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What are 4 types of glomerulonephritis most commonly associated with nephritic syndrome? (descending order)
- 1. Post-streptococcal glomerulonephritis
- 2. Crescentic glomerulonephritis
- 3. IgA nephropathy
- 4. Membranoproliferative glomerulonephritis
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What are 3 things we need for know before performing a renal biopsy?
- 1. Bleeding time (platelet count, PT) - patients with uraemia may have prolonged bleeding
- 2. Blood pressure
- 3. Anatomy of kidneys (U/S required)
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Describe the pathogenesis of post-streptococcal glomerulonephritis.
- Antigens deposit in glomerular capillaries, commonly reside between glomerular membrane and podocytes
- Antibodies bind to antigens and form immune complexes
- Complement is activated (C3a & C5a) and they are chemotactic for leukocytes
- C3a & C5a cause histamine release from mast cells, leading to increased vascular permeability
- C5b-C9 complex directly damages glomerular membrane
- Intercellular adhesion molecules causes adhesion of cells to endothelium
- Podocytes are damaged and retract
- Blood and protein enters Bowman's space
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Name 5 types of glomerulonephritis associated with nephrotic syndrome.
- 1. Membranous glomerulonephritis
- 2. Focal segmental glomerulonephritis
- 3. Minimal change disease
- 4. Membranoproliferative glomerulonephritis
- 5. Diabetic glomerosclerosis
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Name 3 clinical problems associated with proteinuria.
- Hypercoagulability -- e.g. renal thrombus
- Increased infection risk
- CVD
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Name 4 common causes of membranous glomerulonephritis.
- SLE
- Drugs e.g. gold, NSAIDS, captopril
- Infections e.g. hep B, malaria
- Cancers e.g. carcinoma, melanoma, leukaemia
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Name 2 types of glomerulonephritis associated with asymptomatic urinary abnormalities.
- IgA nephropathy - Berger's disease
- Thin basement membrane disease
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Characteristics of the nephrotic syndrome? - 4
- Heavy proteinuria (at least (3.5 grams per day) with hypoproteinaemia
- Generalised oedema
- Increased blood lipids, particularly cholesterol
- Presence of lipids in the urine
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Characteristics of the nephritic syndrome?
- GRF impaired
- Patients feel generally ill with facial oedema, most often noticed early in the morning
- Haematuria (microscopic)
- Hypertension
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Define oliguria.
Excretion of less than 400ml of urine per day
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Name the common causes of acute renal failure (3 categories).
- Prerenal: hypovolemia, renal a. stenosis, ineffective blood delivery e.g. CHF
- Intra-renal: vasculitis, malignant htn, acute tubular necrosis (ischemic,nephrotoxic)
- Postrenal: bilateral ureteric obstruction, bladder-outlet obstruction
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Name 3 main causes of chronic kidney failure in Australia (descending order)
- Diabetic nephropathy
- Glomerulonephritis
- Hypertension
- Reflux nephropathy
- Polycystic kidney disease
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Describe the pathogenesis of oedema, hypercholesterolemia, hypoalbuminemia and infections in nephrotic syndrome.
- Oedema: low oncotic pressure due to hypoalbuminaemia and retention of salt/water by kidneys
- Hypercholesterolemia: liver overproducing lipoproteins due to fall in oncotic pressure
- Hypoalbuminemia: urinary protein loss, increased catabolism of filtered albumin (proximal tubule), redistribution of albumin within body
- Infections: urinary loss of immunoglobulins and defect in complement cascade
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Name 6 contraindincations for renal biopsy.
- PKD
- Solitary kidney
- CRF
- Active urinary infection
- Severe hypertension
- Coagulation disorders
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