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43 Cards in this Set
- Front
- Back
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Acute glomerulonephritis/Nephritic Syndrome is defined by what constellation of SXS?
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* Hematuria with azotemia
* Proteinuria (minor) * Hypertension |
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What is the giveaway sign of the Nephritic syndrome?
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RBC casts in the urine
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How does the Nephritic Syndrome present histologically?
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* Immune deposits in the subendothelium
* Post-infectious "humps" |
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What are the four big signs of the Nephrotic Syndrome?
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* Massive proteinuria
* Edema * Hypercoagulable state * Hyperlipidemia |
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What renal structure is damage in the Nephrotic Syndrome?
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* Glomerular epithelial cells and the Basement Membrane
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Is the Nephrotic Syndrome an inflammatory condition?
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No.
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What happens to urine production in Acute Renal Failure?
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Urine production goes DOWN.
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What are three common causes of Acute Renal Failure?
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* Acute Tubular Necrosis
* Toxins * Drugs |
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Nephritic Syndrome, but with a very "rapid" decrease in GFR?
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Rapidly Progressive Glomerulonephritis
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What are a few histologic characteristic of RPGN?
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* Glomerular "Crescents," indicating severe injury to glomerular basement membranes.
* Glomerular necrosis |
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Chronic Renal Failure has what affect on urine output?
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Normal or high urine output is seen in chronic renal failure, with an eventual fall in GFR.
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What are some of the histologic signs of Chronic Renal Failure?
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* Glomerulosclerosis
* Tubular atrophy * Interstitial Fibrosis |
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What clinical diseases may precede Post-Infectious Glomerulonephritis?
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1) Post-Streptococcal URI
2) Streptococcal skin infection |
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What are the SXS of Post-Infectious Glomerulonephritis?
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* "Coke" colored urine
* RBC casts * Mild proteinuria * Oliguria * Azotemia * Fever & Malaise * HTN * Elevated ASO Titer |
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What are the two histologic findings for Post-Infectous Glomerulonephritis?
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1) Immune complex deposition on the Epithelial GBM
2) Glomerular infiltration of PMNs and Monos |
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What's the etiology of post-strep glomerulonephritis?
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Circulating immune complexes deposit in the glomeruli, leading to an inflammatory response and nephritic syndrome.
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Berger Disease?
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IgA Nephropathy
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What's the leading cause of End-Stage Renal Disease in Asia?
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IgA Nephropathy
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What is the histologic appearance of IgA Nephropathy?
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Immune complex deposition in Mesangal regions, detectable by EM and IF
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What's the pathogenesis of IgA nephropathy?
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* Low-grade immune complex deposition, unknown etiology
* Can occur after respiratory, GI or UTI |
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What's the big difference between "Membranous" and "Membranoproliferative" renal disease?
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* Membranous = Nephrotic
* Membranoproliferative = Nephritic |
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What's unusual about the naming of "Membranous Glomerulonephritis?"
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That its a major cause of the NEPHROTIC syndrome.
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What's another name for Membranous Glomerulonephritis?
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Membranous Nephropathy
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Where do immune deposits occur in Membranous Glomerulonephritis?
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On the epithelial side of the GBM
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"Spiking Picket Fence" pattern on renal biopsy, visible on EM
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Membranous Nephropathy
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What's the pathogenesis of membranous nephropathy?
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Chronic immune complex deposition and injury, often unknown antigen.
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"Tram Tracking Pattern" best seen with silver stains.
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Reduplication of the GBM in Membranoproliferative Glomerularnephritis
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Alport's Syndrome
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* Hereditary Nephritis
* Nerve deafness * Lens dislocation and cataracts * Defect in Type IV Collagen |
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What are the two listed causes of Sub-Epithelial Deposits in the glomerulus?
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1) Membranous glomerulonephritis (actually a nephrotic disease)
2) Post-Strep GN (w/intense inflammation) |
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What are the two listed caused of Sub-Endothelial deposits in the glomerulus?
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1) IgA Nephropathy
2) SLE |
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What's the pathogenesis of Acute Tubular Necrosis?
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1) ARF
2) Granular casts & debris in the urine 3) Little or no proteinuria |
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What are the SXS of Acute Tubular Necrosis?
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1) Loss of proximal tubule brush border
2) Acc'n. of cell debris 3) Mitotic figures in epithelium 4) No significant inflammation |
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Is ATN an inflammatory pathology?
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No significant inflammation is seen in ATN.
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What's the most common cause of Acute Renal Failure?
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Acute Tubular Necrosis
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What's the most common cause of ATN?
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Renal ischemia, triggered by hypotension/shock from trauma, gram-negative sepsis, or hemorrhage.
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What are the SXS of a Rapidly Progressing GN?
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* Hematuria
* RBC casts (glomerular source) * Proteinuria (< 3.5 g/day) * Decreased GFR * Edema * Hypertension |
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What are a few causes associated with Interstitial Nephritis?
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* Bacterial: Pyelonephritis
* Toxic: PCN Antibiotics, NSAIDs * Metabolic (Gout) * Autoimmune (Sjogren's) |
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What are the histologic findings with Interstitial Nephritis?
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* Inflammation of the tubular parenchyma
* Intratubular leukocytes (w/infection) |
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What are the clinical features of Malignant Hypertension?
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* Super high BP (240/120)
* Renal failure * Clinical hx. of HTN (usually) |
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What's the pathogenesis of renal failure in Malignant Hypertension?
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Severe hypertension injures endothelial cells; reaction to injury further reduces GFR, further complicating HTN.
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What are the renal histologic characteristics of Malignant Hypertension?
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* Massive thickening of small arterial walls
* Concentric layering of collagen and smooth mm on arterioles ("onion-skinning") |
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Name some of the Thrombotic Microagiopatic diseases.
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1) Hemolytic Uremic Syndrome (enteric E. coli infection)
2) Thrombotic Thrombocytopenic Purpura |
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What are the renal SXS of Thrombotic Microangiopathies?
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* Renal Failure
* Hematuria * Hemolytic anemia (schistocyte formation) |
