Glomerular Pathology

Question 1

what characterises nephrotic disease

Answer 1

• proteinuria
• oedema
• high cholesterol

Question 2

why is oedema seen in nephrotic disease

Answer 2

the increase protein in the urine reduces the oncotic pressure in the blood

Question 3

where does the damage in the nephron occur in nephrotic disease

Answer 3

podocytes primarily but also the basement membrane

Question 4

what are 3 primary causes of nephrotic disease

Answer 4

• minimal change glomerulonephritis
• FSGS
• membranous glomerulonephritis

Question 5

what is minimal change glomerulonephritis

Answer 5

where circulating factors damage the podocytes meaning they don’t selectively filter as well

Question 6

what age ranges minimal change glomerulonephritis seen

Answer 6

children

Question 7

what is FSGS

Answer 7

where circulating factors damage podocytes and cause glomerulosclerosis

Question 8

what is glomerulosclerosis

Answer 8

where fibrosis occurs in the glomerulus

Question 9

what age range is FSGS seen

Answer 9

adults

Question 10

what can be used to manage minimal change glomerulonephritis

Answer 10

steroids - as these suppress the immune system

Question 11

what is membranous glomerulonephritis

Answer 11

where immune complexes deposit into the podocytes

Question 12

what immunoglobulins are involved in the immune complexes seen in membranous glomerulonephritis

Answer 12

IgG

Question 13

give 2 secondary causes of nephrotic disease

Answer 13

diabetes and amyloidosis

Question 14

true or false: steroids help in the management of FSGS

Answer 14

false

Question 15

what is nephritic disease

Answer 15

where there is blood lost in the urine

Question 16

what characteristics are seen in nephritic disease

Answer 16

haematuria and hypertension

Question 17

where in the nephron is damaged in nephritic disease

Answer 17

blood vessels

Question 18

gives some causes nephritic disease

Answer 18

• alport syndrome
• goodpastures syndrome
• Thin GBM
• vasculitis

Question 19

what is alport syndrome

Answer 19

where there is abnormal type 4 collagen meaning blood can pass through the walls of the of the GBM easier

Question 20

what is the first change that occurs in diabetic nephropathy

Answer 20

hyperfiltration and increased GFR

Question 21

what is goodpasture syndrome

Answer 21

where there is an anti-GBM antibody which leads to inflammation of the glomerulus and holes punched in the GBM allowing the passage of blood

Question 22

what is IgA nephropathy

Answer 22

where IgA is deposited in the mesangia causing an immune response and inflammation of the glomerulus - this means blood can filter through

Question 23

what is IgA vasculitis

Answer 23

where there is an anti neutrophilic cytoplasmic antibody activation which causes neutrophils to break down the GBM

Question 24

what systemic effect is seen in IgA vasculitis

Answer 24

purpura

Question 25

why are proteins filtered during hyper filtration in diabetic nephropathy

Answer 25

the increased glucose is mostly reabsorbed by the SLGT 2 transporters with salt - this means less salt reaches the macula dense resulting in dilation of the afferent and constriction of the efferent arteriole - this means more blood is in the glomerulus increasing the pressure

Question 26

what happens to the basement membrane in diabetic nephropathy

Answer 26

it becomes thicker due to an increase in glomerular pressure

Question 27

what happens to the podocytes in diabetic nephropathy

Answer 27

they become injured

Question 28

what happens to the afferent and efferent arterioles in the later stages of diabetic nephropathy

Answer 28

they both undergo fibrosis, making the lumen smaller - this decreases the GFR

Question 29

what are kimmelstiel-wilson nodules

Answer 29

fibrotic nodules that appear in the glomerulus due to too much glucose

Question 30

what is the microalbuminuria stage of diabetic nephropathy

Answer 30

where the GFR decreases back to normal the GBM thickens, the podocytes are damaged and the mesangia expands first time you can detect protein in the urine

Question 31

what is overt proteinuria

Answer 31

where the GFR falls rapidly giving systemic hypertension (due to less salt delivery to the macula densa)

Question 32

what is given to manage diabetic nephropathy

Answer 32

ACE inhibitors statins change in diet and exercise

Question 33

how do ACE inhibitors help in diabetic nephropathy

Answer 33

they prevent the actions of angiotensin 2 which causes an increase in permeability to proteins, mesangia expansion and construction of the efferent arteriole

Question 34

what is hypertensive nephrosclerosis

Answer 34

where high blood pressure causes chronic kidney disease

Question 35

what other signs will a patient with hypertensive nephrosclerosis have

Answer 35

LV hypertrophy, hypertensive eye disease

Question 36

true or false: hypertensive nephrosclerosis develops rapidly

Answer 36

false - it has a slow progression

Question 37

how is renal artery stenosis different to hypertensive nephrosclerosis

Answer 37

renal artery stenosis causes the hypertension whereas the chronic kidney disease is caused by the already present hypertension in hypertensive nephrosclerosis

Question 38

what happens to the GFR in renal artery sclerosis

Answer 38

it falls rapidly

Question 39

how do acute falls in blood pressure damage the kidneys

Answer 39

damage of the endothelium causes microangiopathic haemolytic anaemia fibrosis of the efferent arteriole leads to necrosis and RAAS activation

Question 40

which arteriole undergoes fibrosis in hypertensive nephropathy

Answer 40

efferent arteriole