Urinary Week 9 - glomerular injury Flashcards Preview

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Flashcards in Urinary Week 9 - glomerular injury Deck (36):
1

What renal compartments can be damaged in renal disease

Glomerular
Tubular
Interstitial
Vascular

2

Sites of glomerular injury

Subepithelial
Glomerular basement membrane
Subendothelial
Mesangial

3

Secondary causes of glomerular injury

Diabetes
Hypertension

4

What occurs in blockage of the glomerulus

Renal failure (nephritic syndrome)
Low GFR
High stage AKI
Haematuria due to degradation of the glomerulus
Hypertension due to failure to control blood volume

5

What occurs in leakage of the glomerulus

Proteinuria including nephrotic syndrome
Haematuria

6

Criteria for nephrotic syndrome

>3.5g filtered in 24 hours

7

Isolated proteinuria suggests what site of glomerular injury

Sub epithelial

8

Symptoms of nephrotic syndrome

Hypoalbuminaemia causes generalised oedema
Poor renal perfusion pressure leads to RAAS activation so more fluid retention

9

Primary causes of nephrotic syndrome/proteinuria

Minimal change glomerulonephritis
Focal segmental glomerulosclerosis
Membranous glomerulonephritis

10

Secondary causes of nephrotic syndrome/proteinuria

Diabetes mellitus (causes microvascular damage, BM thickening, mesangial sclerosis, progressive proteinuria and progressive renal failure)
Amyloidoses

11

Describe minimal change glomerulonephritis - demographic, symptoms, treatment, outcome, histology

Presents in childhood/adolescence and incidence decreases with increasing age
Causes heavy proteinuria or nephrotic syndrome
Responds well to steroids
Usually doesn't progress to renal failure
Under an EM, widened filtration slits are visible

12

Pathogenesis of minimal change glomerulonephritis

Unknown
Damage caused by a circulating factor that is not an immune complex

13

What does focal segmental glomerulosclerosis include

Focal - <50% glomerulus affected
Segmental - involves glomerular tuft
Glomerulosclerosis - patchy scarring of glomerulus

14

Describe focal segmental glomerulosclerosis - demographics, symptoms, treatment, outcome

Presents in adults
Causes nephrotic syndrome and glomerulosclerosis
Not very responsive to steroids
Can progress to renal failure

15

Pathogenesis of focal segmental glomerulosclerosis

Unknown
Damage is caused by a circuiting factor which is not an immune complex

16

What is an immune complex

Antigen-antibody complex that circulates and activates complement

17

Describe membranous glomerulonephritis - demographics, symptoms, outcome, histology

Commonest cause of nephrotic syndrome in adults
Complement activation causes cell damage
1/3 recover, 1/3 don't improve and 1/3 progress to renal failure
Capillary loop is thickened and BM appears spiky due to immune complex deposition

18

Pathogenesis of membranous glomerulonephritis

Antigen and IgG are filtered and react in the sub epithelial space to produce immune complexes I.e it has an autoimmune basis
May also be secondary to malignancies likely lymphoma which triggers the immune system

19

Causes of haematuria

IgA nephropathy
Hereditary nephropathy

20

Causes of nephritic syndrome

Good pasture syndrome
Vasculitis

21

Demographics of IgA nephropathy

Any age

22

Presentation of IgA nephropathy

Haematuria
Triggered by mucosal infections (IgA secreted onto mucosa and activated in infection)
May be proteinuria

23

Treatment and outcome of IgA nephropathy

No treatment (can have transplant)
Significant number progress to renal failure

24

Where is IgA usually deposited and why

Mesangium because there is no basement membrane between the mesangium and blood

25

What are the types of hereditary neuropathies

Thin glomerular basement membrane neuropathy
Alport syndrome

26

Describe thin glomerular basement membrane nephropathy

Isolated haematuria
Thin glomerular basement membrane
Benign

27

Describe Alport syndrome

X linked condition
Abnormal collagen IV production
Deafness
Abnormal glomerular basement membrane
Progresses to renal failure

28

Describe good pasture syndrome

Rapidly progressing glomerular nephritis

29

What is common in smokers with good pastures syndrome

Haemoptysis

30

Cause of good pasture syndrome

Autoantibody (IgG) against collagen IV glomerular basement membrane

31

Outcome of untreated good pasture syndrome

Loss of kidney architecture (irreversible) so fibrosis occurs

32

Treatment of good pasture syndrome

Immunosuppression
Plasmapheresis

33

What is vasculitis

Group of systemic disorders causing inflammation of blood vessels

34

Describe vasculitis

Blood vessels are attacked in the glomerulus by anti neutrophil cytoplasmic antibodies (ANCA) which damage endothelia by activating neutrophils

35

What is required in suspected vasculitis

Urgent biopsy to confirm

36

Histological appearance of vasculitis

Segmental necrosis and crescent formation on a light microscope