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A - MSRA Renal and Urinary [17] > [8] Glomerulonephritis > Flashcards

[8] Glomerulonephritis Flashcards

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1
Q

What is glomerulonephritis?

A

A group of disorders resulting from glomerular damage

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2
Q

What can glomerulonephritis lead to?

A

Proteinuria, with or without haematuria

AKI or end-stage renal failure

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3
Q

How might glomerulonephritis present?

A

Asymptomatic haematuria
Nephrotic syndrome
Nephritic syndrome

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4
Q

What are the causes of glomerulonephritis?

A 
Idiopathic
Immune
Infection
Drugs
Amyloid
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5
Q

What are the immune causes of glomerulonephritis?

A

SLE
Goodpastures
Vasculitis

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6
Q

What are the infectious causes of glomerulonephritis?

A

HBV
HCV
Strep
HIV

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7
Q

What drugs can cause glomerulonephritis?

A

Penicillamine

Gold (?????)

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8
Q

What investigations should be done into glomerulonephritis?

A

Blood
Urine
Imaging

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9
Q

What basic bloods should be done in glomerulonephritis?

A

FBC
U&E
ESR

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10
Q

What other bloods should be done in glomerulonephritis?

A

Complement
Antibodies
Serum protein electrophoresis and Ig
Bloods to look for infection

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11
Q

What Abs should be looked for in glomerulonephritis?

A

ANA
dsDNA
ANCA
GBM

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12
Q

What bloods should be done to look for infection in glomerulonephritis?

A

ASOT (looks for strep)

HBV and HCV serology

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13
Q

What urine testing should be done in glomerulonephritis?

A

Dipstick
Spot PCR
MCS
Bence-Jones protein

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14
Q

What imaging should be done in glomerulonephritis?

A

CXR

Renal US, with or without biopsy

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15
Q

What may be found on CXR in glomerulonephritis?

A

Infiltrates

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16
Q

Give two examples of when infiltrates may be seen on CXR in glomerulonephritis?

A

Goodpasture’s

Wegener’s

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17
Q

What is involved in the general management of glomerulonephritis?

A

Refer to nephrologist

Rx HTN aggressively, including ACEi and ARA

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18
Q

What BP should be aimed for in glomerulonephritis?

A

<130/80

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19
Q

What are the causes of asymptomatic haematuria?

A

IgA nephropathy
Thin BM disease
Alport’s syndrome

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20
Q

Who does IgA nephropathy most common present in?

A

Young males

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21
Q

How does IgA nephropathy commonly present?

A

Episodic macroscopic haematuria occuring a few days after a URTI, with rapid recovery between attacks

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22
Q

What is found on blood testing in Iga nephropathy?

A

Increased IgA

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23
Q

What can IgA nephropathy occassionally lead to?

A

Nephritic syndrome

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24
Q

What is found on biopsy in IgA nephropathy?

