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Glomerulonephritis Flashcards

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1
Q

What are the different types of glomerular diseases?

A

Diabetic nephropathy
Glomerulonephritis
Amyloid nephropathy
Transplant glomerulopathy

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2
Q

What is the commonest cause of end stage renal disease (after diabetes)?

A

Chronic glomerulonephritis

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3
Q

What is glomerulonephritis?

A

Immune-mediated disease of the kidneys affecting the glomeruli (with secondary tubulointerstitial damage)
Disruption of the glomerular capillary wall (endothelium, basement membrane and podocytes) leads to haematuria +/- proteinuria

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4
Q

What does damage to the endothelial or mesangial cells lead to?

A

PROLIFERATIVE LESION
RED CELLS IN URINE
NEPHRITIC SYNDROME

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5
Q

What does damage to the podocytes lead to?

A

NON-PROLIFERATIVE LESION
PROTEIN IN URINE
NEPHROTIC SYNDROME

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6
Q

How do podocytes respond to damage?

A

Atrophy

Loss of size/charge specific barrier

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7
Q

How do mesangial cells react to damage?

A

Proliferate
Release angiotensin 2 (hypertension)
Chemokine release
Attract inflammatory cells

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8
Q

How do endothelial cells react to damage?

A

Vasculitis

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9
Q

How is GN diagnosed?

A

Clinical presentation
Blood tests
Urine: haematuria, proteinuria, dysmorphic RBC, RBC and granular casts, lipiduria, urine protein:creatinine 24hr ratio
Kidney biopsy

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10
Q

What present in urine microscopy is pathognomonic of glomerulonephritis?

A

RBC and granular casts

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11
Q

How can haematuria present?

A

Asymptomatic microscopic haematuria

Episodes of painless macroscopic haematuria = GN should be painless

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12
Q

How can proteinuria present?

A 
Microalbuminuria - 30-300 mg albuminaura/day  
Asymptomatic proteinuria (<1 g/day) 
Heavy proteinuria (1-3 g/day) 
Nephrotic syndrome (>3 g/day)
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13
Q

What do dysmorphic RBC in urine suggest?

A

They’ve been squished through the glomerulus

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14
Q

What are clinical renal presentations of GN?

A

Impaired renal function: AKI (rapidly progressive GN)
CKD/ESRD
Hypertension

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15
Q

What is nephritic syndrome?

A

AKI
Oliguria
Oedema/ fluid retention (due to lack of excretion)
Hypertension (fluid overload)
Active urinary sediment: RBC, RBC and granular cast

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16
Q

What is nephritis syndrome indicative of?

A

Proliferative process

Affecting endothelial cells

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17
Q

What is nephrotic syndrome?

A 
Proteinuria >3 g/day (mostly albumin) 
Hypoalbuminemia (<30) 
Oedema (loss of oncotic pressure) 
Hypercholesterolaemia
Normal renal function
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18
Q

What is nephrotic syndrome indicative of?

A

Non-proliferative process

Affecting podocytes

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19
Q

What are complications of nephrotic syndrome?

A

Infections - you leak antibodies along with fluid
Renal vein thrombosis - polycythaemia
PE
Volume depletion - overaggressive diuretic use leading to pre-renal hypovolemia AKI
Vit D deficiency
Subclinical hypothyroidism

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20
Q

How will the presentation of GN differ from interstitial nephritis?

A

Presence of protein and blood in urine

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21
Q

What are the different types of GN?

A

Primary

Secondary: infections, drugs, malignancies, ANCA, SLE, goodpasture’s, HSP

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22
Q

How are the different types of GN differentiated histologically?

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A

Renal biopsy
Light microscopy
Immunofluorescence (IgG deposits in GBM in goodpasture’s)
Electron micrograph (minimal change glomerulonephritis)

23
Q

What does proliferative and nonproliferative refer to?

Study These Flashcards
A

Presence of absence of proliferation of mesangial cells

24
Q

What does focal or diffuse refer to?

