CM 2.1 - Renal Diseases

SET A —GLOMERULAR DISEASE:

• Occurs in patients with history of infection of Group A beta hemolytic streptococcus (S. pyogenes) that contain M protein

• Acute Glomerulonephritis

• _{^{Rapidly Progressive Glomerulonephritis}}

• _{^{Good Pasture Syndrome}}

• _{^{Wegener’s Granulomatosis}}

• _{^{Henoch Schonlein Purpura}}

SET A —GLOMERULAR DISEASE:

1. What bacteria is the major cause of Acute Glomerulonephritis (AGN)?

2. What infectious agent is specific to this bacteria?

1. Group A beta hemolytic strep (S. pyogenes)

2. M protein

SET A —GLOMERULAR DISEASE:

1. Given that Acute Glomerulonephritis (AGN) is caused by Group A beta strep (S. pyogenes), what clinical findings is found specific to this disease?

1. (+) Anti Streptolysin O (ASO)

SET A —GLOMERULAR DISEASE:

• This disease is often a complication of immune systemic disorder (Systemic Lupus Erythrematosus) with macrophages in the basement memebrane

• _{^{Acute Glomerulonephritis —strep bacterial infection}}

• Rapidly Progressive Glomerulonephritis

• _{^{Good Pasture Syndrome}}

• _{^{Wegener’s Granulomatosis}}

• _{^{Henoch Schonlein Purpura}}

SET A —GLOMERULAR DISEASE:

• This disease is caused by attachment of anti-glomerular basement (autoantibody), followed by complement activation producing capillary destruction

• Also directed to the alveolar basement membrane (lungs)

• _{^{Acute Glomerulonephritis —-strep infc.}}

• _{^{Rapidly Progressive Glomerulonephritis —systemic lupus}}

• Good Pasture Syndrome

• _{^{Wegener’s Granulomatosis}}

• _{^{Henoch Schonlein Purpura}}

SET A —GLOMERULAR DISEASE:

• Classical complains of this disease includes:

  • Hemoptysis → bloody cough

  • Dyspnea → difficulty in breathing

  • Followed by Hematuria
    

• Also positive (+) for Anti-glomerular basement membrane

• _{^{Acute Glomerulonephritis}}

• _{^{Rapidly Progressive Glomerulonephritis}}

• Good Pasture Syndrome

• _{^{Wegener’s Granulomatosis —(+) Anti-neutrophil cytoplasmic antibodies (ANCA)}}

• _{^{Henoch Schonlein Purpura}}

SET A —GLOMERULAR DISEASE:

• This disease is caused by Granuloma-producing inflammation of the small vessels primarily of the kidney and respiratory system
  

• Positive (+) for Anti-neutrophil cytoplasmic antibodies (ANCA)

• _{^{Acute Glomerulonephritis}}

• _{^{Rapidly Progressive Glomerulonephritis}}

• _{^{Good Pasture Syndrome — (+) Anti-glomerular basement membrane}}

• Wegener’s Granulomatosis

• _{^{Henoch Schonlein Purpura}}

SET A —GLOMERULAR DISEASE:

• Classical findings of this disease includes:

  • Blood on sputum (respiratory)

  • Blood on stool (GI symptom)

  • Raised Red Patches on skin

  • Renal Involvement —most serious

• _{^{Acute Glomerulonephritis}}

• _{^{Rapidly Progressive Glomerulonephritis}}

• _{^{Good Pasture Syndrome}}

• _{^{Wegener’s Granulomatosis}}

• Henoch Schonlein Purpura

SET C —GLOMERULAR DISEASE:

• This disease is due to immune complexes with IgA are deposited on the glomerular membrane

• Berger’s Disease (IgA Nephropathy) —IgA

• _{^{Membranous Glomerulonephritis —IgG}}

• _{^{Focal Segmental Glomerulosclerosis (FSGS) —IgM and C3}}

SET C —GLOMERULAR DISEASE:

• This disease is associated with pronounced thickening of glomerular basement membrane following depositions of IgG

• _{^{Berger’s Disease (IgA Nephropathy) —IgA}}

• Membranous Glomerulonephritis —IgG

• _{^{Focal Segmental Glomerulosclerosis (FSGS) —IgM and C3}}

SET C —GLOMERULAR DISEASE:

