Glomerulonephritis Flashcards

1
Q

What is glomerulonephritis?

A

immunologically mediated inflammation of the renal glomeruli
Many different types with different aetiologies

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2
Q

Describe the aetiology of glomerulonephritis

A

Some types caused by deposition of antibody-antigen complexes in glomeruli: causes inflammation + complement activation.
Antigens to which antibodies are produced are UNKNOWN
Causes are usually considered primary (idiopathic) or secondary (to infection, AI, malignancy) + tend to present with similar syndromes

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3
Q

Describe the epidemiology of glomerulonephritis

A

25% of chronic renal failure cases

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4
Q

List 3 presenting features of glomerulonephritis

A

Polyuria or oliguria
Hx of recent infection (fever, sore throat, abdo pain)
Sx of uraemia or renal failure (acute + chronic)

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5
Q

List 5 signs of glomerulonephritis

A
HTN
Proteinuria  
Haematuria (esp. in IgA nephropathy) 
Renal failure  
Nephrotic syndrome or Nephritic syndrome
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6
Q

What triad characterises nephrotic syndrome?

A

Proteinuria > 3.5 g/24 hrs
Low serum albumin < 24 g/L
Oedema

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7
Q

What is nephritic syndrome?

A

Pores in podocytes are large enough to allow protein + RBCs to pass into urine
May also be red cell casts in the urine: indicative of glomerular damage
Other features:
Proteinuria
HTN
Low urine output (due to decreased renal function)

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8
Q

How can nephrotic syndrome lead to hyperlipidaemia?

A

due to the hypoalbuminaema, the liver tries to compensate + increases production of lipids, causing hyperlipidaemia

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9
Q

What bloods are tested in glomerulonephritis?

A

FBC: normocytic, normochromic anaemia
U+Es + creatinine (GFR is more accurate than serum creatinine alone)
LFTs (check albumin + whether liver enzymes are elvevated)
Lipid profile (for hyperlipidaemia)
Complement studies
Antibodies

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10
Q

What antibodies are checked for in glomerulonephritis?

A
ANA (SLE)
Anti-dsDNA (SLE)
ANCA 
Anti-GBM antibody 
Cryoglobulins
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11
Q

What tests are used to investigate urine in glomerulonephritis?

A

Microscopy: check for red cell casts

24 hr collection: creatinine clearance + protein

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12
Q

What other investigations are performed in glomerulonephritis?

A

Renal tract US to exclude other pathology (e.g. obstruction)
Renal Biopsy: For microscopy + determines sub-type
Ix for associated conditions (e.g. HBV, HCV + HIV serology)

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13
Q

List types of glomerulonephritis

A

Minimal-change Glomerulonephritis
Membranous Glomerulonephritis
Membranoproliferative Glomerulonephritis (MPGN)
Focal segmental glomerulosclerosis
Focal segmental proliferative glomerulonephritis
Diffuse proliferative glomerulonephritis
Crescentic Glomerulonephritis
Focal Segmental Necrotising Glomerulonephritis

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14
Q

Describe Minimal-change Glomerulonephritis

A

Light microscopy: minimal change

Electron microscopy: loss of epithelial foot process

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15
Q

What may the antigens to which the antibodies are produced against associated with?

A

Bacteria (e.g. Strep. viridans, Staphylococci)
Viruses (e.g. HBV, HCB, measles, mumps, EBV)
Protozoal (e.g. Plasmodium malariae, schistosomiasis)
Inflammatory diseases (e.g. SLE, vasculitis, cryoglobulinaemia)
Drugs (e.g. gold, penicillinamine)
Metabolic disorders (e.g. DM, HT, thytoiditis)
Deposition diseases (e.g. amyloidosis)
Malignancy/Tumour

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16
Q

How do patients with glomerulonephritis present?

A

Patients present with specific syndromes: either NEPHROTIC or NEPHRITIC

17
Q

What is nephrotic syndrome?

A

increased permeability of the glomerulus leading to loss of proteins into the tubules
LOSS OF A LOT OF PROTEIN

18
Q

List 5 symptoms caused by general vasculitic effects in glomerulonephritis

A
Anorexia
Nausea
Malaise
Skin rash (purpura)
Arthralgia
19
Q

What triad characterises nephritic syndrome?

A

Haematuria
Proteinuria
HTN

20
Q

What is good pastures syndrome? Give 3 features

A

Crescentic Glomerulonephritis with anti-glomerular basement membrane antibodies + anti-alveolar membrane antibodies
Glomerulonephritis, pulmonary haemorrhage + haemoptysis