Glomerulonephritis Flashcards Preview

Renal and urology > Glomerulonephritis > Flashcards

Flashcards in Glomerulonephritis Deck (54):
1

What are the main kinds of glomerular disease?

Diabetic Nephropathy

Glomerulonephritis (GN)

Amyloid/ Light Chain Nephropathy

Transplant Glomerulopathy
 

2

What are the two most common causes of end stage renal disease?

1. Diabetes

2. Chronic glomerulonephritis

3

What is glomerulonephritis?

An immune mediated disease of the kidneys affecting the glomeruli causing secondary tubulointerstitial damage

4

What are podocytes?

Cells that spread out around capillaries in branches, forming protein bridges (actin and myosin) between these branches to provide strong mechanical strength for the capillaries

5

What are mesangial cells?

Cells found between groups of capillaries that work in tandem with the glomerular basement membrane:

They act like smooth muscle cells and can cause vasoconstriction

They have immune function, releasing cytokines

A image thumb
6

What does the glomerular basement membrane consist of?

It is acellular and consists of collagen and protein

7

Which components of the glomerulus are injured in prolfierative glomerulonephritis?

Mesangial cells

Endothelial cells

8

Why does haematuria occur in proliferative GN?

Mesangial and endothelial cells are exposed to blood, so injury causes red cells in urine and a proliferative lesion and activation of the inflammatory cascade

This causes a nephritic syndrome

9

What does injury to podocytes result in?

Non-proliferative lesion and protein in urine

There is no activation of the inflammatory cascade since the podocytes are not exposed to blood

This causes nephrotic syndrome

10

What colour is urine typically in glomerulonephritis?

'Smoky', 'rusty' or coca-cola coloured

11

How should urine be examined if GN suspected and what would be expected?

Urinalysis: haematuria, proteinuria

  Urine microsopy: RBC (dysmorphic), RBC & granular casts, lipiduria

  Urine Protein: creatinine Ratio

24 hour urine - quantify proteinuria

12

How is haematuria normally picked up in glomerulonephritis?

Dipstick test - the haematuria is painless

13

How is proteinuria judged?

Microalbuminuria (30-300mg albuminuria/day)

Asymptomatic proteinuria (< 1 g/day)

Heavy proteinuria (1-3 g/day)

Nephrotic syndrome (> 3 g/day))
 

14

What is the usual diagnosis if red cell casts seen on microscopy of urine?

Q image thumb

Indicates active, aggressive proliferative lesion

15

How does glomerulonephritis present?

Oedema

Hypoalbuminuria

Decresed renal function

Hypertension

Haematuria

Frothy urine

16

Why does hypertension occur in glomerulonephritis?

Fluid retention

Proliferative lesion causing increased renin secretion

17

What are the three indicators of nephrotic syndrome?

Oedema

Hypoalbuminuria

Proteinuria

18

Why does impaired immunity occur in nephrotic syndrome?

Opsonising antibodies are leaked out into urine

19

What is a complication of nephrotic syndrome that would make a patient present with unilateral loin pain and haematuria for the first time, and why?

Renal vein thrombosis

Hypoalbuminuria can change liver function, causing increased production of clotting and fibrotic factors

20

What are the features of nephrotic syndrome?

Proteinuria > 3 g/day (mostly albumin, also globulins)

Hypoalbuminaemia (<30)

Oedema

Hypercholesterolaemia

Usually normal renal function
 

21

What are the features of nephritic syndrome?

Acute Renal Failure

Oliguria

Oedema/ Fluid retention

Hypertension

Active urinary sediment: RBC’s, RBC and granular casts
 

22

What are the complications of nephrotic syndrome?

Infections

Renal vein thrombosis

Pulmonary emboli

Volume depletion: often due to overuse of ACEi, may lead to pre-renal AKI

Vit D deficiency

Subclinical hypothyroidism
 

23

What are the four components of histological classification of glomerulonephritis?

Proliferative/non-proliferative

Focal/diffuse (< or > 50% glomeruli affected)

Global/segmental (all or part glomerulus affected)

Crescentic

24

What does 'crescentic' mean on histological description of glomerulonephritis?

Presence of crescents: cells burst into Bowman's space and form crescents around the glomerulus, causing ischaemia and death of the glomerulus

 

25

What are the principles of treatment of glomerulonephritis?

Reduce degree of proteinuria

Induce remission of nephrotic syndrome

Preserve longterm renal function
 

26

What are some of the non-immunosuppresive treatments of glomerulonephritis?

