Renal Diseases Prt. 1 Flashcards by Kyra Catedral

• Conditions that affect renal function
• Can be classified as:

Glomerular
Tubular
Interstitial
Renal Failure
Renal Lithiasis

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Glomerular Disorders

Glomerular nephritis
Nephrotic syndrome

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Glomerular disorders

Main cause:

Immune complexes

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Glomerular disease

• Deposition of _______ trigger immune reaction producing changes or damages in the glomerular membrane
• Result to thickening of glomerular membrane or complement activation

immune complexes

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Glomerular disorders

• Non-immunologic causes:

• Exposure to chemicals and toxins
• Disruption of the negative charge of the membrane (nephrotic syndrome)
• Deposition of amyloid material
• Thickening of the membrane caused by diabetic nephropathy

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Glomerular disorder

• Sterile inflammation

• Presence of blood, protein and casts in urine

Glomerulonephritis

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Glomerular disorders

• Can progress from acute to chronic to nephrotic syndrome and eventually end stage renal disease (ESRD)

Glomerulonephritis

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Glomerular disorders -Glomerulonephritis

• Sudden onset of symptoms due to glomerular damage

• Symptoms:
• fever, edema (most noticeably around the eyes), fatigue, nausea, hypertension, oliguria, proteinuria, and hematuria

Acute Post-streptococcal Glomerulonephritis

• Acute glomerulonephritis (AGN)

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Glomerular disorders - Glomerulonephritis

Acute Post-streptococcal Glomerulonephritis

• Acute glomerulonephritis (AGN)

• Main cause:______
• Virulence factor:

• Antibody + organism complex deposited in the
glomerular membrane = inflammation reaction

infection by B-hemolytic streptococcus (S. pyogenes)

M protein

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Glomerular disorders - Glomerulonephritis

Hallmark of AGN

BC cast

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Glomerular disorders - Glomerulonephritis

Diagnostic tests for Streptococcal infection

(+) Anti streptolysin O
(+) Anti-DNAse B

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Glomerular disorders - Glomerulonephritis

• More serious; Poorer prognosis

• Main cause: Deposition of immune complexes as a result of complication of another glomerulonephritis or immune disorders (i.e SLE)

Rapidly Progressive (Crescentic) Glomerulonephritis

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Glomerular disorders - Glomerulonephritis

• Immune complexes attract macrophages = damage capillary walls
• Damaged capillary walls release cells and plasma to bowman’s capsule
• Cells & plasma proteins = crescentic formation that destroys capillaries (irreversible)

Rapidly Progressive (Crescentic) Glomerulonephritis

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Glomerular disorders - Glomerulonephritis

• Findings:
• Similar to AGN but worsens as disease progresses
• Marked proteinuria & decreased GFR
• Increased fibrin degradation products + IgA deposition in glomerular membrane

Rapidly Progressive (Crescentic) Glomerulonephritis

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Glomerular disorders - Glomerulonephritis

• Autoimmune disorder caused by Anti-glomerular Membrane
Antibody (Anti-GBM antibodies)

Good Pasteur Syndrome

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Glomerular disorders - Glomerulonephritis

Good Pasteur Syndrome

• Diagnosis:

(+) anti-glomerular membrane antibody in patient’s serum

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Glomerular disorders - Glomerulonephritis

• Findings:

• Hemoptysis and dyspnea followed by hematuria
• Proteinuria and presence of RBC casts
• If left unmanaged, can progress to chronic glomerulonephritis and end stage renal disease

Good Pasteur Syndrome

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Glomerular disorders - Glomerulonephritis

Granulomatosis with Polyanglitis
• Former…

Wegener’s Granulomatosis

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Glomerular disorders - Glomerulonephritis

• Caused by: Anti-Neutrophilic Cytoplasmic Antibody (Autoantibody)

• ANCA binds to neutrophils = neutrophils activated = granuloma formation

Granulomatosis with Polyanglitis

Wegener’s Granulomatosis

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Glomerular disorders - Glomerulonephritis

• Findings:
* Initial respiratory symptoms that later develop renal involvement

• Urine: hematuria, proteinuria, RBC casts
• Blood: Increased creatinine & BUN levels

Granulomatosis with polyangiitis

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Glomerular disorders - Glomerulonephritis

Granulomatosis with polyangiitis

• Diagnosis:

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(+) ANCA in patient’s serum

Glomerular disorders - Glomerulonephritis

Granulomatosis with polyangiitis

• Diagnosis:

• Incubate patient’s_____ +_____ or _____

• Indirect immunofixation = detect____

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serum

ethanol or formalin-fixed neutrophils

ANCA

Glomerular disorders - Glomerulonephritis

Granulomatosis with polyangiitis

Ethanol-fixed neutrophils:_____

Formalin-fixed neutrophils:

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perinuclear pattern (p-ANCA)

granular pattern in the cytoplasm (c-ANCA)

Glomerular disorders - Glomerulonephritis

• Occurs in children following upper respiratory infections

• Decrease platelets = vascular problems

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Henoch-Schonlein Purpura

Glomerular disorders - Glomerulonephritis • Findings: • ***Respiratory & Gastrointestinal*** symptoms • Renal Involvement (most serious complication): • Heavy proteinuria • Hematuria • RBC Casts

