Glomenerulonephritis lecture notes

Question 1

What is glomerulonephritis

Answer 1

Broad term refers to group of parenchymal kidney disease (inflammation and damage to glomeruli)

Question 2

What are signs of glomerulonephritis?

Answer 2

Declining renal function

Hypertension

Haematuria
Proteinuria

Question 3

Glomerulonephritis causes 25% of ____

Answer 3

End stage kidney failure

Question 4

Glomerulonephritis is usually i______ mediated

Answer 4

immunologically

Question 5

What is deposited along the basement membrane attracting inflammatory cells? (Check this)

Answer 5

Immunoglobulins

Question 6

Signs of acute nephritic syndrome there is…

Answer 6

AKI
Haematuria
And often proteinuria
Oliguria
Hypertension
Fluid overload

Question 7

What are conditions that cause acute nephritic syndrome?

Answer 7

ANCA associated vasculitis

Goodpasture’s disease
SLE
Post-streptococcal infection
Crescentic IgA nephropathy

Question 8

R__ c___ c___ on urine microscopy indicates glomerular bleeding, always in acute nephritic syndrome

Answer 8

Red cell clasts

Question 9

What are signs of fluid retention?

Answer 9

Weight gain
Pulmonary oedema
Peripheral oedema
Raised JVP
Orthopnea
SOB
Hypertension

Question 10

What does ANCA stand for?

Answer 10

Antineutrophil cystoplasmic antibodies

Question 11

What is ANCA-AAV?

Answer 11

Anti-neutrophil cytoplasmic antibody-associated vasculitis

Group of autoimmune diseases causing inflammation of blood vessels.

All have presence of antibodies called ANCA in teh blood.

Question 12

What is a sign on the hands of ANCA-associated vasculitis?

Answer 12

splinter haemorrhages

Question 13

How do you treat ANCA-associated vasculitis?

Answer 13

Immunosuppression:
steroids
Cyclophosphamide
Rituximab
plamsa exchange

Question 14

What are 2 types of large vessel vasculitis?

Answer 14

Takayasu arteritis
Giant cell arteritis

Question 15

What are 2 types of medium vessel vasculitis?

Answer 15

Polyarteritis nodosa
Kawasaki disease

Question 16

Who is most at risk of ANCA-AAV?

Answer 16

Caucasians 50-80 y/o

Question 17

How do you diagnose ANCA?

Answer 17

Serum ANCA

Question 18

What would a biopsy of ANCA-AAV show?

Answer 18

Segmental glomerular necrosis with crescent formation.
Active lesions
Fibrosis
Tubular atrophy

Question 19

What is the most common cause of glomerulonephritis in the world?

Answer 19

IgA nephropathy

Abnormality in IgA glycosylation leads to deposition in nephron membrane (mesangium).

Question 20

How do you diagnose IgA nephropathy?

Answer 20

Biopsy:
Diffuse mesangial IgA deposits
Often will find subendothelial and subepithelial deposits

Question 21

How do you treat IgA nephropathy?

Answer 21

Supportive therapy first
Possibly steroids
Budesonide recently recommended by NICE

Question 22

What does SLE stand for?

Answer 22

Systemic Lupus Erythematosus

Question 23

What characterises SLE?

Answer 23

Serology:
Low complement levels of C3 and C4
Anti-nuclear antibody positive
Double stranded DNA antibody positive

Question 24

What are some presentations of SLE?

Answer 24

Renal impairment
Rash
Arthralgia
Neurological symptoms
Pericarditis
Pneomonitis

Question 25

What is treatment for SLE?

Answer 25

Immunosuppression Steroids Cyclophosphamide Mycophenolate Mofetil Rituximab

Question 26

Who is most at risk of SLE?

Answer 26

Females, 15-40 y/o African Americans, Afro-Carribeans, Hispanics, Asians

Question 27

What is Goodpasture's syndrome also known as?

Answer 27

Anti-glomerular basement membrane disease

Question 28

What is the serology in Goodpasture syndrome?

Answer 28

Anti-glomerular basement membrane antibodies

Question 29

What is haemoptysis?

Answer 29

Coughing up blood

Question 30

How do you treat Goodpasture syndrome?

Answer 30

Remove antibody by plasma exchange whilst using immunosuppression via steroids. Aggressive treatment, not best outcome.

Question 31

What is the systemic form of IgA nephropathy called?

Answer 31

Henoch Schonlein purpura?

Question 32

What is the characteristic triad of Henoch Schonlein purpura?

Answer 32

Purpuric rash, abdominal pain, AKI

Question 33

Henoch Schonlein purpura is often s___ l____ but 1/3 wrelapse with some progressing to CKD

Answer 33

self-limiting

Question 34

How do you treat Henoch Schonlein purpura?

Answer 34

Supportive Steroids

Question 35

What is the presentation triad for glomerulonephritis nephrotic syndrome?

Answer 35

Heavy proteinuria Hypoalbuminaemia Oedema

Question 36

What are primary causes of nephrotic syndrome?

Answer 36

Minimal change (children and adults) Membranous (Caucasian adults) Focal Segmental Glomerulosclerosis

Question 36

How do you establish the cause for nephrotic syndrome?

Answer 36

Renal biopsy

Question 37

What are secondary causes of nephrotic syndrome?

Answer 37

Diabetes Amyloid Infections SLE Drugs malignancy

Question 38

What other investigations would be taken for nephrotic syndrome?

Answer 38

Serum albumin, creatinine, lipids and glucose, urinalysis PCR Serum and urine electrophoresis: amyloid, myeloma lupus markers (C3,C4, ANA, dsDNA Ab) Hep B or Hep C antibodies (membranous) Anti-phospholipase A2 receptor antibody

Question 39

What are supportive treatments for nephrotic syndrome?

Answer 39

Control fluid state: diuretics, ACEi/ARBs, spironolactone Statins Anticoagulation (lose coagulation factors) Possibly prophylactic antibiotics

Question 40

Membranous nephropathy is thickening of the glomerular c____ wall with IgG complement deposits in sub-epithelial surface causing leaky glomerulus

Answer 40

capillary

Question 41

What can be used for higher risk membranous nephropathy?

Answer 41

Steroids

Question 42

Why is it called minimal change disease?

Answer 42

Biopsy appears normal on light microscop

Question 43

What does minimal change disease show on electron microscopy?

Answer 43

Fused podocytes

Question 44

How do you treat minimal change disease?

Answer 44

Steroids Second line = tacrolimus, cyclosporin, cyclophospharmide or rituximab

Question 45

Would you take a biopsy if incidentally found haematuria on dipstick?

Answer 45

No unless there signs of impaired kidney function or significant proteinuria

Question 46

What can cause asymptomatic urinary abnormalities?

Answer 46

Type IV collagen variants, inherited. IgA Thin membrane disease

Question 47

What are some causes of CKD?

Answer 47

IgA nephropathy Membranous Diabetes Mesangiocapillary GN HIV associated nephropathy Alports