GLOMERULONEPHRITIS PRINCIPLES

Question 1

What are the 3 layers of the glomerular filtration barrier?

Answer 1

• Fenestrated capillary endothelium: first barrier to filtration
• Basement membrane: made of negatively charged molecules → repels negatively charged molecules such as albumin, also size barrier
• Podocytes (epithelial cells): foot processes wrap capillaries, splits between foot processes filter blood

Question 2

What are the hallmarks of glomerular disease on urine dipstick?

Answer 2

Haematuria and proteinuria

Question 3

What can cause a false positive urine dipstick test when looking at protein?

Answer 3

Dehydration

Question 4

What are the two syndromes on either end of the spectrum of glomerular disease?

Answer 4

Nephritic syndrome: blood and protein loss, renal failure

Nephrotic syndrome: massive proteinuria (largely albumin), hyperlipidaemia

Question 5

Explain why nephrotic syndrome is a hypercoagulable state

Answer 5

Protein loss causes loss of antithrombin III leading to increased thrombosis risk

Question 6

Why are patients with nephrotic syndrome more prone to infection?

Answer 6

Loss of immunoglobulins

Question 7

Which glomerular barriers are damaged in nephrotic vs nephritic syndrome?

Answer 7

• Nephrotic: protein barrier damaged
• Nephritic: entire glomeruli damaged

Question 8

Someone presenting with dark urine, swelling, fatigue and proteinuria of less than 3.5 g per day likely has which syndrome?

Answer 8

Nephritic syndrome

Question 9

How is most glomerular disease diagnosed?

Answer 9

Kidney biopsy