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Renal and Urology > Glomerulonephritis > Flashcards

Glomerulonephritis Flashcards

1
Q

What two things do mesangial cells do

A 
Smooth muscle- Vasocontrictor to limit blood flow to glomerulus and decrease GFR
Immune cells (monocytes)
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2
Q

What leads to a proliferative lesion

A

damage to endothelial or mesangial cells

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3
Q

What results from proliferative lesions

A

red cells in the urine

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4
Q

What leads to a non proliferative lsiosn

A

damage to podocytes

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5
Q

What results from damage to podocytes

A

protein in urine

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6
Q

what type of haematuria is more common in GN

A

microscopic
macroscopic more common with urinary tract pathology
if it is macroscopic - often looks smokey or like coca cola

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7
Q

What does heavy proteinuria urin look like

A

frothy - usually present with 1g or more of protein

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8
Q

How can you tell if the bleeding is coming from the kidney itself rather than further down the tract

A

dysmorphic red cells - glomerular bleeding due to squezzing through gaps

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9
Q

What are red cell cast usually a sign of

A

a nephritic syndrome

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10
Q

what is nephritic sydroem

A

acute renal failure

usually produce less urine

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11
Q

What is nephrotic syndrome

A

Heave protein leak which is mostly albumin
Triad- oedema, proteinurea, hypoalbuminaemia
usually normal urine function

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12
Q

What are the complicaions of nephrotic syndrome

A 
infections
renal vein thrombosis
PE
volume depletion 
Vit D deficiency 
subclinical hypothyroidism - due to loosing albumin
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13
Q

What is the commonest cause of nephrotic syndrome in children

A

minimal change

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14
Q

What it the commonest cause of nephrotic syndrome in adults

A

focal segmental glomerulosclerosis

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15
Q

What is glomerulonephritis

A

immune mediated disease of the kidneys affecting the glomeruli

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16
Q

describe the different processes which lead to nephrotic vs nephritic syndrome

A

nephritic = damage to endothelial or mesangial cells lead to proliferative lesion and blood in urine

nephrotic = damage to podocytes leads to non proliferative lesions and protein in urine

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17
Q

what level of proteinuria would be classified as ‘nephrotic’ syndrome

A

more than 3 grams per day

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18
Q

describe the nephritic syndrome

A

characteised by acute renal failure, oliguria, hypertension and haematuria

there may also be oedema and fluid retention

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19
Q

which cell is affected in nephritic syndrome

A

endothelial cells

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20
Q

decribe the nephrotic syndrome

A

proteinuria more than 3g/day
hypoalbuminaemia
oedema
hypercholesterolaemia

usually normal renal function

21
Q

what cells are affected by the nephrotic syndrome

A

podocytes

22
Q

what are the complications of nephrotic syndrome

A

infection - due to loss of antibodies
RENAL VEIN THROMBOSIS
pulmonary emboli
volume depletion - may lead to AKI

vit D deficiency
subclinical hypothyroidim,

23
Q

Give the nephritic syndromes we need to know

A

IgA nephropathy

Rapidly progressive aka cresenteric glomerulonephritis

24
Q

Give the nephrotic syndromes we need to know about

A

Minimal change
Focal segmental glomerulosclerosis
Membranous

25
Q

Give the nephritic/nephrotic syndromes we need to know

A

Diffuse proliferative i.e post strep GN

Membranoproliferative

26
Q

Key points about minimal change nephropathy

A 
commonest cause of nephrotic syndrome in CHILDREN
idiopathic generally
90 percent remission with oral steroids
some have relapses
does not cause progressive renal failure

it is T cell and cytokine mediated damage to BM

27
Q

treatment of minimal change nephropathy

A

oral steroids

cyclophosphamide is 2 line

28
Q

commenest cause of nephrotic syndrome in adults

A

focal segmental glomerulosclerosis

29
Q

cause of FSGS

A

idiopathic

or secondary to HIV, heroin, obesity

30
Q

prognosis of FSGS

A

50 percent progress to ESRF after 10 years

31
Q

2nd most common cause of nephriotic syndrome in adults

A

membranous

32
Q

causes of membranous nepthropathy

A

infection - hep B or parasties
connective tissue disease - lupus
malignancy
drugs - gold/penacillamine

33
Q

treatment of membranous

A

steroids
alkylating agenst
b cell monoclonal antibodies

34
Q

prognosis of membranous Gn

A

30 percent progress to ESRF in 10 yrs

35
Q

antibody in membranous nephropathy

A

anti PLA2r antibody

36
Q

what is the commenest GN worldwide

A

IgA nephropathy

37
Q

clinical features of IgA nephropathy

A

nephrtic syndrome - haematura and non nephrtoic range proetinuria

AKI
typically symptoms occur after a resp or GI infection

associated with henochschonlein purpura

38
Q

treatment of IgA nephropathy

A

BP control with ACE or ARB

fish oil??

39
Q

features of HSP

A

arthritis
colitis
purpuric skin rash

40
Q

prognosis of IgA

A

25 percent progress to end stage renal failure

41
Q

renal biopsy of IgA nephropathy shows

A

mesangial cell proliferation

Ig A deposits

42
Q

what is rapidly progressive GN

A

rapid deteriation in renal function over a few days

nephritic

associated with glomerular cresents on biopsy

treatable cause of acute renal failure

urinary sediment with RBCs and casts

43
Q

causes of RPGN

A

vasculitis - GPA, microscopic polyangitis
goodpastures
HSP
SLE

44
Q

antibodies present in goodpastures

A

anti glomerular basement membrane antibodeis

45
Q

other features of goodpasture’s

A

pulmonary haemorrhage

46
Q

treatment on RPGN

A

immunosuppress - steroids or cytotoxics (cyclophosphamide/mycophenolate/azathioprine)

plasmapharesis

47
Q

what is diffuse proliferate GN

A

usually occurs post strep in child

nephritic syndrome or AKI presentation

48
Q

what is the most common GN in SLE

A

diffuse proliferative

also can get membranous and rapidly progressive GN

49
Q

what are the causes of membranoproliferative GN

A

cryoglobulinaemia or Hep c = type 1
partial lipodystrophy = type2

this is a mixed nephritic/nephrotic syndrome

Renal and Urology (20 decks)

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