Glomerulonephritis Flashcards
(32 cards)
What is GN?
Immune medated disease of the kidneys affecting the glomeruli
What are the 3 aspects of the pathogenesis of GN?
Humoral - antibody mediated
Cell mediated
Inflammatory cells, mediators and complement
Damage to endothelial or mesangial cells leads to what kind of lesion in GN?
Proliferative lesions and blood in urine - nephritic syndrome
Damage to podocytes leads to what kind of lesion in GN?
Non-proliferative lesion and protein in urine - nephrotic syndrome
How does GN present?
Oedema Haematuria Tired HTN Nephrotic syndrome - proteinuria Nephritic syndrome - haematuria
What level of proteinuria classified as the nephrotic syndrome?
> 3g/day
RBCs in the urine from the glomerulus are described as what shaped?
Dysmorphic
What 3 investigations are required for biopsy sample in GN?
Light microscopy
Electron microscopy
Immunofluorescence
How does cresentic GN form?
Cells burst into Bowman’s sapce ad forma cresta round the glomerulus which compresses it and it becomes ischaemic and dies.
What are the main aims of treatment for GN?
Reduce degree of proteinuria
Induce remission of nephrotic syndrome
Preserve long term renal function
In general what treatment can be given for GN?
ACEi/ARBs Diuretcs Statins Steriods AZA Cyclophosphamide Calcineurin inhibitors - Cyclosporin/Tacrolimus Mycophenolate Mofetil (MMF) Plasmapharesis Antibodies
What is the target BP for GN?
<120/75 if proteinuria
How is minimal change GN diagnosed?
EM: foot process fusion
Normal biopsy, LM and IF
What is the treatment for minimal change GN?
Oral steroids
If steroid-resistant/ dependent then biopsy and cyclophosphamide/CSA
Does minimal change GN cause progressive renal failure?
No
Is minimal change GN proliferative or non-proliferative lesions?
Non-proliferative lesion
What is the most common cause of nephrotic syndrome in adults and children?
Children - Minimal change GN
Adults - Focal Segmental Glomerulosclerosis
What are the secondary causes of focal segmental glomerulosclerosis?
HIV
Heroin use
Obesity
Reflux nephropathy
Describe focal segmental glomerulosclerosis as seen on biopsy?
Minimal Ig deposition on LM
Complement deposition on IF
What is the treatment for focal segmental glomerulosclerosis?
Prolonged steroids
What is the second most common cause of nephrotic syndrome in adults?
Membranous nephropathy
What can cause secondary membranous nephropathy?
Infections - HepB, parasites
CTDs - SLE
Malignancies - carcinomas, lymphomas
Drugs - gold, penicillamine
Describe membranous nephropathy as seen on biopsy?
Subepithelial immune complex deposition in the basement membrane
Does the BM become thicker in membranous nephropathy?
Yes
