Glomerulonephritis Flashcards
(82 cards)
1
Q
What?
A
Immune mediated disease of kidneys affecting glomeruli
2
Q
Types?
A
Idiopathic GN Minimal change nephropathy FSGS Membranous nephropathy IgA nephropathy RPGN
3
Q
Pathogenesis?
A
Humoral (antibody mediated)
Cell- mediated (T cells)
Inflammatory cells, mediators and complements
4
Q
What does damage to endothelial or mesangial cells lead to?
A
Proliferative lesions and red cells in urine
5
Q
What does damage to podocytes lead to?
A
Non- proliferative lesion and protein in urine
6
Q
What causes atrophy?
A
Podocyte damage
7
Q
Microalbuminuria?
A
30- 300mg albuminuria/ day
8
Q
Asymptomatic proteinuria?
A
<1g/ day
9
Q
Heavy proteinuria?
A
1-3g/ day
10
Q
Nephrotic syndrome proteinuria?
A
> 3g proteinuria/ day
11
Q
Clinical presentations of glomerulonephritis?
A
Haematuria Proteinuria Urine microscopy - RBC Red cell casts Impaired renal function Hypertension
12
Q
Nephrotic syndrome?
A
Heavy proteinuria
Hypoalbuminaemia
Fluid retention
13
Q
Nephritic syndrome?
A
Haematuria Proteinuria Fall in GFR Salt and water retention Hypertension
14
Q
Rapidly progressive glomeurlonephritis?
A
Rapid loss of renal function
ESRD within weeks/ months
15
Q
Chronic glomerulonephritis?
A
Much slower deterioration in renal function
Haematuria, proteinuria, hypertension
16
Q
Investigations?
A
Urine dipstick and microscopy Urine protein quantification GFR FBC, ESR, CRP Biochemistry Glucose Serum immunoglobulins, serum and urine protein electrophoresis Serum complement Autoantibodies HBsAg Radiology RENAL BIOPSY
17
Q
Urine dipstick and microscopy?
A
Haematuria and/ or proteinuria
Red cell casts
18
Q
Urine protein quantification?
A
24 hour urine sample or protein: creatinine ratio
19
Q
Biochemistry?
A
Renal function Electrolytes Liver function Low serum albumin in nephrotic syndrome High potassium, low bicarbonate and high phosphate in renal failure
20
Q
Autoantibodies?
A
ANA
Anti- dsDNA
ANCA
Antiglomerular basement membrane antibodies
21
Q
Nephritic syndrome (2)?
A
Acute renal failure Oliguria Oedema/ fluid retention Hypertension Haematuria Proteinuria <3g/ 24 hours
22
Q
Nephrotic syndrome?
A
Proteinuria > 3 g/day (mostly albumin, also globulins) Can be frothy urine Hypoalbuminaemia (<30) Oedema Serum albumin <25g/L
23
Q
Renal function in nephrotic syndrome?
A
Usually normal
24
Q
Most common cause of nephrotic syndrome in children?
A
Minimal change disease
25
What process is indicated in nephrotic syndrome and where is affected?
Non- proliferative process
| Affects podocytes
26
Complications of nephrotic syndrome?
```
Infections
Renal vein thrombosis
Pulmonary emboli
Volume depletion
Vit D deficiency
Subclinical hypothyroidism
```
27
Histological classifications in GN?
Proliferative/ non- proliferative
Focal/ diffuse
Global/ segmental
Crescentic
28
Treatment of nephrotic patients?
```
Fluid restriction
Salt restriction
Diuretics
ACEI/ ARB
Anticoagulation
IV albumin (if volume deplete)
Immunosuppression
```
29
What is the aim of treatment in nephrotic patients?
```
Induce sustained remission
Complete remission (proteinuria <300mg/ day)
Partial remission (proteinuria <3g/ day)
```
30
Main types of idiopathic GN ?
```
Minimal change
FSGS
Membranous
Membranoproliferative
IgA nephropathy
```
31
What is the commonest cause of nephrotic syndrome in children?
Minimal change nephropathy
32
Who gets minimal change nephropathy?
Children 2- 4
33
Renal biopsy on light microscopy and immunofluorescence in minimal change nephropathy?
Normal
| Negative IF
34
Electron microscopy in minimal change nephropathy?
Widespread fusion of epithelial cell foot processes on outside of glomerular basement membrane
35
Clinical features of minimal change nephropathy?
```
Nephrotic syndrome with selective proteinuria
normal renal function
Normal BP
Normal complement
Inc risk of infections
```
36
What is minimal change nephropathy associated with?
Atopy in children - HLA- DR7 positive
37
Treatment for minimal change nephropathy?
