Block 2 Glomerular Diseases

Front 1

Describe the 3 layers of the glomerulus:

Back 1

1. Endothelial layer - lines inner surface of capillry
2. Basement Membrane - determines permeability
3. Epithelial Layer - surrounds outer surface of bowman's capsule, attaches via foot processes to BM

Front 2

What passes/does not pass through glom capillary membrane?

Back 2

Water, electrolytes, glucose, AAs pass easily

Proteins do not pass

Front 3

What is the first protein to pass when the membrane is damaged? Why?

Back 3

albumin - because its the smallest

Front 4

What occurs long beore clinical proteinuria?

Back 4

microalbuminuria

Front 5

When might you normally see protein in the urine?

Back 5

after running alot

Front 6

List 3 secondary causes of glomerular disease?

Back 6

1. SLE
2. DM
3. amyloidosis

Front 7

List the 3 cellular changes that occur in the basement membrane in glomerular disease?

Back 7

1. Proliferative
2. Sclerotic
3. Membranous

Front 8

Describe proliferative changes you might see?

Back 8

increase in cellular components and # of cells (inflammatory or WBC response)

Front 9

Describe sclerotic changes you might see?

Back 9

increase in extracellular components - primarily collagen

Front 10

Describe Membranous changes you might see?

Back 10

incr in glom capullary wall thickness (IC deposition)

Front 11

What does "diffuse" mean?

Back 11

all glomeruli, all parts

Front 12

What does "focal" mean?

Back 12

some gomeruli

Front 13

What does "segmental" mean?

Back 13

certain segment of each glomeruli

Front 14

What does "mesangial" mean?

Back 14

affecting the mesangial cells

Front 15

What are the 2 types of immune mechanisms implicated by glomerulonephritis?

Back 15

1. injury from Abs reacting w/ Ags in the glomerulus

2. Circulating Ag-Ab complexes trapped in glomerular membrane

Front 16

2 origins of antigens?

Back 16

1. endogenous (ex. abs to self - SLE)
2. exogenous (ex. step membrane Ags in APSGN)

Front 17

According to Dr. Otruba - what is the second leading cause of renal failure IN THE WORLD?

Back 17

inflammation of glomerular structures

Front 18

What are the 2 triggers of glomerulonephritis?

Back 18

1. immune
2. non-immune (DM, HTN,Toxins)
3. Hereditary (Alport's syndrome)

Front 19

Which is trigger is most common?

Back 19

immune

Front 20

What word should come to mind when you hear "nephrotic syndromes"

Back 20

subepithelial

Front 21

What is abnormal in nephrotic syndrome?

Back 21

the permeability of glomerular membranes (commonly via changes in the foot processes)

Front 22

What proteins are lost in the urine? What does that loss result in?

Back 22

Igs --> immune suppression/infnx
coag factors --> thrombosis
proteins that carry blood components --> altered drug doses

Front 23

What 4 key clinical features are found in nephrotic syndrome?

Back 23

1. massive proteinuria (>3g/24hr)
2. lipiduria
3. generalized edema
4. hyperlipidemia
5. hypoalbuminemia

Front 24

Nephrotic syndrome is not a _________, but a _____ of ________ due to ________

Back 24

not a SPECIFIC DISEASE, but a CONSTELLATION OF CLINICAL FINDINGS due to increased permeability and loss of plasma proteins in urine

Front 25

3 causes of nephrotic syndrome?

Back 25

1. minimal change dz?
2. Focal semental glomerulosclerosis
3. Membraneous GN

Front 26

What to do during workup?

Back 26

kidney biopsy to determine specific cause of kidney filter dz

Front 27

What is minimal change disease? What age group is it most prevalent in?

Back 27

diffuse loss of foot processes in epithelial layers (fuse together into single thin layer) - can't keep protein out of urine

Kids 2-6

Front 28

What is focal segmental glomerulosclerosis? Who do you see it in?

Back 28

sclerosis of some of the glomerulus

Seen in hispanic or *AA*

Front 29

What is membranous GN? who do you see it in?

Back 29

diffuse thickening of BM from IC deposition (Ab + Ag)

Adults - most common cause of nephrotic syndrome in WHITE ADULTS

Front 30

What word should come to mind when you hear "nephritic syndrome"?

Back 30

subENDOthelial

Front 31

Where do IC deposit in nephritic syndrome?

Back 31

subendothelial, glom BM, or in mesangium

Front 32

What is the most important factor in keeping protein and blood out of the urine?

Back 32

the epithelial cell - podocyte

Front 33

What two processes are activated by nephritic syndrome?

Back 33

1. proliferative inflammatory response
2. Inflammatory process damages capillary wall

Front 34

What clinical findings would you see in nephritic syndrome?

Back 34

1. HTN
2. variable proteinuria
3. decr GRF --> HTN, oligura, edema

Front 35

What is acute nephritic syndrome?

Back 35

acute proliferative damage --> capillary wall damage post-infxn or primary dz (SLE)

Front 36

Clincal features of Acute Nephritic Syndrome?

Back 36

1. sudden hematuria*
2. Proteinuria
3. Decreased GFR --> HTN (late = edema)
4. Oliguria

Front 37

How do medications cause drug related nephropathies?

Back 37

decr blood flow, obstruction (via crystals), hypersensitivity

Front 38

What causes acute interstitial nephritis?

Back 38

drug-induced allergic reaction that promotes interstitial inflammation and tubular damage

Front 39

What causes acute tubular necrosis?

Back 39

dose-dependent direct drug toxicity on tubular epithelia

Front 40

What is the leading cause of renal failure in the US?

Back 40

nephritis = inflammation/necrosis

Front 41

What is nephritis characerized by**?

Back 41

1. hematuria/RBC casts
2. DECR GRF
3. Azotemia
4. Oliguria
5. HTN

Front 42

What does Acute Proliferative Nephritis follow? by how many days?

Back 42

follows infxn (group A b-hemolytic strep) by 7-10d

Front 43

How is acute proliferative nephritis diagnosed? treated?

Back 43

ASO titer

symptomatic tx

Front 44

What is the cause of rapidly progressive nephritis? treatment?

Back 44

no specific cause (poss SLE, vasculitides, goodpastures syndrome)

tx: plasmaphoresis of Abs and immunosuppressive therapy

Front 45

What is IgA Nephropathy (Buergers Dz)? Who is it seen in?

Back 45

deposition of IGA complexes in mesangium

Asian men, 10-30yo

Front 46

What 3 things do all Acute Kidney Injuries have in common?

Back 46

1. rapid deterioration of renal fxn
2. rapid INCR in BUN and Cr
3. Oliguria

Front 47

What are casts?

Back 47

mold of distal nephron lumen

Front 48

when do casts form?

Back 48

when urine protein concentration is high (ex. nephrotic syndrome*)

Front 49

What are hyaline casts?

Back 49

tamm horsfall mucoprotein (gel-like) w/o cells