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Flashcards in Urinary 10 - Glomerular disease Deck (51):
1

What is the main problem in the kidney causing nephrotic syndrome?

Damaged glomerulus = increased permeability = LEAKS PROTEIN

2

Give 2 major symptoms in nephrotic syndrome:

1) Proteinuria > 3.5g/24hrs (+ oedema)
2) Foamy/frothy urine

3

Where is the most likely site of injury in the glomerulus causing glomerular disease?

Subepithelial layer (podocytes)

4

Name 3 common primary causes of Nephrotic syndromw:

1) Minimal change glomerulonephritis
2) Focal segmental glomerulosclerosis
3) Membranous glomerulonephritis

5

What is glomerulonephritis?

Any condition associated with inflammation of the glomerular tuft

6

At what age does Minimal Change Glomerulonephritis typically present?

Childhood/Adolescence

7

What is the main treatment for Minimal Change Gloerulonephritis?

Steroids

8

Does Minimal Change Glomerulonephritis typically progress to renal failure?

No

9

Describe the pathogenesis causing Minimal Change Glomerulonephritis:

Unknown circulating factor damaging podocytes, causing increased permeability of glomerulus

10

What is the name given to any condition associated with inflammation of the glomerular tuft?

Glomerulonephritis

11

What is the meaning of 'focal' when describing glomerular pathology?

Involving <50% of glomeruli on light microscopy

12

What is the meaning of 'segmental' when describing glomerular pathology?

Involving part of the glomerular tuft

13

What is the meaning of 'glomerulosclerosis' when describing glomerular pathology?

Segmental/global capillary collapse, presumed little/no filtration in hardened/sclerotic areas

14

At what age does Focal Segmental Glomerulosclerosis typically present?

~ 40-60 yrs

15

Does Focal Segmental Glomerulosclerosis typically progress to renal failure?

Yes

16

Describe the pathogenesis causing Focal Segmental Glomerulosclerosis:

Unknown circulating factor damaging podocytes

17

Name the 2 glomerular pathologies caused by unknown circulating factors damaging podocytes:

1) Minimal Change Glomerulonephritis
2) Focal Segmental Glomerulosclerosis

18

What is the meaning of 'membranous' when describing glomerular pathology?

Thickening of the glomerular capillary wall

19

Name the commonest cause of Nephrotic syndrome in adults:

Membranous glomerulonephritis

20

What age does membranous glomerulonephritis typically present?

Adulthood

21

Describe the outlook of a patient with membranous glomerulonephritis:

Rule of thirds:
1/3 = will get better
1/3 = will stay the same
1/3 = will progress to renal failure

22

Describe the pathogenesis of membranous glomerulonephritis:

Deposition of immune complexes in the basement membrane under the podocyte layer
= Complement cascade activated
= Cellular injury to podocytes
(Often secondary to malignancies like Lymphoma)

23

Name the antigen and antibody which forms the immune complexes deposited in membranous glomerulonephritis:

Antigen = Phospholipase A2 receptor on podocyte
Antibody = IgG

24

How does proteinuria in nephrotic syndrome lead to oedema?

Increased protein in urine
= decreased protein in blood
= water moves from blood into interstitial space
= oedema

25

What is the most likely cause of persistently foamy urine?

Proteinuria

26

Name 2 common secondary causes of nephrotic syndrome:

1) Diabetes mellitus
2) Amyloidosis

27

Describe the pathogenesis of diabetes mellitus causing nephrotic syndrome:

Persistent high blood glucose injures all parts of the glomerulus:
- Basement membrane thickens and becomes abnormal
- Sclerotic nodules form in mesangium

28

What is the main problem in the kidney causing nephritic syndrome?

Blocked glomerulus

29

List the main features of nephritic syndrome:

- Renal failure = oedema, oliguria, SOB
- Haematuria (microscopic/macroscopic)
- Decreased eGFR
- Red cell casts in urine

30

Where is the most likely site of injury of nephritic syndrome?

Endothelium

31

Which glomerular syndrome describes the blocking of the glomerulus?

Nephritic syndrome

32

Which glomerular syndrome describes protein leaking through the glomerulus?

Nephrotic syndrome

33

Give 5 diseases associated with Nephritic syndrome:

1) IgA nephropathy
2) Thin GBM nephropathy
3) Alport syndrome
4) Goodpasture syndrome
5) Vasculitis

34

Which glomerular syndrome is IgA nephropathy associated with?

Nephritic syndrome

35

Which glomerular syndrome is Thin GBM nephropathy associated with?

Nephritic syndrome

36

Which glomerular syndrome is Alport syndrome associated with?

Nephritic syndrome

37

Which glomerular syndrome is Goodpasture syndrome associated with?

Nephritic syndrome

38

Which glomerular syndrome is Vasculitis associated with?

Nephritic syndrome

39

Which disease is the most common primary cause of glomerulonephritis?

IgA nephropathy

40

Describe the presentation of IgA nephropathy:

Any age
Haematuria
Proteinuria (foamy urine)
Activated by URTI

41

Describe the pathogenesis of IgA nephropathy:

IgA deposited anywhere in glomerulus
= Blocked filter (irreversible)

42

Which nephropathy is typically activated by a URTI?

IgA nephropathy = Nephritic syndrome

43

What is the treatment of IgA nephropathy?

No cure
- IgA deposition = irreversible
- Treat hypertension, dialysis, transplant

44

What is the inheritance pattern of Thin GBM nephropathy?

Autosomal dominant

45

What is the typical inheritance pattern of Alport syndrome?

X-linked recessive

46

Why is Goodpasture's syndrome called a 'cresentic' glomerulonephritis?

Causes accumulation of cells in Bowman's capsule, which compresses the glomerulus forming a crescent shape

47

Describe the pathogenesis of Goodpasture's syndrome:

Autoimmune:
= IgG (anti-GBM autoantibody) attacks collagen IV in basement membrane
= Glomerulus becomes ball of inflammatory cells
= Heals by scarring therefore reduces filtration

48

Why does Goodpasture's syndrome sometimes present with haemoptysis?

Autoantibodies attack collagen IV, which is also present in alveoli membranes.
= More common when lungs are already damaged, ie in smokers

49

What is the treatment of Goodpasture's syndrome?

No cure, can prevent worsening via immunosuppresants and plasmaphoresis

50

Name 2 crescentic glomerulonephritis', and their associated glomerular syndromes:

1) Goodpasture's syndrome
2) Vasculitis (ANCA)
Both cause nephritic syndrome

51

Describe the pathogenesis of Vasculitis (nephropathy):

ANCA (Anti-Neutrophil Cytoplasmic Antibody) causes inflammation of blood vessels