Flashcards in Specific Glomerular Diseases Deck (40)
Good definition of Nephritic Syndrome?
Glomerular diseases characterized by glomerular inflammation and bleeding.
5 common clinical presentations of nephritic syndrome?
Hematuria, red cell casts in urine, azotemia, oliguria, and mild to moderate hypertension.
Define acute proliferative glomerulonephritis and what is the main cause?
Group of diseases characterized by diffuse proliferation of of glomerular cells with infiltration of leukocytes. Typically caused by immune complexes
What is the most common exogenous antigen induced complex causing acute proliferative glomerulonephritis?
Post-infection. Most common infection is streptococcal.
What type of strep infection and what age group of patient is most common on post infection glomerulonephritis?
Strep of the skin or pharynx. Children 6-10 most common.
What is the MOA for post-streptococcal GN?
Immune complexes of strep antigens and antibodies being formed In Situ
What are the 3 strains of A-Beta hemolytic Streptococcal that are nephritogenic?
1,4, and 12
What do they think is the principal antigen in most post strep GN?
What is the classic histologic picture of post strep GN and what is the cause of it?
Enlarged, hyper cellular glomeruli because of infiltrating leukocytes and proliferation of the glomerular cells.
What two things are shown on immunofluorescence as far as being deposited?
IgG and C3
What is the hallmark electron microscopic finding for post strep GN?
Humps, which are the antigen antibody complex at the sub-epithelial surface.
What 4 clinical signs do patients present with when they have post strep GN?
Hematuria (coca cola colored urine), mild hypertension, oliguria, and periorbital edema.
What is rapidly progressive glomerulonephritis and what is its histological hallmark?
Severe glomerular injury but does not have a specific cause. Histo feature is crescents.
What are the three pathogenic mechanisms of RPGN and what is the common demonization in all types?
Antibodies against the GMB, immune complex deposition, and neither, which is usually associated with ANCAs.
What syndrome is an example of the Anti GBM mediated pathway and what are the 2 features of the syndrome?
Goodpasture Syndrome. Antibodies attack the basement membrane in the lungs and kidneys leading to bleeding of the lungs and renal failure.
Besides the crescents, what are two other common histological features of severe glomerular injury in RPGN?
Fibrin strands between the cell layers in the crescents and ruptures in the GBM.
3 clinical presenting symptoms of RPGN?
Severe and fast loss of renal function, severe oliguria, and nephritic syndrome.
What is the big picture problem going on in Nephrotic Syndrome?
Problems with glomerular capillary walls resulting in increased permeability to plasma proteins.
6 main clinical manifestations of nephrotic syndrome?
Massive protein in the urine, hypoalbumin, generalized edema, hyperlipidemia and lipiduria, hypercoagulable state (due to loss of AT3), and hypoimmunoglobulins (so infections).
In children younger than 17 and adults, nephrotic syndrome is caused by what kind of disease/condition?
In children it is cause by a lesion primary to the kidney and in adults it is usually caused by a systemic disease.
What are the 3 most common systemic conditions causing nephrotic syndrome?
Diabetes, amyloidosis and SLE.
What are the 3 most common/important primary glomerular lesions and what ages do they present in and what races if applicable?
1. Minimal change disease - kids
2. Membranous glomerulopathy - Caucasian adults
3. Focal segmental glomerulosclerosis - Hispanics and African Americans of all ages.
How do we characterize Minimal Change Disease?
Effacement of foot processes of visceral epithelial cells and is only detectable by electron microscopy.
What are the 3 reasons Minimal Change Disease points to an immunological basis and what is the one thing that this disease does not present with?
1. Associated with respiratory infections
2. Great response to corticosteroids
3. T cell mediated attack
NO immune complex deposition.
What are two clinical features of Minimal change disease?
Selective Proteinuria (mostly albumin) and dramatic response to corticosteroids.
How do we characterize membranous nephropathy?
Thickening of the glomerular capillary wall because of deposits containing Ig on the subepithelial side of the basement membrane.
What is the primary cause of Membranous nephropathy and when identifiable, what is the cause of it associated with, 4 things?
Usually idiopathic. Drugs (NSAIDS and penicillin), SLE, Malignant tumors (lung and colon), and infections (Hep B and C).
What is the hallmark histo feature of Membranous Nephropathy?
Uniform, diffuse Thickening of the glomerular cap wall.
What is the hallmark electron Microgram feature of Membranous Nephropathy?
Irregular spikes protruding from the GBM.