Glomerulonephritis

Question 1

What is GN?

Answer 1

immune mediated disease of the kidneys affecting the glomeruli

Question 2

What are the two possible pathophysiologies of GN?

Answer 2

humoral antibody mediated - antigen recognises the kidney to be forgien in so there are immune complexes deposited and block the sieve
cell mediated - T cells are upregulated causing toxic damage

Question 3

What is the underlying pathophysiology of GN?

Answer 3

distruption to the barrier of the glomerular capillary wall which leads to haematuria and/or proteinuria

Question 4

What are the 3 cel types that can be damaged in GN?

Answer 4

endothelial cells
mesangial cells
podocytes

Question 5

What is the most common cell to be damaged in GN?

Answer 5

mesangial cells

Question 6

What are the characteristics of endothelial and mesangial cell GN?

Answer 6

proliferative lesion
aggressive disease
blood in urine

Question 7

What are the characteristics of podocyte cell GN?

Answer 7

no inflammatory response
non proliferative lesion
protein leak

Question 8

What do mesangium cells release when they are damaged?

Answer 8

Ang 2

chemokine release

Question 9

What disease does mesangial cell damage commonly present with?

Answer 9

HSP

Question 10

How is GN diagnosed?

Answer 10

painless haematuria
microalbuminuria
asymptomatic proteinuria
nephrotic/nephritic syndrome 
impaired renal function

Question 11

What do red cell casts in the urine show?

Answer 11

endothelial injury

Question 12

What does nephritic syndrome indicate?

Answer 12

endothelial injury

Question 13

What is nephritic syndrome?

Answer 13

acute renal failure
oliguria and haematuria 
oedema/fluid retention
hypertension 
active urinary sediment - granular casts, RBCs

Question 14

What does nephrOtic syndrome indicate?

Answer 14

podocyte injury

Question 15

What is nephrOtic syndrome?

Answer 15

proteinuria >3g/day
hypoalbuminuria - causes low oncotic pressure so water is driven out of cells and into tissues
oedema
hypercholesterolaemia
NORMAL RENAL FUNCTION

Question 16

What are the complications of nephrotic syndrome?

Answer 16

infections
renal vein thrombosis
pulmonary emboli in lungs and legs
volume depletion - may lead to AKI

Question 17

What are the blood pressure targets for someone with GN?

Answer 17

<130/80

OR <120/75 if proteinuria

Question 18

What are the treatments for GN?

Answer 18

Antihypertensives - ACEis/ARBs (reduce proteinuria)
diuretics
statins
Immunosuppresives 
Plasma pheresis 
IV immunoglobulins
monoclonal T and B cell antibodies

Question 19

What can cause GN?

Answer 19

idiopathic - mainly
infections - HIV, hepatitis, bacteria
drugs - gold, penicilamine
malignancies - immune response against abnormal cells
part of systemic disease - GPA, good pastures, HSP

Question 20

How is GM diagnosed and classified?

Answer 20

light microscopy
electron microscopy
immunoflurensence

Question 21

What is seen on light microscopy of GN?

Answer 21

sclerosis
crescents - BAD
if vasculitis - sarcoid
inflammatory cells and reactive proliferations

Question 22

What is seen on electron microscopy of GN?

Answer 22

can look at the basement membrane and see what layers are damaged

Question 23

What is seen on immunofluresence of GN?

Answer 23

in good pastures - linear IgG againsts the collagen in the basement membrane

Question 24

What is goodpastures syndrome?

Answer 24

IgG antibodies attack the subunit of collagen in the basement membrane in the lungs and kidney

Question 25

How does goodpastures present?

Answer 25

haemoptysis | kidney failure

Question 26

How does vasculitis affect the glomerular sieve?

Answer 26

distrupts the membrane charges and blocks the membrane and allows things like RBCs and albumin and protien through

Question 27

What are the different types of idiopathic GN?

Answer 27

``` IgA nephropathy Focal segmental Membranous Minimal change Membranoproliferative ```

Question 28

Describe IgA nephropathy?

Answer 28

``` commonest GN in the world mesangial cell proliferation IgA depostis in mesangium on immunofloresence BP control/ACEi/ARBS/fish oil neprhitic syndrome and smokey urine ```

Question 29

Describe focal segmental GN?

Answer 29

adults - HIV, sickle cell, IV drug users, obesity nephritic syndrome remission with prolonged steroids IgG/complement depositon on immunofluresence

Question 30

Describe Membranous?

Answer 30

often caused by lupus infections, drugs, malignancy, autoimmune nephrotic syndrome SPIKEY thick membranes - white spaces are the immune complexes in the basement membranes, antigens stick to and damage podocytes treament - steroids, ankylating agents, B cell monoclonal antibodies

Question 31

Describe Minimal change?

Answer 31

``` kids get it! presents with nephrotic syndrome good prognosis with steroid treatment antibody against Podocytes normal renal biopsy ```

Question 32

Describe membranoproliferative?

Answer 32

adults and children are affected can be nephrotic or nephritic big lobulated hypercellular glomeruli with thick membranes - tram tracks