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Glomerulopathy (Pathophysiology (Classification (Focal Part of kidney…
Glomerulopathy
Pathophysiology
Mechanism
Inflammation of glomerulus impedes blood flow,
causing compensatory HTN
Damage to glomerulus allows protein and blood into the urine
Proliferative change of glomerular cells, BM thickening,
crescent formation (cell infiltration into Bowman's space)
Classification
Focal
Part of kidney affected
Diffuse
Most of kidney affected
Segmental
Part of glomerulus affected
Global
Most glomerulus affected
Spectrum
Spectrum between nephritic and nephrotic syndrome
Predominantly nephrotic e.g. minimal change, membranous
Predominantly nephritis e.g. crescenteric GN, acute prolif GN
Types
Nephritic (acute nephritis)
Immune response triggered by e.g. infection
bacterial antigens trapped in glomerulus
Nephrotic
Triad of proteinuria, hypoalbuminaemia, and oedema
Rapid progressive GN
Progresses to ESRF in days
Immune complex disease, anti-GBM or vasculitic
Clinical
presentation
Asymptomatic
Haematuria
(may be non-visible)
Peripheral oedema
(some)
Diagnosis
Examination
Abdo exam
Hepatospenomegaly (infection),
peripheral oedema (nephrotic type)
Investigations
Bloods
FBC, CRP, U+E, GFR (normal/low nephrotic, low if nephritic),
LFTs, clotting, glucose, lipids (high if nephrotic)
Immune screen (ANCA, ANA, dsDNA, C3/C4, anti-GBM)
Virus screen (HIV, HBV, HCV)
Bedside
Obs (HTN if nephritic, fever)
Urine
Dipstick - blood (nephritic), protein (low nephritic, high nephrotic)
MCS (casts, infection)
ACR (high if nephrotic)
Imaging
USS KUB: nil change
Biopsy
Area of kidney affected
Amount of kidney (focal, diffuse)
Amount of glomeruli (segmental, global)
Immunofluorescent markers (Ig, complement)
EM (minimal change)
History
DH
Meds, allergies
FH
Renal disease
Immune disease
PMH
Known medical conditions
Autoimmune disease
Systemic infections
SH
Living arrangements, school/occupation,
smoking, alcohol, diet, drugs
PC/HPC
Asymptomatic, haematuria,
frothy urine
Management
Per cause
Definition
Pathology of the glomeruli and nephrons
by inflammatory or non-inflammatory mechanisms
i.e. nephrotic and nephritic syndromes
Epidemiology
Common