A

IgA deposition in mesangium

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25
How is IgA nephropathy managed?
Steroids or cyclophosphamide if decreased renal function
26
What is the prognosis of IgA nephropathy?
20% develop end-stage renal failure after 20 years
27
What is the inheritance pattern of thin BM disease?
Autosomal dominant
28
What is the risk of end-stage renal failure in thin BM disease?
Very small
29
What is the inheritance pattern of Alport's syndrome?
85% of cases are X-linked
30
How does thin BM disease present?
Persistent, asymptomatic microscopic haematuria
31
What are the features of Alport's syndrome?
Haematuria and proteinuria lead to progressive renal failure Sensorineural deafness Lens dislocation and cataracts Retinal 'flecks'
32
How does Alports syndrome present in females?
With haematuria only
33
What are the features of nephritic syndrome?
``` Haematuria and red cell casts Proteinuria Hypertension Oedema Oliguria and progressive renal impairment ```
34
Is the haematuria macroscopic or microscopic in nephritic syndrome?
Can be either
35
Where is oedema common in nephritic syndrome?
Periorbital
36
What are the causes of nephritic syndrome?
Proliferative/post-streptococcal | Crescentic/RPGN
37
Who is proliferative/post-streptococcal nephritic syndrome most common in?
Young children
38
How does proliferative/post-streptococcal nephritic syndrome present?
Malaise and nephritic syndrome with smoky urine developing 1-2 weeks after sore throat or skin infection
39
What is found on blood testing in proliferative/post-streptococcal nephritic syndrome?
``` Increased ASOT (titre for strep) Decreased C3 ```
40
What is found on biopsy in proliferative/post-streptococcal nephritic syndrome?
IgG and C3 deposition
41
How is proliferative/post-streptococcal nephritic syndrome managed?
Supportive treatment
42
What is the prognosis of proliferative/post-streptococcal nephritic syndrome?
95% of children make a full recovery, but a minority develop RPGN
43
What is the importance of crescenteric/RPGN?
It is the most aggressive form of GN, which can lead to end-stage renal failure in days
44
What are the types of RPGN?
Type 1 - Anti-GBM (Goodpasture's) Type 2 - Immune complex deposition Type 3 - Pauci immune
45
What % of cases of RPGN are type 1?
5%
46
What happens in Goodpasture's?
There are antibodies to non-collagenous domain of type 4 collagen
47
What are the features of Goodpasture's?
Haematuria and haemoptysis
48
What does the CXR show in Goodpasture's?
Infiltrates
49
How is Goodpasture's managed?
Plasmapheresis and immunosuppression
50
What % of cases of RPGN are due to immune complex deposition?
45%
51
What causes immune complex deposition RPGN?
It is a complication of anny immune complex deposition, e.g. Berger's, post-strep, endocarditis, SLE
52
What % of cases of RPGN are Pauci immune?
50%
53
What causes cANCA +ve Pauci immune RPGN?
Wegener's
54
What causes pANCA +ve Pauci immune RPGN?
Microscopic polyangiitis | Churg-Strauss
55
What are the features of nephrotic syndrome?
Proteinuria Hypoalbuminaemia Oedema
56
What is the diagnostic criteria for proteinuria in nephrotic syndrome?
PCR >300mg/mM, or 3g/24 hours
57
What is considered to be hypoalbuminaemia in nephrotic syndrome?
<35g/L
58
Where does oedema develop in nephrotic syndrome?
Periorbital Genital Ascites Peripheral
59
What is the consequence of the oedema in nephrotic syndrome?
Often intravascularly depleted, with decreased JVP
60
What are the potential complications of nephrotic syndrome?
Infection VTE Hyperlipidaemia
61
Why is there an increased risk of infection in nephrotic syndrome?
Decreased Ig | Decreased complement activity
62
What is the risk of VTE in nephrotic syndrome?
Up to 40%
63
What is the result of the risk of hyperlipidaemia in nephrotic syndrome?
You should check lipids
64
Which nephrotic syndrome patients should have a biopsy?
All adults
65
What should be done before biopsy in children with nephrotic syndrome?
Give steroids and see if they help (children mostly have minimal change glomerulonephritis)
66
What are the causes of nephrotic syndrome?
``` Minimal change glomerulonephritis Membranous nephropathy FSGS Membranoproliferative/mesangiocapillary GN Secondary to system disease ```
67
What systemic diseases might nephrotic syndrome be secondary to?
Diabetes mellitus SLE Amyloidosis
68
What kind of nephrotic syndrome is produced in diabetes mellitus?
Glomerulosclerosis
69
What kind of nephrotic syndrome is produced in SLE?
Membranous
70
What is the most common cause of nephrotic syndrome in children?
Minimal change glomerulonephritis
71
What is minimal change glomerulonephritis associated with?
URTI
72
What is found on biopsy in minimal change glomerulonephritis?
Normal light microscopy | Fusion of podocytes on electron microscopy
73
How is minimal change glomerulonephritis managed?
Steroids
74
What is the prognosis of minimal change glomerulonephritis?
1% progress to end-stage renal failure
75
What % of cases of adult nephrotic syndrome are caused by membranous nephropathy?
20-30%
76
What is membranous nephropathy associated with?
Cancer Autoimmune disease Infections Drugs
77
What cancers is membranous nephropathy associated with?
Lung Colon Breast
78
What autoimmune diseases is membranous nephropathy associated with?
SLE | Thyroid disease
79
What infections is membranous nephropathy associated with?
HBV
80
What drugs is membranous nephropathy associated with?
Penicillamine | Gold
81
What is found on biopsy in membranous nephropathy?
Subepithelial immune complex deposits
82
How is membranous nephropathy managed?
Immunosuppression if renal function declines
83
What is the prognosis of membranous nephropathy?
40% spontaneous remission
84
Which race is FSGS most common in?
Afro-Caribbeans
85
What are the categories of FSGS?
Idiopathic | Secondary
86
What might FSGS be secondary to?
Vesicoureteral reflux Berger's HIV Sickle-cell disease
87
What is found on biopsy in FSGS?
Focal scarring | IgM deposition
88
How is FSGS managed?
Steroids, or cyclophosphamide/ciclosporin
89
What is the prognosis of FSGS?
30-50% progress to end-stage renal failure
90
Can FSGS reoccur in transplants?
Yes
91
Is membranoproliferative/mesangiocapillary GN common?
No, it is rare
92
Does membranoproliferative GN cause nephritic or nephrotic syndrome?
Can be either
93
What other conditions is membranoproliferative GN associated with?
HBV HCV Endocarditis
94
What is the prognosis of membranoproliferstive GN?
50% progress to end-stage renal failure
95
What needs to be monitored in nephrotic syndrome?
U&E BP Fluid balance Weight
96
How is nephrotic syndrome managed?
Treat underlying cause | Management of symptoms and complications
97
How is oedema caused by nephrotic syndrome managed?
Salt and fluid restriction | Furosemide
98
How is proteinuria caused by nephrotic syndrome managed?
ACEi / ARA
99
How is hyperlipidaemia caused by nephrotic syndrome managed?
Statins
100
How is VTE caused by nephrotic syndrome managed?
Tinzaparin idk what this is but the notes are like 6 years old so probs just normal management now idk xo

A - MSRA Renal and Urinary [17] (17 decks)

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