Podcast
Questions and Answers
What is the functional unit of the kidney?
What is the functional unit of the kidney?
What constitutes heavy proteinuria in nephrotic syndrome?
What constitutes heavy proteinuria in nephrotic syndrome?
What are the main features of nephrotic syndrome?
What are the main features of nephrotic syndrome?
Heavy proteinuria, generalized oedema, hypoalbuminaemia, hyperlipidaemia
Glomerulonephritis is caused only by immune complex-mediated injury.
Glomerulonephritis is caused only by immune complex-mediated injury.
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The commonest cause of nephrotic syndrome in children is _____ disease.
The commonest cause of nephrotic syndrome in children is _____ disease.
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Which microscopy techniques are used to examine renal biopsy specimens?
Which microscopy techniques are used to examine renal biopsy specimens?
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What is the primary pathology observed in minimal change disease?
What is the primary pathology observed in minimal change disease?
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Which condition is associated with the highest prevalence of focal segmental glomerulosclerosis?
Which condition is associated with the highest prevalence of focal segmental glomerulosclerosis?
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In renal diseases, the term 'oedema' refers to _____ retention.
In renal diseases, the term 'oedema' refers to _____ retention.
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Study Notes
Introduction
- Proteinuria is the presence of protein in urine, normal values are greater than 30 milligrams/ 24 hours for adults, and greater than 100 milligrams/ m2/ 24 hours
- Nephrotic syndrome is a serious condition characterized by heavy proteinuria (greater than 3.5 grams/ 24 hours), generalized edema, hypoalbuminemia, and hyperlipidemia.
The Nephron
- Nephrons are the functional units of the kidneys.
- Each nephron contains a glomerulus, proximal convoluted tubule, loop of Henle, distal tubule and collecting duct.
- The nephron is responsible for producing urine via the glomerulus, filtration, and tubular reabsorption and secretion.
Glomerular Disorders
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Glomerulonephritis (GN) is an inflammatory condition of the glomerulus.
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The majority of glomerular disorders are immune-complex mediated.
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Immune complexes form and deposit in the glomerulus, leading to injury & inflammation.
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Glomerular disorders can also be caused by:
- Cytokines
- Lymphokines
Glomerulonephritis Classification
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GN can be classified by aetiology and morphology.
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Aetiological classification:
- Immune complex mediated
- Non-immune complex mediated (cytokines & lymphokines)
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Morphological classification:
- Focal/Diffuse: 50% of glomeruli are involved.
- Segmental/Global: 50% of glomerular tufts are involved.
- Non-proliferative types:
- Minimal change disease (MCD)
- Focal Segmental Glomerulosclerosis with Hyalinosis (FSH / FSGS)
- Membranous glomerulonephritis
- Proliferative types:
- Membranoproliferative glomerulonephritis
- Crescentic types:
Glomerulopathies
- Renal involvement as part of a systemic disease process:
- Diabetes mellitus (DM)
- Systemic lupus erythematosus (SLE)
- Amyloidosis
- HIV Associated Nephropathy (HIVAN) / HIV
- Immune Complex Kidney disease (HIVICK)
Renal Biopsy
- Renal biopsy is the gold standard for diagnosing glomerular pathology.
- Techniques used to examine biopsied specimens:
- Light microscopy (LM)
- Immunofluorescence microscopy (IMF)
- Electron microscopy (EM)
Primary Renal Diseases
- Primary renal diseases resulting in proteinuria/nephrotic syndrome:
- Minimal change disease (MCD)
- Focal segmental glomerulosclerosis (FSGS)
- Membranous GN
- Membranoproliferative GN
Minimal Change Disease (MCD)
- The most common cause of nephrotic syndrome in children (2-6 years old).
- Often responsive to steroid therapy.
- Aetiology is unclear, but thought to be podocytopathy (disease of the podocytes).
- Pathology:
- LM: Normal
- IMF: Negative
- EM: Podocyte foot process effacement (loss of normal structure)
- Prognosis:
- Children: Good, majority resolve.
- Adults: Variable outcome, small percentage progress to chronic renal failure.
Focal Segmental Glomerulosclerosis (FSGS)
- More prevalent in black patients.
- Increasing incidence with HIV epidemic.
- Aetiology unclear, but thought to be podocytopathy.
- Pathology:
- LM: Focal lesions, Hyalinosis (scarring)
- IMF: Negative
- EM: Podocyte foot process effacement (loss of normal structure)
- Prognosis: Variable, some progress to chronic renal failure.
Membranous Glomerulonephritis
- More common in adults.
- Often associated with autoimmune diseases like Lupus.
- Aetiology involves immune-complex deposition.
- Pathology:
- LM: Thickening of the glomerular basement membrane.
- IMF: Positive for IgG and C3.
- EM: Electron dense deposits along the glomerular basement membrane.
- Prognosis: Variable, some progress to chronic renal failure.
Membranoproliferative Glomerulonephritis
- Classification: Type I and Type II.
- Often associated with autoimmune diseases.
- Aetiology is thought to be immune-complex deposition.
- Pathology:
- LM: Thickening of the glomerular basement membrane and proliferation of mesangial cells.
- IMF: Positive for IgG, IgM, and C3.
- EM: Electron dense deposits in the mesangium and along the glomerular basement membrane.
Summary
- Glomerular diseases are diverse and can be challenging to manage.
- Understanding the different types of glomerular disorders is important for proper diagnosis and treatment.
- While many glomerular disorders have a good prognosis, some can lead to chronic renal failure.
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Description
Test your knowledge on proteinuria, nephrotic syndrome, and nephron structure. This quiz covers key aspects of glomerular disorders and their implications. Perfect for students studying renal physiology and pathology.
