Please enable JavaScript.

Coggle requires JavaScript to display documents.

Renal Disease - Coggle Diagram

- - - - Massive proteinuria => 3.5 grams per day
      - Hypoalbuminaemia
      - Oedema
      - Hyperlipidaemia
      - Lipiduria
    - - Minimal Change Disease
        
        Epidemiology
        
        Children
        
        Insidious onset in otherwise healthy child
        
        Uncommon is adults
        
        Cause
        
        Idiopathic
        
        NSAIDs
        
        Lithium
        
        Immune checkpoint inhibitors
        
        Malignancy
        
        Lymphomas
        
        Leukaemias
        
        URTIs
        
        Allergic reactions & insect stings
        
        Immunisations - vaccine?
        
        Microscopy
        
        Normal on light microscopy
        
        Effacement of podocyte foot processes on electron microscopy
        
        Presentation
        
        Preferential albuminuria
      - Focal Segmental Glomerulosclerosis
        
        Primary Idopathic
        
        Acute onset
        
        Haematuria
        
        Hypertension
        
        Secondary
        
        Slow onset
        
        Increasing proteinuria
        
        Renal impairement
        
        Causes
        
        HIV
        
        Heroin
        
        IgA nephropathy
        
        Microscopy
        
        Light microscopy
        
        Focal sclerosis of glomeruli
        
        Portion of glomerular tuft - segmental
        
        Electron microscopy
        
        Effacement of podocyte foot processes
      - Membranous nephropathy
        
        Definition
        
        Immune complex nephrtitis
        Slowly progressive
        
        Primary Idiopathic
        
        Autoantibodies to PLA2R1 on podocytes
        
        Secondary
        
        Infections
        
        Hep B and C
        
        HIV
        
        Malignancy
        
        Lung
        
        Colon
        
        Melanoma
        
        Leukaemia
        
        Lymphoma
        
        Drugs
        
        Gold
        
        Penicillamine
        
        NSAIDS
        
        Anti-TNF
        
        Autoimmune
        
        Sarcoidosis
        
        Lupus
        
        Rheumatoid arthritis
        
        Microscopy
        
        Light
        
        Diffuse thickening of Glomerular Basement memebrane
        
        Electron
        
        Subepithelial immunoglobulin-containing deposits along th GMB - Spike and dome pattern
        
        Immunofluorescence
        
        Ganular deposits of IgG, κ and λ light chains and complement along capillary walls
      - Membranoproliferative Glomerulonephritis
        
        Presentation
        
        Nephrotic syndrome
        
        Cause
        
        Complement mediated
        
        Main type - C3 mediated
        
        C3 dense deposit disease
        
        C3 glomerulonephritis
        
        Microscopy
        
        Light
        
        Mesangial proliferation
        
        Electron
        
        Broad linear dense deposits in GMB Bowman's capsule, amesangium and tubular basement membrane
        
        Immunoflourescence
        
        Garland and granular mesangial C3
        
        Immune-Complex / Monoclonal Ag-Mediated
        
        Microscopy
        
        Light
        
        Proliferation of mesangial and epithelial cells
        
        Thickened duplicated GMB with Tram Track appearance
        
        Electron
        
        Dense subendothelial deposits
        
        Mesangial deposits
        
        Immunofluorescence
        
        C3 deposition in cappillary walls and mesangium
        
        Lumpy and bumpy
      - Systemic Disease
        
        Diabetes
        
        Lupus
        
        Amyloid
  - - - Renal biopsy
    - - Treat underlyding disorder
        
        Hypertension
        
        Hyperlipidaemia
        
        Proteinuria
      - Dialysis
      - Transplant
    - - Isolated haematuria +/- proteinuria
      - Nephrotic syndrome
      - Nephritic syndrome
      - Acute kideney injury
      - Chronic kidney disease
  - - - Minimal change disease
      - Focal segmental glomerulosclerosis
      - Membranous nephropathy
      - Membranorpoliferative glomerulonephritis
      - IgA nephropathy
      - Rapidly progressive Crescentic glomerulonephritis
      - Acute proliferative glomerulonephritis - postinfx , other
    - - Diabetes mellitus
      - Systemic Lupus Erythematosus (SLE)
      - Amyloidosis
      - Goodpasture syndrome
      - Microscopic polynagitis
      - Granulomatosis with polyangiitis (GPA)
      - Henoch Schonlein purpura
      - Bacterial endocarditis
      - Multiple myeloma
  - - - Mesangial cell proliferation
      - Infiltration of WBC
      - Cresents
    - - Immune complex deposition
      - Increased synthesis of preotein components
  - - - Characterised by glomerular inflammation
    - - Haematuria
      - Red cell casts in the urine
      - Azotaemia - nitrogen in urine
      - Oliguria
      - Hypertension
      - Proteinuria
      - Odema
    - - Acute proliferative glomerulonephtritis
      - Exudative glomerulonephritis
      - Crescentric glomerulonephritis
      - SLE
      - Microscopic polyangiitis
    - - Children / Adolescents
        
        IgA nephropathy
        
        Acute prolifrative post streptococcal glomerulonephritis
        
        Henoch-Chonlein purpura (HSP)
        
