Glomerulonephritis Flashcards
(21 cards)
what team?
WILDCATS
Define Glomerulonephritis
immune mediated disease of the kidneys affecting the glomeruli
+ secondary tubulointerstitial damage
Name the 2 different types of mechanisms by which GN occurs
Humoral (antibody mediated)
- Intrinsic/planted antigen
- deposition of circulating immune complexes
Cell mediated (T-cells) -cause the release of inflammatory cells, mediators and complement
Describe the structure of the glomerulus?
from internal to external
capillary lumen lined with endothelial cells, under that lies the GBM and the mesangial cells at the centre of the capillaries
podocytes are located o the outside of the capillaries (epithelium)
them the bowman’s space
what are the two forces involved in the capillary barrier function?
-size and charge (the cm is neg charged)
process behind the development of:
- proliferative lesion? and presentation?
- non-proloferative lesion? and presentation?
-damage to endothelial or mesangial cells
RBC in urine = haematuria
-damage to podocytes
protienuria (albumin)
investigation and diagnosis in GN
Bloods
Examination of the urine:
- urinalysis for haematuria and proteinuria
- Urine microscopy (RBC dysmorphia, RBC & granular casts, lipiduria)
- urine protein /creatinine ratio
-Kidney biopsy
Clinical presentation of Nephritic syndrome? (6)
Acute renal failure Oliguria Oedema/ fluid retention Hypertension active urinary sediment (RBCs/ RBC & granular casts) Proliferative process
Clinical presentation of Nephrotic syndrome? (6)
Proteinuria > 3g/day (albumin)
Hypoalbuminaemia (
Complication of Nephrotic syndrome? (6)
infections (due to loss of antibodies)
Renal vein thrombosis
PE
volume depletion (over aggressive use of diuretics,may lead to ARF)
Vit D deficiency
Subclinical hypothyroidism
causes of GN? (4)
Idiopathic
Infectious
Drugs
Systemic disease (ANCA assoc vasculitis, lupus, Goodpastures, HSP)
Name the 3 histological investigations done on biopsy?
Light microscopy
immunofluorescence
electron microscopy
Histological classification of GN, name the 4 terms used
Proliferative/non-proliferative
referring to presence or absence of mesangial cells
Focal/diffuse
50% glomeruli affected
Global/segmental
all part glomerulus affected
Crescenteric
Presence or crescents, epithelial cell extra capillary proliferation e.g. RPGN in vasculitis
Treatment of GN
- types (2)
- what these types involve (1=5, 2=3»9)
-Non immunosuppressive
Anti-hypertensives (target BP
Principles of treating nephrotic patient
- general (6)
- after ^^
- define sustained remisson in nephrotic syndrome
-Fluid/Salt restriction Diuretics ACE Inhibitors/ ARBs ? Anticoagulation IV Albumin (only if volume deplete)
- immunosuppression
- Complete= proteinuria
Maine types of GN? (5)
Minimal change FSGS- focal segmental glomerulosclerosis Membranous Membranoproliferative IgA Nephropathy
Minimal change nephropathy
- population
- biopsy
- treatment
- PRF?
- caused by?
-commonest nephrotic syndrome in children
-normal on LM and IF but foot process fusion on EM
non-proliferative
- oral steroids, 2nd line cyclophosphoamide in resistant/recurrence
- nope
- interleukin 13 (IL-13)
FSGS
- population
- biopsy
- treatment
- PRF?
- caused by (immune component & secondary cause)
- commonest cause of Nephrotic syndrome in adults
- focal segmental glomerulosclerosis with minimal Ig/complement deposition on IF
- prolonged steroids
- yes
-suPAR- up-regulates integrins and causes podocyte effacement
HIV/Heroin use/Obesity/ Reflux nephropathy
Membranous nephropathy
- population
- biopsy
- treatment
- PRF?
- caused by (immune component & secondary cause)
- 2nd commonest cause of NS in adults
- subepithelial immune complex deposition in the BM, thickened BM
- steroids, alkylating agents, B cell monoclonal Ab
- yes
-Anti PLA2r antibody infections (hepatitis B/ parasites) connective tissue diseases (lupus) malignancies (carcinomas/ lymphoma) drugs (gold/penicillamine)
IgA nephropathy
- population
- biopsy
- treatment
- PRF?
- presentation
- associations
- commonest in world
- mesangial cell proliferation and expansion and Ig A deposits in the mesangium
- BP control/ ACE inhibitors & ARBs/ Fish oil
- yes
-Asymptomatic microhaematuria +/- non-nephrotic range proteinuria
Macroscopic haematuria after resp/GI infection
AKI/ CKD
-Associated with Henoch-Schonlein Purpura (HSP) (arthritis/colitis/ purpuric skin rash)
Rapidly progressive glomerular nephritis
- presentation
- associations
- biopsy
- blood test and what results indicate?
- treatment
- AKI + active urinary sediment
- systemic disease (ANCA pos and ANCA neg)
- glomerular crescents
- test for ANCA
positive: Systemic vasculitis (Wegener’s granulomatosis and microscopic polyangitis)
negative: Goodpastures disease, HSP, SLE - Immunosuppression
Steroids (IV Methylprednisolone / Oral Prednisolone)
Cytotoxics (Cyclophosphamide/ Mycophenolate/ Azathioprine
Monoclonal antibody directed against CD20 receptor of B cells (rituximab).
Plasmapharesis