Study These Flashcards
A

More or less than 50% of glomeruli affected

25
What does global or segmental refer to?
All or part of glomerulus affected
26
What does crescentic refer to?
Presence of cresents - epithelial cell extracapillary proliferation e.g. RPGN in vasculitis
27
What are the treatment principles of GN?
Reduce degree of proteinuria Induce remission of nephrotic syndrome Preserve long term renal function
28
What are the non-immunosuppressive treatments of GN?
``` Anti-hypertensives (target BP <130/80 - <120/75 if proteinuria) ACEi/ARB Diuretics Statins Anticoagulants/aspirin/ antiplatelets ```
29
What immunosuppressive drugs are used in GN?
Corticosteroids (prednisolone) Azathioprine Alkylating agents (cyclophosphamide) Calcineurin inhibitors (cyclosporin /tacrolimus)
30
What can be used for immunosuppression in GN?
Drugs Plasmapheresis Antibodies: IV immunoglobulin (monoclonal T or B cells)
31
What is the general treatment of a nephrotic patient?
``` Fluid restriction Salt restriction Diuretics ACEi/ARB Anticoagulation IV albumin if volume deplete Immunosuppression ```
32
What are the main types of primary GN?
``` Minimal change FSGS Membranous Membranoproliferative IgA nephropathy ```
33
What is the commonest cause of nephrotic syndrome in children?
Minimal change nephropathy
34
What can be seen histologically in minimal change nephropathy?
Normal renal biopsy on light microscopy and immunofluorescence with foot process fusion on EM
35
How is minimal change nephropathy treated?
Oral steroids | Does NOT cause progressive renal failure
36
What is the commonest cause of nephrotic syndrome in adults?
Focal segmental glomerulosclerosis (FSGS)
37
What can cause FSGS?
Primary | Secondary: HIV/heroin use/obesity/reflux nephropathy
38
What will FSGS look like histologically?
Light microscopy: focal segmental glomerulosclerosis | Minimal Ig/complement deposition on IF
39
How is FSGS treated?
Prolonged steroids | 50% will progress to end stage renal failure after 10 years
40
What is the 2nd commonest cause of nephrotic syndrome in adults?
Membranous nephropathy | Thickened basement membrane
41
What causes membranous nephropathy?
Primary Secondary: infections (hep B/ parasites), connective tissue disease (SLE), malignancies (carcinomas/ lymphomas), drugs (gold, penicillamine)
42
What will renal biopsy show in membranous nephropathy?
Subepithelial immune complex deposition in the basement membrane
43
How is membranous nephropathy treated?
Steroids Alkylating agents B cell monoclonal Ab 30% progress to end stage renal failure within 10 years
44
What is the commonest glomerulonephritis in the world?
IgA nephropathy
45
How will IgA nephropathy present?
Asymptomatic microhaematuria +/- non-nephrotic range proteinuria Macroscopic haematuria after resp/GI infection AKI/ CKD
46
What condition is IgA nephropathy associated with?
Henoch-schonlein purpura: arthritis, colitis, purpuric skin rash, renal involvement
47
What will renal biopsy show in IgA nephropathy?
Mesangial cell proliferation and expansion on light microscopy with IgA deposits in mesangium on IF
48
How is IgA nephropathy treated?
BP control - ACEi/ ARB | 25% progress to end stage renal failure within 10-30 years
49
What is rapidly progressive glomerulonephritis?
Treatable cause of acute renal failure | Rapid deterioration in renal function over days/weeks
50
What will RPGN show on biopsy?
Glomerular crescents
51
What ANCA-positive conditions can cause RPGN?
GPA - c-ANCA | MPA - p-ANCA
52
What ANCA-negative conditions can cause RPGN?
Goodpasture's disease - anti-GBM Henoch Schonlein Purpura IgA SLE
53
Describe what occurs in ANCA associated vasculitis?
Neutrophils primed inducing PR3 and MPO to cell surface where they interact with ANCA in blood stream Neutrophils adhere to endothelial cells Release of proteolytic enzymes and reactive oxygen species ANCA activated neutrophils promote inflammatory process and perpetuate vasculitis
54
What is the treatment of RPGN?
Strong immunosuppression with supportive care including dialysis Immunosuppression with IV steroids or cytotoxics (cyclophosphamide/ azathioprine) Plasmapheresis

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