Anti-hypertensives 

ACE inhibitors/ ARBs

Diuretics

Statins

 

27

What are some of the immunosuppressive drugs used to treat glomerulonephritis?

Corticosteroids (Prednisolone po/MethylPred IV)

Azathioprine

Alkylating agents (Cyclophosphamide/ Chlorambucil)

Calcineurin inhibitors (Cyclosporin/Tacrolimus)

Mycophenolate Mofetil (MMF)

28

Why is plasmapheresis used in immunosuppresive treatment of GN?

Used to remove antibodies causing the GN from the circulation

29

Why are antibodies used in immunosuppressive treatment of glomerulonephritis?

Monoclonal T or B cell antibodies can be used to switch off B cell production to stop production of antibodies causing GN

30

How are nephrotic patients managed?

Fluid restriction

Salt restriction

Diuretics

ACE Inhibitors/ ARBs

IV Albumin (only if volume depleted)

Immunosuppression

31

What values of proteinuria indicate remission from nephrotic syndrome?

Complete remission: proteinuria < 300 mg/day
Partial remission: proteinuria < 3g/day
 

32

What is the commonest cause of nephrotic syndrome in children?

Minimal change nephropathy

33

What is the pathology in minimal change nephropathy?

Podocyte foot process fusion

A image thumb
34

What is the first line treatment for minimal change nephropathy?

Oral steroids - 94% go into remission

35

What is the second-line treatment for minimal change nephropathy?

Cyclophosphamide

36

Does minimal change nephropathy cause progressive renal failure?

No

37

What is the commonest cause of nephrotic syndrome in adults?

Focal segmental glomerulosclerosis

38

What is the pathology in focal segmental glomerulosclerosis?

Affects small parts of the glomerulus in segments causing scarring and sclerosis

Stops formation of protein bridges between podocytes

39

Does focal segmental glomerulosclerosis cause renal damage?

50% progress to end stage renal failure after 10 years
 

40

What can cause focal segmental glomerulosclerosis?

HIV

Heroin use

Obesity

Reflux nephropathy

41

What is the second commonest cause of nephrotic syndrome in adults?

Membranous nephropathy: most common cause in the UK

42

What are some secondary causes of membranous nephropathy?

Infections (hepatitis B/ parasites)

Connective tissue diseases (lupus)

Malignancies (carcinomas/ lymphoma)

Drugs (gold/penicillamine)
 

43

What can be seen on renal biopsy with membranous nephropathy?

Subepithelial immune complex deposition in the basement membrane
 

44

What is the treatment for membranous nephropathy?

Steroids

Alkylating agents

B cell monoclonal Ab
 

45

What is the commonest glomerulonephritis in the world?

IgA nephropathy

46

How does IgA nephropathy present?

Asymptomatic microhaematuria ± non-nephrotic range proteinuria

Macroscopic haematuria after resp/GI infection

AKI/ CKD
 

47

What is IgA nephropathy associated with?

Associated with Henoch-Schonlein Purpura (HSP)

(arthritis/colitis/purpuric skin rash)
 

48

What is seen on renal biopsy?

Mesangial cell proliferation and expansion on light microscopy with IgA deposits in mesangium on IF

49

How is IgA nephropathy treated?

BP control

ACE inhibitors & ARBs

Fish oil

50

What is the disease process in IgA nephropathy?

Slight genetic abnormality in IgA causes it to become stuck in the kidney: tends to lodge in mesangial cell, stimulating proliferation

Endothelial depositon causes cytokine aggregation and an inflammatory cascade occurs

51

What may cause rapidly progressive glomerulonephritis in an ANCA positive patient?

Systemic Vasculitis

Wegener’s granulomatosis (Granulomatosis with polyangitis)

Microscopic polyangiitis

52

What are some of the ANCA negative causes of rapid progressive glomerulonephritis?

Goodpasture’s disease: Anti-GBM

Henoch Scholein Purpura HSP/IgA

 Systemic Lupus Erythematosus 
 

53

What is rapidly progressive glomerulonephritis?

A treatable cause of acute renal failure with rapid deterioration in renal function over days/weeks

There is active urinary sediment (RBC’s, RBC & Granular Casts) causing haematuria

54

What is the treatment for rapidly progressive glomerulonephritis?

Immediate immunosuppression and treatment of systemic cause:

Steroids (IV Methylprednisolone /oral prednisolone)

Cytotoxics (Cyclophosphamide/Mycophenolate/ Azathioprine

Plasmapheresis