renal disease

Question 1

kidney compartments?

Answer 1

Glomerulus –Filtration of plasma •Tubulointerstitium –Modification of glomerular filtrate –Production Epo and Vit D3 •Vascular –Maintain blood flow and monitor pressure

Question 2

evidence of pre renal failure?

Answer 2

Hypotension –Tachycardia –Oligo/anuria –Sepsis –Trauma

Question 3

clinical patterns of intriinsic renal sisease?

Answer 3

Nephritic syndrome •Haematuria •Proteinuria (mild) Variably •Hypertension •Reduced GFR Nephrotic syndrome •Proteinuria (>3g/24hr) •Hypoalbuminaemia •Peripheral oedema •Hyperlipidaemia Variably •Haematuria •Reduced GFR

Question 4

classification of renal disease?

Answer 4

histological pattern, immunological content aetiology clinical much cross over classification not logical Investigated by renal biopsy

Question 5

immunology of renal dieease?

Answer 5

direct immunoflourescence IgG IgA IgM C3 Fibrin 1) anti-GBM disease experimental In man Goodpastures syndrome complexes rate site-, sub endothelial, sub epithelial, mesangial cellular response– complement activation?

Question 6

important correlations?

Answer 6

acute proliferative GN- post infective •crescentic /rapidly progressive GN •IgA nephropathy •minimal change •membranous •Mesangio proliferative

Question 7

acute proloferation?

Answer 7

All glomeruli involved- diffuse •Proliferation++ neutrophils and endothelial cells •IF- Granular IgG and C3 •EM- sub-epithelial deposits “humps”

Question 8

crescentic gn?

Answer 8

Clinical: Presents with rapidly progressive GN (RPGN) Number of causes: Anti GBM Anti neutrophil antibodies Some types now treated sucessfully with immunosuppressives; requires specialist management.

Question 9

pathology of crescentic gn?

Answer 9

Pathogenesis exudation of plasma proteins into the urinary space thrombosis and inflammation progression from fibrinous cellular fibrous

Question 10

most common gn?

Answer 10

Follows infection by Strep group A –Certain subtypes •Any site –throat, skin •Strep antigen and IgG antibody complex and circulate- then deposited in the kidney •3 weeks at peak of antibody response

Question 11

diagnose proliferative gn?

Answer 11

History and examination •Raised Creatinine •Anti-streptolysin (ASO) antibody •Reduced C3 levels

Question 12

proliferative gn management?

Answer 12

Supportive •Generally good prognosis particularly kids

Question 13

reasons for rapidly progressive glomerulonephritis?

Answer 13

wegeners granulomatosis goodpastures disease immune sysrem attacks anyigen in lung and kidney

Question 14

rpgn diagnosis?

Answer 14

Basic Blood tests –Serial U and E, FBC, LFT, Bone, Coag screen •Specialist Blood tests –Antineutrophil antibody (ANA) –Antineutrophil cytoplasmic antibody (ANCA) –Antiglomerular basement membrane antibody (Anti GBM) •Renal biopsy

Question 15

rpgn treatment?

Answer 15

Immediate renal referral •Immunosuppression –Steroids –Cyclophosphamide –Plasma exchange •Dialysis •Prognosis variable depends on speedy diagnosis