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Glomerular disease Flashcards

(36 cards)

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1
Q

Define glomerulonephritis

A
  • Group of disease due to damage to the glomeruli

- Many are due to inflammatory changes in the glomerular capillaries and basement membrane (but not all)

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2
Q

Types of presentations with glomerular disease

A
  1. Asymptomatic urinary abnormalities
    - haematuria
    - proteinuria
  2. Nephritic syndrome
  3. Nephrotic syndrome
  4. ESRD
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3
Q

What does the term diffuse mean in terms of renal pathology

A

Majority of glomeruli are abnormal

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4
Q

What does the term focal mean in terms of renal pathology

A

Some of the glomeruli are abnormal

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5
Q

What does the term global mean in terms of renal pathology

A

The entire glomerulus is involved

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6
Q

What does the term segmental mean in terms of renal pathology

A

Only part of the glomerulus is abnormal

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7
Q

What does the term proliferation mean in terms of renal pathology

A

Hyperplasia of one of the glomerular cell types: mesangial, endothelial, parietal epithelial, with or without inflammatory cell infiltration

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8
Q

What does the term ‘membranous changes’ mean in terms of renal pathology

A

Capillary wall thickening due to immune deposits or alterations in basement membrane

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9
Q

What does the term ‘crescent formation’ mean in terms of renal pathology

A

Parietal epithelial cell proliferation and mononuclear cell infiltration form crescent-shape in Bowman’s space

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10
Q

Define nephrotic syndrome

A

Group of disorders classified by (HELP)

1. Hypoalbuminaemia <25g/L
2. Edema
3. Lipid abnormalities - hyperlipidaemia
4. Proteinuria >3g/24H

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11
Q

Classification and aetiology of nephrotic syndrome

A

Primary

  1. Minimal change disease
  2. Focal segmental glomerulosclerosis
  3. Membraneous glomerulopathy
  4. Membranoproliferative GN

Secondary

  1. Diabetes
  2. Amyloid
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12
Q

Top 3 primary and secondary causes of nephrotic syndrome in adults

A

Primary

  1. Membranous nephropathy
  2. Focal segmental glomerulosclerosis
  3. Minimal change
  4. IgA

Secondary

  1. Diabetic
  2. SLE
  3. Amyloidosis
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13
Q

Top 3 causes of nephrotic syndrome in children

A

Primary

  1. Minimal change (77%)
  2. Focal segmental glomerlucosclerosis
  3. Membranoproliferative GN

Secondary

  1. SLE
  2. HSP
  3. Lymphoma
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14
Q

Epidemiology of nephrotic syndrome

A
  1. Most common cause adults = membranous nephropathy + diabetic nephropathy
  2. Most common cause in young adults = FSGS
  3. Adult males = primary glomerular most common (55%)
  4. Adult female = secondary glomerular (725)
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15
Q

Hx of nephrotic syndrome

A
  1. New onset oedema
    - initially periorbital or peripheral
    - later genital, ascites, anasarca
  2. Frothy urine
  3. General:
    - lethargy
    - fatigue
    - reduced appetite
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16
Q

Define nephritic syndrome

Study These Flashcards
A

Group of disorders classified by HOPAH

  1. Haematuria / RBC casts
  2. Oligouria
  3. Proteinuria
  4. Azotaemia
  5. Hypertension (mild)
17
Q

Hx of nephritic syndrome

Study These Flashcards
A
  1. Cola coloured urine
  2. Flank pain
  3. Generalised systemic Sx
  4. Post infections = 2-3 post strep-throat /URTI
18
Q

Aetiology of nephritic syndrome

Study These Flashcards
A

Primary

  1. Post-infectious GN
  2. IgA nephropahy (Bergers) / HSP
  3. Rapidly progressive GN (aka crescentic GN)
  4. Proliferative GN

Secondary

  1. SLE
  2. Vasculitis
19
Q

Hx of nephritic syndrome

Study These Flashcards
A
  1. Cola coloured urine
  2. Flank pain
  3. Generalised systemic Sx
  4. Post infections = 2-3 post strep-throat /URTI
20
Q

