Glomerulonephritis Flashcards
(42 cards)
what makes up the renal parenchyma
tubules, interstitium, glomeruli
what type of disease is glomerulonephritis
glomerular disease
what are the two types of glomerulonephritis
chronic- 2nd commonest cause of end stage renal failure
acute- important treatable cause of acute renal failure
what is glomerulonephritis
range of immune mediated diseases of the kidneys affecting the glomeruli (with secondary tubulointerstitial damage)
what is the difference between primary and secondary glomerulonephritis
primary= no associated disease (majority idiopathic) secondary= glomerular involvement is part of systemic disease (e.g. SLE, infections, drugs, malignancies, ANCA, goodpastures, HSP)
what does damage to endothelial or mesangial cells cause
a proliferative lesion
- red cells in urine
- aggressive nephritic picture
- influx of inflammatory cells
what does damage to podocytes cause
a non proliferative lesion
- protein in urine
- dont get dramatic inflammatory response
- loose ability to retain albumin
what happens when there is podocyte damage
it atrophies
loss of specific barrier function
proteinuria
what happens when there is mesangium damage
proliferative response
release of Ang.2, chemokines
attract inflammatory cells
what causes damage to the glomerular endothelium
vasculitis
what tests to diagnose GN
blood tests urinalysis urine microscopy- RBC (dysmorphic), RBC & granular casts, lipiduria urine protein: creatinine ratio kidney biopsy
what types of haematuria will renal presentation cause
asymptomatic microscopic
episodes of painless haematuria (wont produce painful haematuria)
what are the parameters of proteinuria
Microalbuminuria (30-300mg albuminuria/day) Asymptomatic proteinuria (< 1 g/day) Heavy proteinuria (1-3 g/day) Nephrotic syndrome (> 3 g/day))
do you do a kidney biopsy for everyone
no as risk of bleeding
what are red cell casts Pathognomonic of
GN with injury to mesangium
what are the clinical presentations of GN
impaired renal fucntion (AKI, CKD/ ESRD)
hypertension
nephritic/nephrotic syndrome
nephritic-nephrotic syndrome
what is nephritic syndrome
- acute renal failure
- oliguria
- oedema/ fluid retention (caused by reduce urine output)
- hypertension
- active urinary sediment (RBC’s, granular casts)
what is nephritic syndrome indicative of
proliferative process
affecting endothelial cells
what is nephrotic syndrome
- proteinuria >3g/day
- hypoalbuminaemia
- oedema
- hypercholesterolaemia (live working overtime)
- usually normal renal function (normal creatinine and BP)
what is nephrotic syndrome indicative of
a non proliferative process affecting podocytes
what are the possible complications of nephrotic syndrome
infection (loss of opsonising antibodies)
renal vein thrombosis
PE (increased DVT risk)
volume depletion (overaggressive use of diuretics may lead to ARF)
vit d def
subclinical hypothyroidism
How does the presentation of GN differ from a non glomerular disease like Interstitial Nephritis?
In glomerular disease can have blood or protein in urine
In a interstitial nephritis- should not have blood or protein or urine
how do you classify GN
aetiology (primary or secondary)
histology (renal biopsy, light microscopy, immunofluorescence, EM)
what are the histological classifications of GN
proliferative vs non proliferative (proliferation of mesangial cells)
focal/ diffuse (< or > 50% glomeruli affected)
global/ segmental (all or part of glomerulus affected)
crescentic (presence of cresents- epithelial cell extracapillary proliferation- e.g. RPGN in vasculitis)
