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Glomerulonephritis Flashcards

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1
Q

What is Glomerulonephritis

A

Inflammation of Glomerulus

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2
Q

Glomerulonephritis is responsible for how much end stage kidney disease

A

15%

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3
Q

Glomerulonephritis classified based on

A

kidney biopsy findings

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4
Q

Glomerulonephritis features

A

Haematuria
Proteinuria
Hypertension
Renal Impairment

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5
Q

Nephritic State

A

Active Urine Sediment: Haematuria, Dysmorphic RBCS, Cellular Casts
Hypertension
Renal Impairment

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6
Q

Nephrotic Syndrome Features (4)

A

Oedema
Nephrotic Range Proteinuria >3.5g/day or 350mg/mmol creatinine
Hypoalbuminaemia: Serum Albumin <35g/L
Dyslipidaemia

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7
Q

What is nephrotic range of proteinuria

A

> 3.5g/day or 350mg/mmol creatinine

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8
Q

Hypoalbuminemia is classified as

A

Serum Albumin <35g/L

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9
Q

Proliferative Glomerulonephritis classified as

A

Excessive numbers of cells in glomeruli. These include infiltrating leucocytes

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10
Q

Non Proliferative Glomerulonephritis classified as

A

Glomeruli look normal or have areas of scarring. They have normal numbers of cells

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11
Q

Which diseases classified as Non Proliferative Nephrotic Glomerulonephritis

A

Minimal Change Disease
Membranous Neuropathy
FSGS

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12
Q

Which diseases classified as Proliferative Nephrotic Glomerulonephritis

A

IgA Nephropathy

Lupus Neuprhtis

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13
Q

Which diseases classified as Proliferative Nephritic Glomerulonephritis

A

Post Infectious GN

ANCA Associated GN

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14
Q

Commonest cause of Glomerulonephritis

A

IgA Nephropathy

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15
Q

IgA Nephropathy characterised by

A

IgA deposition in the mesangium and mesangial proliferation.

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16
Q

IgA Nephropathy most common in

A

2nd and 3rd decade of life with males more commonly affected.

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17
Q

IgA Nephropathy can progress to

A

end stage kidney disease or halving eGFR at 10 years

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18
Q

Presentation of IgA Nephropathy

A

Microscopic haematuria.
Micoscopic haematuria + proteinuria
Nephrotic syndrome
IgA crescentic glomerulonephritis

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19
Q

Post Streptoccal Glomerulonephritis follows

A

10-21 days after throat or skin infection

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20
Q

Post Streptoccal Glomerulonephritis commonly associated with

A

Lancefield Group A Streptocci

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21
Q

Post Streptoccal Glomerulonephritis genetic predisposition

A

HLA-DR, -DP, -DP.

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22
Q

Anti GBM Disease characterised by

A

Circulating Anti GBM

Related to Crescentic Glomerulonephritis

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23
Q

Anti GBM Disease Presentation

A

Nephritis (anti-GBM glomerulonephritis)

Nephritis+ lung haemorrhage (Goodpasture’s syndrome).

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24
Q

Anti GBM Disease Peaks

A

Two peaks: 3rd decade and 6th/7th decade.