• This disease is associated with:

  • Sjogren’s Syndrome

  • Syphilis

  • Hepatitis B

  • Gold and Mercury Treatment

  • Malignancy

• _{^{Berger’s Disease (IgA Nephropathy) —IgA}}

• Membranous Glomerulonephritis —IgG

• _{^{Focal Segmental Glomerulosclerosis (FSGS) —IgM and C3}}

SET C —GLOMERULAR DISEASE:

• This disease is due to damage of podocytes and affects only certain numbers and areas of glomeruli

• Immune deposits primarily IgM and C3

• _{^{Berger’s Disease (IgA Nephropathy) —IgA}}

• _{^{Membranous Glomerulonephritis —IgG}}

• Focal Segmental Glomerulosclerosis (FSGS) —IgM and C3

SET C —GLOMERULAR DISEASE:

• This disease is associated with abuse of heroin and analgesics, and also with HIV/AIDS

• _{^{Berger’s Disease (IgA Nephropathy) —IgA}}

• _{^{Membranous Glomerulonephritis —IgG}}

• Focal Segmental Glomerulosclerosis (FSGS) —IgM and C3

SET B —GLOMERULAR DISEASE:

• This disease is marked by different alterations in the cellularity of the glomerulus and peripheral capillaries

• Membranoproliferative Glomerulonephritis (MPGN)

  • Type 1 — increase cellularity in subendothelial cells of mesangium

  • Type 2 —dense deposits in the basement membrane

• _{^{Chronic Glomerulonephritis}}

• _{^{Minimal Change Disease (Lipid Necrosis)}}

• _{^{Nephrotic Syndrome}}

• _{^{Alport Syndrome}}

SET B —GLOMERULAR DISEASE:

• Remember that Membranoproliferative Glomerulonephritis (MPGN) is due to alteration of cellularity, what type of MPGN is due to increased cellularity in the subendothelial cells of mesangium

• Membranoproliferative Glomerulonephritis (MPGN)

  • Type 1 — increase cellularity in subendothelial cells of mesangium

  • Type 2 —dense deposits in the basement membrane

• _{^{Chronic Glomerulonephritis}}

• _{^{Minimal Change Disease (Lipid Necrosis)}}

• _{^{Nephrotic Syndrome}}

• _{^{Alport Syndrome}}

SET B —GLOMERULAR DISEASE:

• Remember that Membranoproliferative Glomerulonephritis (MPGN) is due to alteration of cellularity, what type of MPGN is due to dense deposits in the basement membrane?

• Membranoproliferative Glomerulonephritis (MPGN)

  • Type 1 — increase cellularity in subendothelial cells of mesangium

  • Type 2 —dense deposits in the basement membrane

• _{^{Chronic Glomerulonephritis}}

• _{^{Minimal Change Disease (Lipid Necrosis)}}

• _{^{Nephrotic Syndrome}}

• _{^{Alport Syndrome}}

SET B —GLOMERULAR DISEASE:

• Remember that Membranoproliferative Glomerulonephritis (MPGN) is due to alteration of cellularity, what type of MPGN can progress to nephrotic syndrome?

• Membranoproliferative Glomerulonephritis (MPGN)

  • Type 1 — increase cellularity in subendothelial cells of mesangium

  • Type 2 —dense deposits in the basement membrane

• _{^{Chronic Glomerulonephritis}}

• _{^{Minimal Change Disease (Lipid Necrosis)}}

• _{^{Nephrotic Syndrome}}

• _{^{Alport Syndrome}}

SET B —GLOMERULAR DISEASE:

• Remember that Membranoproliferative Glomerulonephritis (MPGN) is due to alteration of cellularity, what type of MPGN associates with px experiencing symptoms of chronic glomerulonephritis?

