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urinary > glomerulonephritis > Flashcards

glomerulonephritis Flashcards

1
Q

define glomerulonephritis

A

Inflammation of the glomerulus

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2
Q

What is relied on for the diagnosis and classification of glomerulonephritis

A

Kidney biopsy

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3
Q

What is the function of podocytes

A

They support the glomerulus barrier and prevent larger structures like albumin passing through

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4
Q

What is the filtration system of the glomerulus made up of

A

Endothelial cells on the inner side, basement membrane in the middle and podocytes on the outside

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5
Q

What are clinical features seen in glomerulonephritis

A

Haematuria
Proteinuria
Hypertension
Renal impairment

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6
Q

How does glomerulonephritis cause hypertension

A

Disruption of the glomerulus so less filtration and therefore cannot get rid of salt and water

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7
Q

How does glomeulonephritis cause renal impairment

A

Unable to get rid of the waste products

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8
Q

What are the features of a nephritic state

A

Hypertension
Renal impairment
Active urinary sediment - haematuria, dysmorphic red blood cells and cellular casts

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9
Q

What are the features of nephrotic syndrome

A

(More protein based)
Oedema
Nephrotic range proteinuria - more than 3.5g/day creatinine
Hypoalbuminaemia - serum albumin less than 35g/L
Dyslipidaemia - imbalance of HDL and LDL in the blood

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10
Q

What happens in a nephritic state

A

There is an invasion of neutrophils which damages all 3 layers of the wall which leads to cellular casts, albumin and blood leaking throug

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11
Q

What happens in nephrotic syndrome

A

Some thickening to the basement membrane but mainly the podocytes become short and ill so their foot processes come apart which leads to albumin being able to slip through

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12
Q

What are the two classifications which glomerulonephritis can be split into

A

Proliferative - excessive number of cells in the glomerulus including infiltrating leukocytes

Non-proliferative - glomerulus loom normal or have some areas of scarring - they have a normal number of cells

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13
Q

What does diffuse mean

A

More than 50% of the glomeruli is affected

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14
Q

What does focal mean

A

Less than 50% of the glomerulus is affected

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15
Q

What does global mean

A

The whole glomerulus is affected

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16
Q

What does segmental mean

A

Parts of the glomerulus are affected

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17
Q

What are the proliferative types of glomerulonephritis

A

Mesangioproliferative GN - e.g IgA nephropathy
Membranoproliferative GN - e.g Lupus nephritis
Diffuse proliferative GN - e.g post infectious GN
Crescentic GN - e.g ANCA associated GN

Crescentic glomerulonephritis is the only proliferative GN without proliferative in the nake

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18
Q

What are the non proliferative types of Glomerulonephritis

A

Minimal change disease
Membranous nephropathy
Focal and segmental glomeruosclerosis (FSGS)

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19
Q

What is the most common cause of glomerulonephritis

A

IgA nephropathy

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20
Q

Describe IgA nephropathy

A

Characterised by IgA deposition in the mesangium which caused mesangial cell proliferation
It is most common in males

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21
Q

How does IgA nephropathy present

A

Microscopic and macroscopic haematuria
Proteinuria
Nephrotic syndrome
IgA crescentic GN - devastating effect on kidney

22
Q

What is the normal creatinine level

A

60-110 micromol/L

23
Q

What should the urine protein creatinine ratio be

A

No more than 30mg/mmol

24
Q

What infection usually causes glomerulonephritis post infection

A

Group A strep - follows 10-21 days after the infection - this is why sore throat is common before the post-streptococcal GN

25
Q

What can make urine darker

A

Haematuria

26
Q

What does a low C3 on investigations suggest

A

The compliment system is activated - another feature of post infective GN

27
Q

What is the treatment for post infectious Glomerulonephritis

A

Antibiotics are debatable but the hypertension and oedema have to be dealt with so a loop diuretic like furosemide is given

28
Q

What causes the crescent in crescentic glomerulonephritis

A

Significant proliferation occurring in the capillary due to a rupture and spillage of infiltrate into the bowman’s capsule

29
Q

What is anti-GBM disease

A

rare disease caused by circulating Anti-GBM
10-20% of cases lead to crescentic gomerulonephritis

30
Q

What does anti-GMB present as

A

Anti-GBM glomerulonephritis
Good pasture’s syndrome

31
Q

What is good pasture’s syndrome

A

Nephritis plus lung haemorrhage

32
Q

How is anti-GBM diagnosed

A

Showing that there is anti-GBM antibodies in the serum and kidney

33
Q

What is the treatment for anti-GBM disease

A

Aggressive immunosuppression with steroids, plasma exchange an cyclophosphamide

34
Q

What does proliferative glomerulonephritis normally present with

A

Nephritic state - haemturia, hypertension with or without renal impairment and proteinuria

35
Q

How does non-proliferative glomerulonephritis present

A

Nephrotic syndrome

36
Q

How is the oedema in nephrotic syndrome treated

A

Salt and fluid restriction with loop diuretics

37
Q

How is hypertension in nephrotic syndrome treated

A

Use the renin-angiotensin-aldosterone system with a blockade such as an ACEi such as ramipril (end in pril)

38
Q

How is the risk of thrombosis reduced in nephrotic syndrome

A

Heparin or warfarin

39
Q

How is dyslipidaemia in nephrotic syndrome treated

A

Statins

40
Q

What happens in minimal change disease

A

Podocytes are shrunken and the foot projections are not interacting as they should be which lets larger proteins such as albumin through

41
Q

How is minimal change disease treated

A

With steroids:
prednisolone 1mg/kg for up to 16 weeks, then slowly taper for 6 months once remission is achieved

42
Q

What is the sudden onsetWhat appears a few days after developing minimal change disease

A

Oedema (few days after)

43
Q

What is the main issue with minimal change disease prognosis

A

The steroid toxicity associated which accumulates overtime with the treatment

44
Q

What is the normal serum albumin

A

35-50g/l

45
Q

What should cholesterol levels be

A

<5.2 mmol/l

46
Q

What is the treatment of focal segmental glomerularsclerosis

A

Trail of steroids

47
Q

What is the commonest cause of nephrotic syndrome in adults

A

Membranous nephropathy

48
Q

What is a serological marker for membranous nephropathy

A

They normally come back antibody positive for anti-phospholipase A2 receptor

49
Q

What is the treatment of membranous nephropathy

A

The general measures are done first but if the kidney begins to deteriorate, immunosuppression is done

Cyclophosphamide and steroids are alternated for 6 months

Tacrolimus and rituximab can be given as immunosuppressants as well

50
Q

What is Tacrolimus

A

Immunosuppresant used to prevent bodies rejecting donor organs

51
Q

What is Rituximab

A

Immunosuppressant cancer drug

52
Q
A

urinary (24 decks)

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