Glomerulonephritis Flashcards Preview

Renal and Urology > Glomerulonephritis > Flashcards

Flashcards in Glomerulonephritis Deck (49):
1

What two things do mesangial cells do

Smooth muscle- Vasocontrictor to limit blood flow to glomerulus and decrease GFR
Immune cells (monocytes)

2

What leads to a proliferative lesion

damage to endothelial or mesangial cells

3

What results from proliferative lesions

red cells in the urine

4

What leads to a non proliferative lsiosn

damage to podocytes

5

What results from damage to podocytes

protein in urine

6

what type of haematuria is more common in GN

microscopic
macroscopic more common with urinary tract pathology
if it is macroscopic - often looks smokey or like coca cola

7

What does heavy proteinuria urin look like

frothy - usually present with 1g or more of protein

8

How can you tell if the bleeding is coming from the kidney itself rather than further down the tract

dysmorphic red cells - glomerular bleeding due to squezzing through gaps

9

What are red cell cast usually a sign of

a nephritic syndrome

10

what is nephritic sydroem

acute renal failure
usually produce less urine

11

What is nephrotic syndrome

Heave protein leak which is mostly albumin
Triad- oedema, proteinurea, hypoalbuminaemia
usually normal urine function

12

What are the complicaions of nephrotic syndrome

infections
renal vein thrombosis
PE
volume depletion
Vit D deficiency
subclinical hypothyroidism - due to loosing albumin

13

What is the commonest cause of nephrotic syndrome in children

minimal change

14

What it the commonest cause of nephrotic syndrome in adults

focal segmental glomerulosclerosis

15

What is glomerulonephritis

immune mediated disease of the kidneys affecting the glomeruli

16

describe the different processes which lead to nephrotic vs nephritic syndrome

nephritic = damage to endothelial or mesangial cells lead to proliferative lesion and blood in urine

nephrotic = damage to podocytes leads to non proliferative lesions and protein in urine

17

what level of proteinuria would be classified as 'nephrotic' syndrome

more than 3 grams per day

18

describe the nephritic syndrome

characteised by acute renal failure, oliguria, hypertension and haematuria

there may also be oedema and fluid retention

19

which cell is affected in nephritic syndrome

endothelial cells

20

decribe the nephrotic syndrome

proteinuria more than 3g/day
hypoalbuminaemia
oedema
hypercholesterolaemia

usually normal renal function

21

what cells are affected by the nephrotic syndrome

podocytes

22

what are the complications of nephrotic syndrome

infection - due to loss of antibodies
RENAL VEIN THROMBOSIS
pulmonary emboli
volume depletion - may lead to AKI

vit D deficiency
subclinical hypothyroidim,

23

Give the nephritic syndromes we need to know

IgA nephropathy
Rapidly progressive aka cresenteric glomerulonephritis

24

Give the nephrotic syndromes we need to know about

Minimal change
Focal segmental glomerulosclerosis
Membranous

25

Give the nephritic/nephrotic syndromes we need to know

Diffuse proliferative i.e post strep GN
Membranoproliferative

26

Key points about minimal change nephropathy

commonest cause of nephrotic syndrome in CHILDREN
idiopathic generally
90 percent remission with oral steroids
some have relapses
does not cause progressive renal failure

it is T cell and cytokine mediated damage to BM

27

treatment of minimal change nephropathy

oral steroids
cyclophosphamide is 2 line

28

commenest cause of nephrotic syndrome in adults

focal segmental glomerulosclerosis

29

cause of FSGS

idiopathic
or secondary to HIV, heroin, obesity

30

prognosis of FSGS

50 percent progress to ESRF after 10 years

31

2nd most common cause of nephriotic syndrome in adults

membranous

32

causes of membranous nepthropathy

infection - hep B or parasties
connective tissue disease - lupus
malignancy
drugs - gold/penacillamine

33

treatment of membranous

steroids
alkylating agenst
b cell monoclonal antibodies

34

prognosis of membranous Gn

30 percent progress to ESRF in 10 yrs

35

antibody in membranous nephropathy

anti PLA2r antibody

36

what is the commenest GN worldwide

IgA nephropathy

37

clinical features of IgA nephropathy

nephrtic syndrome - haematura and non nephrtoic range proetinuria

AKI
typically symptoms occur after a resp or GI infection

associated with henochschonlein purpura

38

treatment of IgA nephropathy

BP control with ACE or ARB
fish oil??

39

features of HSP

arthritis
colitis
purpuric skin rash

40

prognosis of IgA

25 percent progress to end stage renal failure

41

renal biopsy of IgA nephropathy shows

mesangial cell proliferation
Ig A deposits

42

what is rapidly progressive GN

rapid deteriation in renal function over a few days

nephritic

associated with glomerular cresents on biopsy

treatable cause of acute renal failure

urinary sediment with RBCs and casts

43

causes of RPGN

vasculitis - GPA, microscopic polyangitis
goodpastures
HSP
SLE

44

antibodies present in goodpastures

anti glomerular basement membrane antibodeis

45

other features of goodpasture's

pulmonary haemorrhage

46

treatment on RPGN

immunosuppress - steroids or cytotoxics (cyclophosphamide/mycophenolate/azathioprine)

plasmapharesis

47

what is diffuse proliferate GN

usually occurs post strep in child
nephritic syndrome or AKI presentation

48

what is the most common GN in SLE

diffuse proliferative

also can get membranous and rapidly progressive GN

49

what are the causes of membranoproliferative GN

cryoglobulinaemia or Hep c = type 1
partial lipodystrophy = type2

this is a mixed nephritic/nephrotic syndrome