Glomerulonephritis Flashcards
(39 cards)
What is meant by Nephritis?
Inflammation of the kidneys
What is Nephritic syndrome?
A group of symptoms, NOT a diagnosis, it simply means there is a clinical picture of having inflammation of their kidney
No set criteria
List 4 features of Nephritic syndrome
- Haematuria (microscopic or macroscopic)
- Oliguria
- Proteinuria < than 3g/24 hours (any more = nephrotic syndrome)
- Fluid retention
What is Nephrotic syndrome?
Refers to a group of symptoms without specifying the underlying cause
Has a set criteria
What 4 criteria comprise Nephrotic syndrome
- Peripheral oedema
- Proteinuria > 3g/24 hrs
- Serum albumin < 25g / L
- Hypercholesterolaemia
What is Glomerulonephritis?
An umbrella term for conditions that cause inflammation of or around the glomerulus and nephron
List 4 types of Glomerulonephritis
- Post streptococcal GN → self limiting disease with good prognosis
- Membranoproliferative GN
- IgA Nephropathy → most common biopsy diagnosis
- Rapidly Progressive GN (2) → most common biopsy diagnosis
What is Interstitial nephritis?
Term to describe a situation where there is inflammation of the space between cells and tubules (the interstitium) within the kidney
NOT the same as glomerulonephritis
What is Glomerulosclerosis?
The pathological process of scarring of the tissue in the glomerulus
NOT a diagnosis in itself, more a term to describe damage and scarring by other diagnoses
Most treatment of glomerulonephritis are what?
usually immunosuppression based
When/how does Post streptococcal GN (PSGN) occur?
1 – 3 weeks after a β-haemolytic streptococcus infection,
ie. tonsillitis by Streptococcus pyogenes
Pathogenesis of PSGN
Immune complex (IgG, IgM and C3) deposition in the glomeruli
Leads to an acute deterioration in renal function, causing AKI
Light microscopy changes of PSGN
Diffuse proliferative glomerulonephritis with prominent endocapillary proliferation with neutrophils
In what clinical scenario would we have a high suspicion of PSGN
Evidence of recent tonsillitis caused by streptococcus.
ie. history of tonsillitis, (+) throat swab results, anti-streptolysin antibody titres on blood test
Clinical presentation of PSGN?
Can range from asymptomatic microscopic haematuria to nephritic syndrome
Blood findings of PSGN?
- low C3
- raised ASO titre
Management of PSGN
Management is supportive, ~80% make a full recovery
- Antibiotics
- Antihypertensives and diuretics for complications ie. HTN and oedema
What is Membranoproliferative glomerulonephritis (MPGN)?
A pattern of glomerular injury on kidney biopsy with characteristic light microscopic changes:
- hypercellularity
- thickening of GBM
Histological lesion are a not specific disease, need exploration of cause
Pathogenesis of MPGN
Thickened GMB:
- deposition of immune complexes and/or complement factors
- Interposition of mesangial cells and other cellular elements between GBM and endothelial cell
- new basement membrane formation
Hypercellularity:
- Proliferation of mesangial cells and influx of circulating monocytes
- Leads to lobular appearance of glomerular tuft
Classification of MPGN? (2)
- Types I, II, III - based on EM findings
2.
- Immune complex mediated (Infections ie. Hep B&C, SLE)
- Complement mediated
- Not related to immune complexes or complements
Treatment and prognosis of MPGN
- Treat cause if found – infections, Myeloma etc
- Immunosuppression with aggressive disease
- Can recur after kidney transplantation
IgA Nephropathy is also known as what?
Berger’s disease
What condition is related to IgA Nephropathy?
Henoch-Schonlein Purpura (which is an IgA vasculitis)
Pathogenesis of IgA Nephropathy
IgA deposits in nephrons of the kidney and causes inflammation (nephritis)
