Flashcards in Glomerulonephritis Deck (54)
What is GN?
Immune mediated disease of the kidneys affecting the glomeruli (with secondary tubulointerstitial damage)
Damage to endothelial or mesangial cells leads to which type of lesion?
Proliferative lesion and red cells in urine
Damage to podocytes leads to which kind of lesion?
Damage to podocytes leads to a non-proliferative lesion and protein in the urine
Urinalysis findings of glomerulonephritis?
Urine microscopy would show what in glomerulonephritis?
RBC (dysmorphic), RBC and granular casts, lipiduria
Haematuria in GN presentation
Episodes of painless macroscopic haematuria
>3g protein per day
<1g per day
Red cell casts are pathogonomic of what?
Red blood cells in GN?
Acute Renal Failure
Oedema/ Fluid retention
Active urinary sediment
RBC’s, RBC & Granular Casts
Indicative of a proliferative process
Proteinuria 3 g/day (mostly albumin, also globulins)
Usually normal renal function
Indicative of a non proliferative process
Hypercholesterolaemia in nephritic or nephrotic syndrome?
Nephrotic syndrome complications?
Infections - loss of opsonising antibodies
Renal vein thrombosis
Volume depletion (overaggressive use of diuretics) - may lead to ARF (pre-renal)
Vit D deficiency
Most common cause of glomerulonephritis?
Systemic diseases associated with glomerulonephritis?
ANCA associated systemic vasculitis
Proliferative or non-proliferative
usually refers to presence or absence of proliferation of mesangial cells
< or > 50% of glomeruli affected
All or part of glomerulus affected
Presence of crescents - epithelial cell extracapillay proliferation e.g. RPGN in vasculitis
(RPGN = rapidly progressing glomerulonephritis)
Easier explanation of crescenteric glomerulonephritis?
Crescenteric more often seen in conditions like Goodpastures and systemic vasculitis
(crescenteric GN = when there is an accumulation of cells outside the capillary loops, but within the Bowman’s capsule)
-Presents as RPGN
Treatment of GN
Treatment of GN (immunosuppression)
Corticosteroids (Prednisolone po/MethylPred IV)
Alkylating agents (Cyclophosphamide/ Chlorambucil)
Calcineurin inhibitors (Cyclosporin/Tacrolimus)
Mycophenolate Mofetil (MMF)
Plasmaphoresis: TPE (therapeutic plasma exchange)
Antibodies: IV immunoglobulin
Monoclonal T or B cell antibodies
General treatment of nephrotic patients
IV albumin (only if volume deplete)
What is complete remission?
What is partial remission?
What is partial remission?
Commonest cause of nephrotic syndrome in children
Minimal change nephropathy
Biopsy, ML & IF and EM findings of minimal change nephropathy
Normal LM & IF
Foot process fusion on EM
How to treat minimal change nephropathy
94% remission with oral steroids
Second-line drugs: cyclophosphamide/CSA
(some are steroid resistant/dependent or have multiple relapses
Does not cause progressive renal failure
Possibly caused by IL-13
Minimal change nephropathy
Commonest cause of nephrotic syndrome in adults (35%)
10 or 20 (HIV/Heroin use/Obesity/ Reflux nephropathy)
Renal biopsy: As its name describes on light microscopy with minimal Ig/ Complement deposition on IF
Remission with prolonged steroids in 60 %
50 % progress to end stage renal failure after 10 years
Focal Segmental Glomerulosclerosis
Risk factors for FSGS
HIV/heroin use/obesity/reflux nephropathy
Renal biopsy findings of FSGS
Focal segmental glomerulosclerosis (as the name tells you lol)
Minimal Ig/complement deposition on IF
Treatment of FSGS
Remission with prolonged steroids in 60%
50% progress to end stage renal failure after ten years
New data implicating soluble urokinase plasminogen activator receptor (suPAR).
Upregulate integrins (cell signalling molecules).
67% of patients have increased suPAR levels.
2nd commonest cause of nephrotic syndrome in adults (15-30%)
10 or 20
Important 20 causes include:
infections (hepatitis B/ parasites)
connective tissue diseases (lupus)
malignancies (carcinomas/ lymphoma)
Renal biopsy: subepithelial immune complex deposition in the basement membrane
Steroids/ Alkylating agents/B cell monoclonal Ab
30% progress to end stage renal failure in 10 years
Causes of nephropathy
Infections (hep B/parasites)
Connective tissue diseases (lupus)
Renal biopsy findings in membranous nephropathy
Subepithelial immune complex deposition in the basement membrane
Treatment for membranous nephropathy?
B cell monoclonal antibodies
-30% progress to end stage renal failure in 10 years
Anti PLA2r antibody
Present in >70% cases of primary membranous nephropathy
Thickened basement membrane on silver stain?
What does the basement membrane look like in membranous nephropathy? and what stain would you use?
Thickened basement basement membrane using silver stain
Commonest GN in the world?
Associated with HSP
(remember HSP is IgA complex mediated anyway)
Renal biopsy findings of IgA nephropathy?
Mesangial cell proliferation and expansion on light microscopy with IgA deposits in mesangium on IF
Drugs used in IgA nephropathy?
ACEi & ARB
Which stain would show mesangial cell proliferation and expansion?
A treatable cause of acute renal failure
Rapid deterioration in renal function over days/weeks
Active urinary sediment (RBC’s, RBC & Granular Casts)
May be part of systemic disease.
Associated with glomerular crescents on biopsy.
Rapidly progressing glomerulonephritis
How do you detect ANCA? (anti-neutrophil cytoplasmic antibodies)
Treatment for RPGN
Treatment must be prompt!
Strong immunosuppression with supportive care including dialysis if needed