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25
Anti GBM Disease Diagnosis
demonstrating anti-GBM antibodies in serum and kidney
26
Anti GBM Disease Treatment
aggressive immunesuppression: steroid, plasma exchange, and cyclophosphamide.
27
How does Proliferative Glomerulonephritis present
with nephritic state | Haematuria + variable proteinuria + hypertension +/- renal impairment
28
Proliferative Glomerulonephritis can cause
rapid decline needing dialysis
29
To save nephrons in Proliferative Glomerulonephritis diagnosis
Clinical suspicion + immunology screen + renal biopsy
30
Nephrotic Syndrome Management
Treat oedema: salt and fluid restriction and loop diuretics. Hypertension: use Renin-Angiotensin-Aldosterone-blockade. Reduce risk of thrombosis: Heparin or Warfarin. Reduce risk of infection e.g. pneumococcal vaccine. Treat dyslipidemia e.g. statins.
31
Minimal Change Disease features
Commonest form in children. Sudden onset of oedema – days. Remission with steroids (often). Relapse occurs in two thirds of patients.
32
Minimal Change Disease Treatment
Prednisolone – 1mg/kg for up to 16 weeks. Once remission achieved , slow taper over 6 months. Initial relapse treated with further steroid course. ``` Subsequent relapses treated with Cyclophosphamide Cyclosporin Tacrolimus Mycophenolate mofetil Rituximab ```
33
How to treat relapses of minimal change disease
``` Cyclophosphamide Cyclosporin Tacrolimus Mycophenolate mofetil Rituximab ```
34
How does Focal and Segmental Glomerulonephritis present
Nephrotic Syndrome
35
Pathology of Focal and Segmental Glomerulonephritis
tip lesion, collapsing, cellular, perihilar, and not otherwise specified.
36
Focal and Segmental Glomerulonephritis has high chance of
end stage kidney disease
37
Focal and Segmental Glomerulonephritis treatment
Cyclosporin or Cyclophosphamide or Rituximab
38
Commonest cause of Nephrotic Syndrome in Adults
Membranous Nephropathy
39
Serology Markers in Nephrotic Syndrome
Anti-phospholipase A2 receptor (PLA2R) antibody Thrombospondin type 1 domain containing 7A
40
Secondary causes of Nephrotic Syndrome
Malignancies SLE Rheumatoid arthritis. Drugs: NSAIDs, gold, penicillamine.
41
Membranous Nephropathy Treatment
General measures for at least 6 months. Immunesuppression if symptomatic nephrotic syndrome, rising proteinuria or deteriorating renal function. Cyclophosphamide and steroids (alternate months) for 6 months. Tacrolimus. Rituximab.
42
Prognosis for Membranous Nephropathy good for patients whose
proteinuria resolves
43
Membranous Nephropathy can recur in
Renal Transplant
44
Non Proliferative Glomeuleonphritis presents with
Nephrotic Syndrome
45
Key diagnosis in Non Proliferative Glomeuleonphritis
Renal Biopsy
46
What tubule comes off glomerulus
proximal
47
Blood enters glomerulus via
afferent arteriole
48
All proteins equal to or larger than albumin including immunoglobulins where will they go in glomerulus
stay in plasma will not be filtered
49
Filter barrier in glomerulus contains what 3 things
Endothelial cell cytoplasm basal lamina podocyte
50
basal lamina is what type of tissue
connective
51
filtrate goes into where before proximal tubule
bowmen space
52
blood cells and unfiltered proteins exit glomerulus via
efferent arteriole
53
Diabetic Glomerulus disease has no what deposition
immunoglobulin
54
Glomerulonephtis common presentation
Haematuria Heavy Proteinuria (Nephrotic Syndrome) Slowly increasing Proteinuria Acute Renal Failure
55
Haematuria main causes
UTI Urinary Tract Stone Urinary Tract Tumour Glomerulonephritis
56
IgA in Iga Nephropathy stains
green
57
Which Immunoglobin and Complement component are in all mesangial area of al glomeruli
IgA and C3
58
Does IgA get filtered into urine in IgA Nephropathy
No it gets stuck in mesangium
59
What gets clogged with antibody in glomerulonephritis
Mesangium and not filter membrane
60
what happens to glomerulus basement membrane in membranous glomerulonephritis
it gets thickened
61
What immunoglobulin is deposited in membranous glomerulonephritis
IgG it gets stuck between basal lamina and podocyte and not filtered into urine
62
In normal glomerulular basement membrane what happens to antibody and albumin
stay in plasma and not filtered
63
What happens when IgG activates complement C3
it punches holes in filter allowing albumin to be filtered into urine causing nephrotic syndrome
64
which immunoglobulin is too big to be filtered into urine
IgG
65
what percentage of those with membranous glomerulonephritis get chronic renal failure within 10 years
1/4
66
What are the adhesions to bowmen capsules in diabetic nephropathy
glomerulus attempt to stop leak of albumin into urine
67
what is the thickened capillary wall leaking in diabetic nephropathy
albumin
68
what compresses capillaries in diabetic neprhopathy
increased mesangial matrix
69
what reduces blood flow to glomerulus in diabetic nephropathy
arterioles being thick and narrow
70
what are the nodules of mesangial matrix called in diabetic nephropathy
Kimmelsteil Wilson Lesion
71
Causes of Crescentic Glomerulonephritis
Granulomatosis with Polyangitis (Wegener) Microscopic Polyarteritis Antiglomerular Basement Membrane Disease
72
Granulomatosis with Polyangitis affects
Vasculitis which affects kidneys, nose and lungs
73
Serum tests in wegerers shows
presence of anti neutrophil cytoplasmic antibodies (ANCA)
74
ANCA are not deposited where
in kidney
75
ANCA are directed against what in glomerular disease
proteinase 3 and myeloperoxidase
76
If Wegener's (Granulomatosis with Polyangitis) is left untreated what happens
Fatal
77
By giving Cyclophosphamide for Wegener Granulomatosis with Polyangitis) what happens?
75% complete remission

Systems 2nd Year Renal (30 decks)

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