23. ZTF glomerulonephritis Flashcards
what does the term nephritis mean
Nephritis is a very generic term that means inflammation of the kidneys. It is a very non-specific descriptive term and is not a diagnosis or syndrome that has any criteria
what does nephritic syndrome or acute nephritic syndrome mean
refers to a group of symptoms, not a diagnosis. When we say a patient has “nephritic syndrome” it simply means they fit a clinical picture of having inflammation of their kidney and it does not represent a specific diagnosis or give the underlying cause
unlike nephrotic syndrome, there are no set criteria for nephritic syndrome however there are the what features in nephritic syndrome
- Haematuria means blood in the urine. This can be microscopic (not visible) or macroscopic (visible).
- Oliguria means there is a significantly reduced urine output.
- Proteinuria is protein in the urine. In nephritic syndrome, there is less than 3g / 24 hours. Any more and it starts being classified as nephrotic syndrome.
- Fluid retention
what is the criteria for a patient to have nephrotic syndrome
- Peripheral oedema
- Proteinuria more than 3g / 24 hours
- Serum albumin less than 25g / L
- Hypercholesterolaemia
what is glomerulonephritis
umbrella term applied to conditions that cause inflammation of or around the glomerulus and nephron. There are many conditions that can be described as glomerulonephritis
- there are specific diseases and diagnosis that have their own pathophysiology
what is interstitial nephritis
term to describe a situation where there is inflammation of the space between cells and tubules (the interstitium) within the kidney.
- acute interstitial nephritis
- chronic tubulointerstitial nephritis
what is glomerulosclerosis
a term to describe the pathological process of scarring of the tissue in the glomerulus. It is not a diagnosis in itself and is more a term used to describe the damage and scarring done by other diagnose
- can be caused by any type of glomerulonephritis or obstructive uropathy and by specific disease called focal segmental glomerulosclerosis
Name the specific types of glomerulonephritis
- Minimal change disease
- Focal segmental glomerulosclerosis
- Membranous glomerulonephritis
- IgA nephropathy (AKA mesangioproliferative glomerulonephritis or Berger’s disease)
- Post streptococcal glomerulonephritis (AKA diffuse proliferative glomerulonephritis)
- Mesangiocapillary glomerulonephritis
- Rapidly progressive glomerulonephritis
- Goodpasture Syndrome
what are most types of glomerulonephritis treated with
immunosuppression (eg steroids)
blood pressure control with ACEi or ARB
what does nephrotic syndrome predispose a patient to
thrombosis, HTN and high cholesterol
what is the most common cause of nephrotic syndrome in children
- Minimal change disease
- Focal segmental glomerulosclerosis
- Membranous glomerulonephritis
minimal change disease
it is usually idiopathic and treated successfully with steroids
what is the most common cause of nephrotic syndrome in adults
- Minimal change disease
- Focal segmental glomerulosclerosis
- Membranous glomerulonephritis
focal segmental glomerulosclerosis
What is the most common cause of primary glomerulonephritis (not caused by another disease)
IgA nephropathy (AKA mesangioproliferative glomerulonephritis or Berger’s disease)
• Post streptococcal glomerulonephritis (AKA diffuse proliferative glomerulonephritis)
• Mesangiocapillary glomerulonephritis
• Rapidly progressive glomerulonephritis
• Goodpasture Syndrome
IgA nephropathy aka burgers disease
what is the peak age of presentation of IgA nephropathy ie bergers disease
20
what does histology show for IgA nephropathy ie Berger’s disease
IgA deposits and glomerular mesangial proliferation
what is the most common type of Glomerulonephritis overall
- Minimal change disease
- Focal segmental glomerulosclerosis
- Membranous glomerulonephritis
- IgA nephropathy (AKA mesangioproliferative glomerulonephritis or Berger’s disease)
- Post streptococcal glomerulonephritis (AKA diffuse proliferative glomerulonephritis)
- Mesangiocapillary glomerulonephritis
- Rapidly progressive glomerulonephritis
- Goodpasture Syndrome
membranous Glomerulonephritis
bimodal peak in age in 20s and 60s
histology shows IgG and compliment deposits on the basement membrane
can be secondary to malignancy, rheumatoid disorders and drugs eg NSIADs
how does Post streptococcal glomerulonephritis (AKA diffuse proliferative glomerulonephritis) usually present
typically under 30 and
1-3 weeks after a streptococcal infection (eg tonsillitis or impetigo
they develop nephritic syndrome
is usually a full recovery
what is good pasture syndrome
Anti-GBM (glomerular basement membrane) antibodies attack glomerulus and pulmonary basement membranes. This causes glomerulonephritis and pulmonary haemorrhage
in an exam, if a patient presents with acute kidney failure and haemoptysis what are you thinking of
good pastures syndrome
or granulomatosis with polyangitis (aka wagerers granulomatosis)
what is good pastures syndrome associated with
anti GBM antibodies
what is wagerers granulomatosis (a type of vasculitis|) associated with
anti neutrophil cytoplasmic antibodies (ANCA)
these patients may also have a wheeze, sinusitis and a saddle shaped nose
in rapidly progressive Glomerulonephritis what does histology show
and what is it often secondary to
Histology shows “crescentic glomerulonephritis”
Often secondary to Goodpasture syndrome
