Glomerulonephritis Flashcards

(35 cards)

1
Q

What is glomerulonephritis (GN) (a.k.a. nephritic syndrome)?

A

Glomerular injury

Applies to a group of disease that are generally, but not always, characterised by inflammatory changes in the glomerular capillaries and the glomerular basement membrane (GBM)

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2
Q

What diseases are included in GN?

A
  • membranous GN
  • minimal change disease
  • focal segmental glomerulosclerosis
  • IgA nephropathy
  • forms of rapidly progressive GN (vasculitis and anti-GBM disease a.k.a., Good Pastures|)
  • lupus nephritis (due to SLE)
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3
Q

Which countries is IgA nephropathy most common in?

A

Developed

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4
Q

Does IgA nephropathy present more in younger or older patients?

A

Presents at any age

Peaks in 2nd and 3rd decade

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5
Q

Which ethnicity is at increased risk of IgA nephropathy?

A

East Asians/Chinese

Caucasians

Rare in African and Caribbean groups

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6
Q

What % of people with IgA nephropathy present with visible haematuria with an URTI (synpharingitic haematuria)?

A

40-50%

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7
Q

What % of people with IgA nephropathy present with dipstick abnormalities detected at routine medical checks?

A

20-30%

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8
Q

What % of people with IgA nephropathy present with rapidly progressive GN (i.e., nephritic syndrome)?

A

10%

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9
Q

What % of IgA nephropathy is familial?

A

10%

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10
Q

What condition causes nephritic syndrome in younger patients?

A

HSP

Can also present with:
- rash
- arthralgia
- abdominal pain +/- bloody diarrhoea
- renal disease

Looks like IgA on biopsy - hence called IgA vasculitis

Age > 8 at presentation more likely to develop renal involvement

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11
Q

What does minimal change disease (MCD) typically present as?

A

Nephrotic syndrome

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12
Q

What % of children and what % of adults with nephrotic syndrome have MCD?

A

90% children

10% adults

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13
Q

What is the onset of MCD?

A

Rapid

Occurs in days to 1-2 weeks

Large urinary protein losses

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14
Q

Is MCD mainly primary or secondary?

A

Mainly primary

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15
Q

Name some secondary causes of MCD?

A

NSAIDs

Cancer

Drugs

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16
Q

How is renal function affected by MCD?

A

Usually normal

17
Q

What does focal segmental glomerular sclerosis (FSGS) present as?

A

Nephrotic syndrome

18
Q

What % of people with FSGS also have haematuria?

19
Q

Name some causes of secondary FSGS?

A

Obesity

HIV

Heroin

Reduced nephron mass

20
Q

Which type of FSGS can be acute?

A

Primary

(secondary = sub-acute)

21
Q

What Tx can primary FSGS respond to?

A

Steroids

Tacrolimus

22
Q

What % people with membranous nephropathy present with nephrotic syndrome?

23
Q

Which racial group does membranous nephropathy affect?

24
Q

Which gender does membranous nephropathy affect more?

A

Male more than females

25
Which antibody is associated with membranous nephropathy?
PLA2R antibody
26
What % of membranous nephropathy cases are primary?
75%
27
Name some causes of secondary membranous nephropathy
NSAIDs Malignancy Hepatitis B Gold Penicillamine
28
What is the Tx for membranous nephropathy?
Lifestyle - low-salt and low-protein diet Medications - ACEis/A2RBs - statin - furosemide +/- hydrochlorothiazide - corticosteroid + cytotoxic or immunosuppressive therapy e.g., tacrolimus - treatment of underlying cause
29
What causes lupus nephritis?
SLE
30
What is SLE?
Autoimmune condition Can be ANA +ve Relapses and remissions
31
Which gender and ethnicity is SLE more common in?
Women South-East Asian
32
What % of SLE cases have renal involvement?
50%
33
Which other symptoms can present in SLE?
A multi-system disease - arthritis/arthralgia - fatigue - photosensitive skin rash - butterfly rash and red patches - heart - lungs = pleuritis, pneumonitis, PE, pulmonary haemorrhage - GI = mouth and nose ulcers, severe abdo pain - haem = anaemia, high BP - TED - neuropsychiatric - eyes - spleen - bones
34
What investigations can be done in GN?
Baseline bloods - U&Es - eGFR - LFTs - lipid profile - bone - TFTs - FBC - clotting screen Virology - hep B, C - HIV Cryoglobulin (abnormal proteins in blood causing it to clump together at temperatures below 37) Immunoglobulins Serum Protein Electrophoresis Serum Free light chains C3/C4 ANA anti-dsDNA 24 hour urine or nowadays UPCR Renal USS Renal biopsy Podocin/nephrin sequence analysis PLA2R antibody Blood sugars
35
Sources
https://bestpractice.bmj.com/topics/en-gb/941/treatment-algorithm#patientGroup-0-0 https://bestpractice.bmj.com/topics/en-gb/207 https://bestpractice.bmj.com/patient-leaflets/en-gb/html/3000007/Glomerulonephritis BSMS Year 3 Intrinsic Renal disease 03.04.2020 lecture