Oral steroids (prednisolone)
38
Second line drugs in minimal change nephropathy?
Cyclophosphamide/ CSA or ciclosporin
39
Does minimal change nephropathy cause progressive renal failure
No my breh
40
FSGS?
Focal segmental glomerulosclerosis
41
What is the commonest cause of nephrotic syndrome in adults?
FSGS
42
Renal biopsy in FSGS?
Light microscopy - minimal Ig/
| Complement deposition on
43
What may FSGS be associated with?
Haematuria
Hypertension
Impaired renal function
44
Treatment of FSGS?
4 months high dose prednisolone
| If unsuccessful -> addition of cyclophosphamide or ciclosporin
45
How many with FSGS progress to ESRF?
50%
46
Collapsing glomerulopathy?
Associated with HIV
47
2nd commonest cause of nephrotic syndrome in adults?
Membranous nephropathy
48
what occurs in membranous nephropathy?
Widespread thickening of glomerular basement membrane
49
Who is more at risk of getting membranous nephropathy?
Men
50
What may membranous nephropathy present with?
Protineuria or nephritic syndrome, hypertension
51
2nd degree causes of membranous nephropathy?
Infections (hep B/ parasites)
Connective TD (SLE)
Malignancies (carcinoma/ lymphoma)
Drugs (gold/ penicillamine)
52
Renal biopsy in membranous nephropathy?
Subepithelial immune complex deposition in basement membrane
53
What may the idiopathic form of membranous nephropathy respond to?
Alternate months of corticosteroids with chlorambucil or cyclophosphamide, or to ciclosporin
54
Appearance of membranous nephropathy?
Thick membranes
Sub- epithelial immune deposits
Silver stain -> spikes
55
Membranoproliferative/ mesangiocapillary glomerulonephritis (MCGN)?
Proliferation of mesangial cells, inc in mesangial matrix and thickening of glomerular basement membrane
56
How may MCGN present?
Nephritic or nephrotic syndrome in young adults or children
57
What is MCGN associated with?
Low levels of C3
58
Appearance of MCGN?
Big lobulated hyper cellular glomeruli with thick membranes
| Tram tracks
59
How many with MCGN develop ESRD?
~50%
60
Treatment of MCGN?
Nephrotic its with corticosteroids (no proven benefit)
61
What is IgA nephropathy?
Asymptomatic microhaematuria +/- non- nephrotic range proteinuria
Genetically abnormal IgA
62
Cause of IgA nephropathy?
Genetic
Acquired defect e.g. coeliac
Post infectious
63
Who gets IgA nephropathy?
Post infection
64
Is IgA nephropathy nephritic or nephrotic?
Nephritic
65
Appearance of IgA nephropathy?
IgA deposition in mesangium
66
Presentation of IgA nephropathy?
Macroscopic Haematuria after resp/ GI infection
67
What is IgA nephropathy associated with?
Henoch-Schonlein Purpura (HSP) (arthritis/colitis/ purpuric skin rash)
68
Renal biopsy in IgA nephropathy?
Mesangial cell proliferation and expansion on light microscopy with IgA deposits in mesangium on IF
69
Kidneys in IgA nephropathy?
AKI/ CKD
70
How many with IgA nephropathy progress to ESRF?
~25%
71
Treatment for IgA nephropathy?
BP control/ ACEI or ARB/ fish oil
72
Rapidly progressive glomerulonephritis? (RPGN)
Treatable cause of renal failure
Rapid deterioration in renal function over days/ weeks
Active urinary sediment (RBC, RBC and granular casts)
73
What may RPGN be part of?
Systemic disease
74
What is RPGN associated with?
Glomerular crescents on biopsy
75
Treatment for RPGN?
Prompt immunosuppression
Steroids (IV methylprednisolone/ oral prednisolone)
Cytotoxics (cyclophosphamide/ mycophenalate/ azathioprine)
Plasmapharesis
76
Good pastures syndrome?
Due to antibodies directed against alpha 3 chain of type IV collagen
77
What is type IV collagen a structural component of?
Glomerular basement membrane
78
What do 50% patients with good pastures have?
Pulmonary haemorrhage
79
Presentation of good pastures?
Rapidly progressive glomerulonephritis
| Usually leading to renal failure if untreated
80
Treatment of Goodpastures?
Prednisolone
Cyclophoshphamide
Plasma exchange
81
Salt losing nephropathy?
Renal loss of sodium
Leads to hyponatraemia and ECV loss
Sometimes after UTI
82
Acute tubulointerstitial nephritis?
Patient started on new drug
Symptoms of fever, rash, urine abnormalities
Prednisolone
