Glomerulonephritis Flashcards
(57 cards)
what types of glomerular disease are there
Diabetic nephropathy
Glomerulonephritis
Amyloid/light chain nephropathy
Transplant glomerulopathy
what is glomerulonephritis
one type of glomerular disease
immune-mediated disease of the kidneys affected the glomeruli causing inflammation (and secondary tubulointerstitial damage)
what is the second most common cause of end stage renal failure
chronic glomerulonephritis
what is acute glomerulonephritis
a treatable cause of acute renal failure
why does the site and type of injury to the glomerulus give different clinical presentations
because different cells in the glomerulus respond to damage in different ways
what happens to endothelial cells when they are damaged
cell injury causes vasculitis - this leads to rapid ischaemia and death of the glomerulus and BLOOD in urine
what happens to mesangial cells when they are damaged
a proliferative lesion is formed and red blood cells AND protein are found in urine
also causes high BP
what happens to podocyte cells when they get damage
non-proliferative lesion
small podocyte cells allow proteins to slip through but not RBCs
protein in urine
how does glomerulonephritis present (clinically)
- haematuria
- proteinuria
- dysmorphic red blood cells on urine microscopy
- red cell casts
- Impaired renal function (AKI, CKD, ESRD)
- hypertension
- nephritic syndrome or nephrotic syndrome or nephrotic-nephritic syndrome
how does the haematuria present in glomerulonephritis
asymptomatic microscopic haematuria
episodes of painless macroscopic haematuria
what are the stages of proteinuria
Microalbuminuria (30-300mg/day)
Asymptomatic proteinuria (<1g/day)
heavy proteinuria (1-3g/day)
nephrotic syndrome (>3g/day)
how can you tell if the blood in the urine is coming from the glomerulus
If the red blood cells on microscopy are dysmorphic (look squished)
if there are red cell casts
if the cells look normal on microscopy then the bleeding is coming from further down
what is nephritic syndrome
symptoms/signs involving loss of a lot of BLOOD in kidney disease
suggests disease in the ENDOTHELIAL CELLS
what are the symptoms/signs of nephritic syndrome
AKI Oliguria Oedema/fluid retention Hypertension Active urinary sediment -RBCs, RBC and granular casts
What is nephrotic syndrome
symptoms/signs involving loss of a lot of PROTEIN in kidney disease
caused by disease in the podocytes
what are the signs/symptoms of nephrotic syndrome
Proteinuria >3g/day Hypoalbuminaema (<30) Oedema (due to low osmolarity of the blood bc of lack of protein pushing water out) Hypercholesterolaemia Normal renal function
what are some complications of nephrotic syndrome
Infections (loss of opsonising antibodies)
Renal vein thrombosis
Pulmonary emboli
Volume depletion (overaggressive use of diuretics)
Via D deficiency
Subclinical hypothyroidism
what is one of the main differences between glomerular disease and non-glomerular kidney disease
you don’t get blood in the urine in non-glomerular disease just glomerular
what are the 2 main classifications of glomerulonephritis
Primary (idiopathic) most common!!
Secondary (caused by infections, drugs, malignancies, systemic diseases
what histological test can you do to determine the cause of glomerulonephritis
renal biopsy
- light microscopy
- immunofluorescence
- electron microscope
what are the histological classifications of glomerulonephritis
Proliferative or non-proliferative (usually revers to mesangial cell proliferation)
Focal/diffuse (>or<50% of glomeruli affected)
Global/segmental (all or parts of the glomerulus affected)
Cresentic (presence of crescents - epithelial extra capillary proliferation)
what is the aim of treatment for glomerulonephritis
Reduce protienuria
Induce remission of nephrotic syndrome
preserve long term renal function
what non-immunosuppressive treatments can be used for GN
Anti-hypertensives (target <130/80 or <120/75 if proteinuria)
- ACEi/ARB
- Diuretics
- Statins
- anticoagulants/antiplatlets
what immunosuppressive treatments are used for glomerulonephritis
Corticosteroids Azathioprine Alkylating agents (cyclophosphamide) Calcineurin inhibitors Mycophenolate mofetil
Plasmapharesis
Antibodies
- IV immunoglobin
- monoclonal T or B cell antibodies