        Haemolytic Uraemic syndrome (HUS)
      - Adults
        
        Goodpasture syndrome
        
        Systemic lupus eythematosus
        
        Rapidly progressive glomerulonephritis (PGNG)
        
        Membranoproliferative glomerulonephritis (MPGN)
        
        Infective endcocarditis
        
        ANCA - mediated vasculits
    - - Epidemiology
        
        Children and young adults
      - Presentation
        
        Gross haematuria after non-specific URTI
        
        Haematuria subsides after several days, then recurs ever few months
        
        Loin pain
        
        Progression to chronic renal failure
      - Microscopy
        
        Light
        
        Mesangial proliferation
        
        Immunofluorescence
        
        Mesangial deposition of IgA
    - - Definition
        
        Glomerular deposition of immune complexes with proliferation and swelling of glomerular cells and WBC infiltration
      - Prototypic Pattern
        
        Post streptococcal GN
        
        Pneumococcus
        
        Staphlococcus
        
        Viruses - Mumps, measlesm chickenpox, hepatitis B and C
      - Presentation
        
        Malaise
        
        Fever
        
        Nausea
        
        Gross haematuria dark brown olour
        
        Low serum complement
        
        Anti-streptolysin O antibody
      - Microscopy
        
        Light
        
        Increased cellularity of glomerular tufts
        
        Electron
        
        Deposited immune complexes in subepitheial humps
        
        Immunofluorescence
        
        Granular deposits of IgG and complement
      - Prognosis
        
        Recovery in children
        
        Rapidly progressive glomerulonephritis
        
        Adults - End stage renal disease
    - - Definition
        
        Cliical syndrome not a specific aetiological causes
      - Presentation
        
        Rapid progressive loss of real function with features of nephritis syndrome
        
        Death from renal failure - weeks to months
        
        Immunological glomerular injury
      - Types
        
        Type 1
        Anti-GBM
        
        Microscopy
        
        Immunofluorescence - Linear deposits of IgG and C3 on GMB
        
        Binding of anti-GBM antibodies to pulmonary capillary basement membranes - haemorrhage
        
        Ant-GMB antibodies in serum - treated with plasmaphersis
        
        Inludes
        
        Goodpastures syndrome
        
        Alport syndrome
        
        Type 2
        Immune Complex
        
        Microscopy
        
        Immunofluorescence - Granular deposits along GMB
        
        May complicate any immune complexnephritis
        
        Not helped by plasmapheresis
        
        Includes
        
        IgA nephropathy - Berger's disease
        
        Post strep GN
        
        Diffues proliferative GN
        
        Type 3
        Pauci Imunne
        
        Microscopy
        
        LAck of anti-GBM antibodies or immune deposition
        
        Elevated serum ANCA
        
        Component of systemic vasculitis or idiopathic
        
        Inlcudes
        
        ANCA vasculitis
        
        Microscopic polyangitis
      - Pattern of Immune Complex Deposition
        Immunoflourescence
        
        A: Linera
        Characteristic of classc anti-BBM disease - Goodpastures
        
        B: Granular
        Characteristic of immune complex glomerulonephritis
    - - Group of heterogeneous familial renal disease ass with mutations in collagen genes that manifest with glomerular injury
      - Alport syndrome
        
        Presentation
        
        Haematuria
        
        Progression to chronic renal failure
        
        Eye disorders
        
        Lens dislocation
        
        Posterior cataracts
        
        Corneal dystrophy
        
        Genetics
        
        X linked
        
        Males cpressed full syndrome
        
        Female heterozygotes present with haematuria
    - - Diabetic Nephropathy
        
        Major cause of renal morbidity and mortality
        
        Leading cause of chronic kidney failure someplaces like??
      - Henoch-Schonlein Purpura
        
        Childhood syndome
        
        Presentation
        
        Skin lesions
        
        Abdominal pain
        
        Intestinal bleeding
        
        Arthralgias
        
        Renal disease
        
        Renal manifestations in 1/3
        
        Renal manifestations
        
        Gross or microscopic haematuria
        
        Nephritic syndrome
        
        Nephrotic syndrome
      - Lupus Nephritis
        
        Presentation
        
        Renal lesions
        
        Recurrent microscopic or gross haematuria
        
        Nephritis syndrome
        
        Rapidly progessive glomerulonephritis
        
        Nephrotic syndrome
        
        Acute and chronic renal failure
        
        Hypertension
- - - - Hypoperfusion
        
        Blood loss
        
        MI
        
        Severe dehydration
    - - Intrinsic kidney disease
    - - Obstruction of urine flow
        
        REnal stones
        
        Tumours
  - - - Elevation of blood urea nitrogen (BUN)
        and Creatine
        Reflects decreased GFR
    - - Presentation
        
        Fatigue
        
        Loss of apeptite
        
        Weight loss
        
        ITch
        
        Thirst
        
        Seizures
        
        Coma
        
        GI Bleed
        
        N+V
      - Elevation of blood urea level, represents failure of renal excretory fx
  - - - Hypertension
      - Ankle odema
      - Pulmonary oedema
    - - Arrythmias
    - - Itch
      - Bone disease
    - - Nausea
      - Anorexia
      - Encephalopathy
    - - Secondary hyperparathyroidism
      - Bone disease
    - - Anaemia