes and monocytes, basement layer proliferation

Question 18

What is diffuse glomerulonephritis?

Answer 18

where every glomerulus is involved

Question 19

What is global glomerulonephritis?

Answer 19

where the whole glomerulus is involved

Question 20

What other tool is used to diagnose glomerulonephritis?

Answer 20

immunostains

Question 21

How may the glomerulus become injured?

Answer 21

necrotising legions and sclerosing legions (where segments scar and contract)

Question 22

What is the most common cause of end stage renal failure in Australia?

Answer 22

diabetic nephropathy

Question 23

What is diabetic nephropathy due to?

Answer 23

chronic hyperglycaemia

Question 24

What is a common early presentation of diabetic nephropathy?

Answer 24

proteinuria

Question 25

What are the typical lesions in diabetic nephropathy?

Answer 25

spherical collagen nodules in mesangium, basement membrane thickening, hyaline arteiololsclerosis