Define membranous nephropathy

Study These Flashcards
A
  • Thickening of basement membrane due to sub epithelial immune deposits (IgG, C3) without associated cellular proliferation or infiltration
  • male 1 : 1 female
21
Q

Aetiology of membranous nephropathy

Study These Flashcards
A
  • Usually idiopathic
  • Can be secondary to:
    1. Infections: hepB, syphilis
    2. Autoimmune disease: SLE, RA, thyroid
    3. Malignant
    4. adverse drug reactions: gold etc.
22
Q

Hx / PE of membranous nephropathy

Study These Flashcards
A
  1. Oedema
  2. Weight gain
  3. Fatigue

PE

  1. +/- hypertension
  2. Urine dipstick: heavy proteinuria
23
Q

Ix of membranous nephropathy

Study These Flashcards
A
  1. CBE:
  2. EUC: incr creatinine
  3. LFT + albumin: hypoalbuminaemia
  4. Lipid profile
  5. Complement: C3, C4
  6. Renal biopsy
24
Q

Findings on renal biopsy in membranous nephropathy

Study These Flashcards
A

Light microscopy
1. Thickened GBM with little or no cellular proliferation or infiltration

Electron microscopy

  1. Electron dense deposits across the GBM and in subepithelial space
  2. Foot process effacement

Immunoflourescence:
1. Diffuse, granular, IgG + C3 deposition

25
Tx of membranous nephropathy
Supportive 1. Adequate protein intake 2. Sodium restriction ``` Medications 1. Antihypertensives: ACEi to reduce proteinuria Immunosupressive (if severe) 1. Steroids 2. Cyclophosphamide or chlorambucil ```
26
Complications of membranous nephropathy
1. Risk of renal vein thrombosis 2. Hypertension 3. Chronic renal failure 4. Hypercoagulable states
27
Define focal segmental glomerulosclerosis
Histological pattern of kidney injury characterised by podocyte injury and glomerular scarring that results in proteinuria and progressive kidney disease
28
Aetiology of FSGS
Primary 1. Idiopathic (80%) - hypothesised to be d.t. circulating permeability factor of unknown origin Secondary 1. Genetic mutations 2. Vital infection: HIV, parvovirus, CMV, EBV 3. Drug effects: NSAIDs 4. Reflux nephropathy 5. Massive obesity
29
Hx/PE
1. +/- oedema (no hypoalbuminaemia) PE 1. HTN 2. Urine dipstick: proteinuria +++
30
Ix of FSGS
1. LFTs: + albumin - no hypoalbuminemia 2. Urinalysis: heavy proteinuria microhaematuria 3. Renal biopsy
31
Pathophysiology of hypoalbuminaemia in minimal change and membranous glomerulonephritis
Release of cytokines TNF + ILN1 --> suppression of hepatic albumin secretion --> decr. albumin
32
Findings on renal biopsy in FSGS
Light microscopy 1. Focal (some glomeruli), segmental (part of glomerular tuft) mesangial collapse & sclerosis 2. Peripheral hyalinosis Electron microscopy 1. Podocyte injury / effacement Immunoflourescence: 1. IgM + C3
33
Tx of FSGS
If they have nephrotic syndrome: Idiopathic 1. ACEi or ARBs 2. Dietary sodium restriction 3. Corticosteroids 4. Immunosuppressive: cyclosporin or tacrolimus (calcineurin inhibitors) Secondary 1. ACEi or ARBs 2. Dietary sodium restriction
34
Findings on renal biopsy in diabetic nephropathy
Light microscopy 1. Diffuse increase in mesangial matrix 2. Sclerotic mesangial nodules 3. Fibrin cap (peripheral hyalinosis) 4. Hyaline arteriolosclerosis of the afferent and efferent arterioles Electron microscopy 1. Podocyte foot process effacement 2. Uniformly thick glomerular basement membrane 3. Expanded mesangial matrix Immunoflourescence: 1. IgG, IgM + C3 in sclerosed glomerular segments
35
Most common cause of nephritic syndrome in adults
IgA nephropathy
36
Most common cause of nephritis syndrome in children
Post-streptococcal glomerulonephritis

Renal/urology (4 decks)

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