• Membranoproliferative Glomerulonephritis (MPGN)

  • Type 1 — increase cellularity in subendothelial cells of mesangium

  • Type 2 —dense deposits in the basement membrane

• _{^{Chronic Glomerulonephritis}}

• _{^{Minimal Change Disease (Lipid Necrosis)}}

• _{^{Nephrotic Syndrome}}

• _{^{Alport Syndrome}}

SET B —GLOMERULAR DISEASE:

• This disease is marked by decrease in renal function resulting from glomerular damage precipitated by other renal disorder

• _{^{Membranoproliferative Glomerulonephritis (MPGN)}}

  • _{^{Type 1 — increase cellularity in subendothelial cells of mesangium}}

  • _{^{Type 2 —dense deposits in the basement membrane}}

• Chronic Glomerulonephritis

• _{^{Minimal Change Disease (Lipid Necrosis)}}

• _{^{Nephrotic Syndrome}}

• _{^{Alport Syndrome}}

SET B —GLOMERULAR DISEASE:

• This disease is due to disruption of podocytes

• Occur in children following allergic rxn and immunization and posession of Human Leukocyte Antigen B12 (HLA-B12)

• _{^{Membranoproliferative Glomerulonephritis (MPGN)}}

  • _{^{Type 1 — increase cellularity in subendothelial cells of mesangium}}

  • _{^{Type 2 —dense deposits in the basement membrane}}

• _{^{Chronic Glomerulonephritis}}

• Minimal Change Disease (Lipid Necrosis)

• _{^{Nephrotic Syndrome}}

• _{^{Alport Syndrome}}

SET B —GLOMERULAR DISEASE:

• What antigen is associated with Minimal Change Disease (Lipid Nephrosis)

• Human Leukocyte Antigen B12 (HLA B12)

SET B —GLOMERULAR DISEASE:

• This disease is due to disruption of electrical charge of the podocytes

• _{^{Membranoproliferative Glomerulonephritis (MPGN)}}

  • _{^{Type 1 — increase cellularity in subendothelial cells of mesangium}}

  • _{^{Type 2 —dense deposits in the basement membrane}}

• _{^{Chronic Glomerulonephritis}}

• _{^{Minimal Change Disease (Lipid Necrosis)}}

• Nephrotic Syndrome

• _{^{Alport Syndrome}}

SET B —GLOMERULAR DISEASE:

• Given that Nephrotic Syndrome is due to disruption of electrical charge of podocytes. What are the 4 classical findings of this disease (according to manual)

• Massive Proteinuria (>3.5 g/day) → _{^{(Normal: <10 mg/dL or 100 mg/day)}}

• HYPOAlbuminemia → _{^{protein easily can pass through}}

• HYPERLipidemia → _{^{hypoalbuminemia stimulate lipid production by liver}}

• Pronounced Edema → _{^{low albumin leads to low oncotic pressure of capillaries}}

SET B —GLOMERULAR DISEASE:

• This disease id due to genetic disorder showing lamellated and thinning glomerular basement membrane

• _{^{Membranoproliferative Glomerulonephritis (MPGN)}}

  • _{^{Type 1 — increase cellularity in subendothelial cells of mesangium}}

  • _{^{Type 2 —dense deposits in the basement membrane}}

• _{^{Chronic Glomerulonephritis}}

• _{^{Minimal Change Disease (Lipid Necrosis)}}

• _{^{Nephrotic Syndrome}}

• Alport Syndrome

TUBULAR DISORDERS:

• This tubular disease is associated with damage to renal tubular cells caused by Ischemia (↓ blood flow) and Toxic Agents
  

• This disorder usually is resolved when underlying cause is corrected

• Acute Tubular Necrosis (ATN)

• _{^{Fanconi Syndrome}}

• _{^{Diabetic Nephropathy}}

TUBULAR DISORDERS:

• This tubular disease is associated with Cystinosis and Hartnup disease
  

• Urine findings includes Glucosuria and Cystine Crystals

• _{^{Acute Tubular Necrosis (ATN)}}

• Fanconi Syndrome

• _{^{Diabetic Nephropathy}}

TUBULAR DISORDERS:

• This tubular disease is the MOST COMMON CAUSE OF END STAGE RENAL DISEASE (ESRD)

• DIABETIC NEPHROPATHY

  • _{^{Berger’s Disease (IgA Nephropathy) → Common Cause GLOMERULONEPHRITIS}}

TUBULAR DISORDERS:

• This tubular disease is associated with depositions of glycosylated proteins resulting from poorly controlled blood glucose levels

• _{^{Acute Tubular Necrosis (ATN)}}

• _{^{Fanconic Syndrome}}

• Diabetic Nephropathy