S7 L2 Glomerulonephritis and Histology of the Glomerulus

Question 1

Label this histology image of the Cortex

Answer 1

Question 2

Histology of cortex - more pictures

Answer 2

Question 3

Histology of the cortex - label

Answer 3

Question 4

Histology of the cortex - label

Answer 4

Question 5

Histoloy - Between cortex and medulla

Answer 5

Question 6

Histology - Medulla

Answer 6

Question 7

ATN

• What is this?
• When does it occur?
• What happens?

Answer 7

Question 8

Glomerulonephritis (GN)

• What is this?
• Which structures can be damaged?
• What system is involved?

Answer 8

Question 9

2 types og glomerular nephritis

• State
• Explain the differences (in the kidney)
• Explain the differences in symptoms

Answer 9

Question 10

Nephrotic Syndrome

• Triad of…
• What other features occurs too?

Answer 10

Question 11

Causes of Nephrotic Syndrome

Answer 11

Question 12

Diabetic Nephropathy

• What is this?
• What happens?
• How is GFR affected?
• Treatment?

Answer 12

Thickening of BM
Thickening of wall of afferent arteriole

Question 13

Minimal Change Disease

• Common cause of nephrotic syndrome in which group of people?
• What happens?
• Prognosis?
• Presentation?

Answer 13

Question 14

Membranous Glomerulonephritis

• What is this?
• What happens?
• Treatment

Answer 14

Question 15

Focal Segmental Glomerulosclerosis

• What is this?
• Causes
• Treatment

Answer 15

Question 16

Histology:

• Diabetic Nephropathy
• Membranous Glomerulonephritis
• Focal Segmental Glomerulosclerosis

Answer 16

Question 17

Management of Nephrotic Syndrome

Answer 17

Question 18

Nephritic Syndrome

• Triad of…
• Other features

Common causes of Nephritic Syndrome

Answer 18

Nephritic Syndrome
• IgA Nephropathy (Berger’s Disease)
• Rapidly progressive GN
• Goodpasture’s (Anti GMB)
• Post-streptococcal GN

Question 19

IgA Nephropathy (Berger’s Disease)

• What is this?
• Symptoms?
• Treatment

Answer 19

Question 20

Rapidly Progressive Glomerulonephritis

• What is this?
• Loss of renal function in… (timeframe)
• Treatment

Answer 20

Question 21

Goodpasture’s Syndrome

• What is this?
• What happens?
• Treatment?
• Prognosis?

Answer 21

Question 22

Post-Streptococcal Glomerulonephritis

• What is this?
• Cause?
• Treatment?
• Prognosis?

Answer 22

Question 23

Management of Nephritic Syndorme
- 5…

Answer 23

Question 24

Differential diagnosis of glomerular disease
- Summary of all the diseases just covered - scale from: Nephrotic and Nephritic diseases

Answer 24

Question 25

GW: - How do you classifiy or describe nephritic glomerulonephritis? - What in the urine could case colouring? - Use of a renal ultrasound? - How would you treat someone with Post-Streptococcal GN?

Answer 25

• **Nephritic** - Haematouria and hypertension (specific symptoms associated with nephritic. Also has: proteinuria, hypertension, Haematouria, oedema Blood in the urine US: Looking for stones (will be normal in glomerulnephritis) * Antibiotics - give something different to what she’s had before * Fluid restriction * Control hypertension and proteinuria - ACEi * Treat oedema - diuretics e.g. furosemide, fluid restriction * Analgesia * Steroids (much, much later)

Question 26

GW: - Nephitic syndrome vs Nephrotic syndrome

Answer 26

**Nephrotic syndrome** - triad of symptoms: • Proteinuria • Hypoalbuminaemia • Oedema Damage to the: podocytes More leaky capillaries Don’t really see a drop in GFR, only see a drop in GFR if it is really bad Patients may have increased urination with this Does not always caused a reduced kidney function **Nephritic syndrome -** • Inflammation, reactive cell proliferation, breaks in GBM • Triad of: Haemotouria, hypertension, low GFR (might have proteinuria) • Does not always case a reduced kidney function

Question 27

GW: - What is the difference between a primary and secondary cause of glomerulonephritis? - If creatinine is in normal range, is it definiatly normal? - Process of what can happen in diabetic nephorpathy - starting stages... - What happens to the processes in the tubule with advancing kidney disease?

Answer 27

* Primary - renal cause * Secondary - systemic (kidney is one of many organs affected) Always think - this creatinine is in the normal range, but is it normal for this patient? E.g. what is creatinine affected by: • Weight, height, muscle mass ---- lots of glucose in the blood — glucose enter tubules — Na is required for glucose to be reabosorbed — Causes low Na+ in the DCT — Macula densa cells notices the low Na+ — It then thinks the blood pressure is low — Activates RAAS — RAAS will increase filtration of the blood (leads to hyperfiltration) With worse kidney disease: • Mainly secretion affected • Filtration gets worse, filtration stays the same, so greater eGFR. (The eGFR is worse than it appears) **In advanced renal disease: Filtration is affected, reabsorption and secretion aren’t as much (at all)**