Henoch-Schonlein Purpura

Glomerular disorders - Glomerulonephritis ***Complete recovery in >50% of patients,*** but some progress to a more serious form of glomerulonephritis and renal failure

Henoch-Schonlein Purpura

Glomerular disorders - Glomerulonephritis • Deposition of ***IgG complexes*** = thickening of glomerular membrane

Membranous Glomerulonephritis

Glomerular disorders - Glomerulonephritis Membranous Glomerulonephritis Disease associated with deposition of IgG Complex:

• SLE • Sjogren syndrome • Hepatitis B • Secondary syphilis • Mercury treatments r Malignancy

Glomerular disorders - Glomerulonephritis • 70% of cases: idiopathic • Disease slowly progresses and can develop to nephrotic syndrome

Membranous Glomerulonephritis

Glomerular disorders - Glomerulonephritis • Findings: • Hematuria • RBC Casts (rare)

Membranous Glomerulonephritis

Glomerular disorders - Glomerulonephritis • ***Changes in cellularity of glomerulus and capillaries*** • Very poor prognosis

Membranoproliferative Glomerulonephritis

Glomerular disorders - Glomerulonephritis Membranoproliferative Glomerulonephritis • Increased cellularity in ***bowman's capsule*** = thickening of the membrane • Progress to nephrotic syndrome

Type 1

Glomerular disorders - Glomerulonephritis Membranoproliferative Glomerulonephritis • ***”dense deposit disease"*** • Dense deposits in the ***basement membrane, tubules and bowman's capsule*** • Exhibit symptoms of chronic glomerulonephritis

Type 2

Glomerular disorders - Glomerulonephritis Membranoproliferative Glomerulonephritis • Endothelial and sub-endothelial deposits

Туре 3

Glomerular disorders - Glomerulonephritis • Significant damage to the glomerulus caused by acute glomerulonephritis

Chronic Glomerulonephritis

Glomerular disorders - Glomerulonephritis • Findings: • Fatigue, anemia, hypertension, edema, and oliguria • Increased serum creatinine and BUN levels

Chronic Glomerulonephritis

Glomerular disorders - Glomerulonephritis Chronic Glomerulonephritis • Urine: proteinuria and hematuria with varieties of casts •________ = chronic glomerulonephritis is already progressing to end-stage renal disease (ESRD)

Broad cast

Glomerular disorders - Glomerulonephritis IgA Nephropathy Aka

Berger's Disease

Glomerular disorders - Glomerulonephritis • ***Mucosal infection:*** increased IgA complexes = deposited in the glomerular membrane

IgA Nephropathy • Berger's Disease

Glomerular disorders - Glomerulonephritis • Findings: • Spontaneous/ periodic macroscopic hematuria • Disease may ***remain asymptomatic for 20 years or more*** • If left unmanaged, may progress to chronic glomerulonephritis and end-stage renal disease

IgA Nephropathy • Berger's Disease

Glomerular disorders • Damage to shield of negativity and podocytes • Albuminuria & Lipiduria

Nephrotic Syndrome

Glomerular disorders • Decreased blood albumin results to: • Edema • Decreased coagulation factors & immunoglobulins • Prone to infection & coagulation disorders

Nephrotic Syndrome

Glomerular disorders Nephrotic Syndrome • Urinary findings: (2)

• Marked proteinuria (>3.5g/day) • Lipiduria

Glomerular disorders Nephrotic Syndrome •_________ • Hallmark of nephrotic syndrome • Lipids droplets inside RTE cells • Polarizing microscope:_____ formation

Oval fat bodies Maltese cross formation

Glomerular disorders - Nephrotic Syndrome Minimal Change Disease Aka

Lipid nephrosis or Nil Disease

Glomerular disorders - Nephrotic Syndrome • Damage to shield of negativity and podocytes but with ***minimal cellular changes in the glomerulus*** • ***Most common cause of nephrotic syndrome in children.***

Minimal Change Disease (Lipid nephrosis or Nil Disease)

Glomerular disorders - Nephrotic Syndrome Minimal Change Disease (Lipid nephrosis or Nil Disease) • Idiopathic but associated with_____

HLA-B12 (postulated as t-cell disorder)

Glomerular disorders - Nephrotic Syndrome Minimal Change Disease (Lipid nephrosis or Nil Disease) • Good prognosis: responds well to_____ treatment

corticosteroid

Glomerular disorders - Nephrotic Syndrome • Only affect ***certain areas of podocytes*** • Most common cause of primary glomerulonephritis in adults

Focal Segmental Glomerulosclerosis

Glomerular disorders - Nephrotic Syndrome Focal Segmental Glomerulosclerosis a._____ - idiopathic b._____ • Diseases (HIV & Hepatitis) or drugs (analgesic & heroin abuse) • Findings • Similar to nephrotic syndrome with moderate to heavy proteinuria and hematuria

Primary Secondary

Renal Diseases Prt. 1 Flashcards

(50 cards)