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Renal Week 2 2017/18 > 4: Glomerulonephritis > Flashcards

4: Glomerulonephritis Flashcards

1
Q

What is glomerulonephritis?

A

Autoimmune disease of the glomeruli

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2
Q

What is the commonest cause of renal failure after diabetes?

A

Glomerulonephritis

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3
Q

What immune components mediate glomerulonephritis?

A

Antibodies

T cells

Inflammatory cells, cytokines, complement

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4
Q

What are the three layers of the glomerular membrane?

A

Endothelium of glomerular capillary

Glomerular basement membrane

Podocytes

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5
Q

Glomerulonephritis causes disruption of which structure?

What symptoms are seen?

A

Glomerular membrane

Proteinuria

Haematuria

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6
Q

What signs are produced if glomerulonephritis damages

a) endothelial or mesangial cells
b) podocytes?

A

a) Haematuria

b) Proteinuria

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7
Q

What happens to podocytes when they are damaged by glomerulonephritis?

A

Atrophy

No inflammation, but allows leakage of protein

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8
Q

What happens to mesangial cells if they are damaged by glomerulonephritis?

A

Proliferation

Vasoconstriction (by angiotensin II)

Inflammatory response

Haematuria

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9
Q

What happens to endothelial cells if they are damaged by glomerulonephritis?

A

Vasculitis

Haematuria

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10
Q

Endothelial damage causes (slow / rapid) decline in renal function.

A

rapid decline in renal function

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11
Q

Does mesangial damage cause rapid decline in renal function?

A

No

Haematuria and proteinuria

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12
Q

What urine tests can be done for someone with glomerulonephritis?

A

Urinalysis

Urine microscopy - for cell casts, culture

P/C ratio - to quantify proteinuria

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13
Q

What investigation can you do if you’re struggling to classify glomerulonephritis after urine analysis?

A

Kidney biopsy

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14
Q

Is haematuria painful?

A

No

may be in UTI

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15
Q

On urine microscopy, what do red blood cells look like if they’ve come from the

a) kidneys
b) bladder?

A

a) Dysmorphic

b) Intact

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16
Q

What type of casts are seen in glomerulonephritis?

A

Red cell casts

pathognomic of GN, usually endothelial damage

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17
Q

What can acutely or chronically deteriorate due to glomerulonephritis?

A

Renal function

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18
Q

What are the presentations of

a) NEPHRITIC SYNDROME

b) NEPHROTIC SYNDROME?

A

a) Acute renal failure, oliguria, oedema, hypertension, urinary sediment

caused by inflammation

b) Proteinuria, hypoalbuminaemia, oedema, hypercholesterolaemia

due to inability of kidneys to retain albumin

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19
Q

What type of glomerulonephritis causes nephritic syndrome?

A

Endothelial

Mesangial

because they proliferate and cause inflammation

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20
Q

What type of glomerulonephritis causes nephrotic syndrome?

A

Podocyte damage

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21
Q

What is renal function like in

a) nephrotic syndrome
b) nephritic syndrome?

A

a) Normal
b) Gammied

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22
Q

What are people with nephrotic syndrome at increased risk of?

A

Cardiovascular disease

Infection

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23
Q

How does the presentation of GN differ from that of interstitial nephritis?

A

Shouldn’t see proteinuria, haematuria on dipstick

As glomerulus isn’t involved

24
Q

What is the cause of primary GN?

A

Idiopathic autoimmune disease

25
Q

What are some causes of secondary GN?

A

Infections

Drugs

Malignancy

Vasculitis

Connective tissue diseases

26
Q

What cells tend to proliferate when damaged in GN?

A

Mesangial cells

Endothelial cells

27
Q

What is the difference between focal and diffuse GN?

A

Focal - < 50% affected

Diffuse - > 50% affected

28
Q

How is glomerulonephritis treated with drugs?

A

Antihypertensive drugs - ACE inhibitors, ARBs, diuretics (also help with fluid overload)

Statins

then

Immunosuppression - IV steroids, azathioprine, antibody injections, biologic agents

29
Q

How are people with nephrotic syndrome managed?

A

Oedema, so:

fluid restriction

salt restriction

diuretics

ACE inhibitors / ARBs

30
Q

People with glomerulonephritis usually need ___ after symptomatic relief.

A

immunosuppression

31
Q

Why are people with nephrotic syndrome at risk of infection?

A

Fluid overloaded, salty blood, oedematous

So adding immunosuppressants further increases infection risk

32
Q

What is the commonest cause of nephrotic syndrome in children?

A

Primary GN - MINIMAL CHANGE GLOMERULONEPHRITIS

33
Q

Does minimal change GN cause renal failure?

A

NO

34
Q

What change is seen in minimal change glomerulonephritis?

A

Podocyte atrophy

35
Q

What syndrome is caused by minimal change glomerulonephritis?

A

Nephrotic syndrome

36
Q

How is minimal change glomerulonephritis treated?

A

Oral steroids

37
Q

What is the commonest cause of nephrotic syndrome in adults?

A

Primary GN - FOCAL SEGMENTAL GLOMERULOSCLEROSIS

38
Q

50% of people with focal segmental glomerulosclerosis develop ___ ___.

A

renal failure

39
Q

Why can focal segmental glomerulosclerosis cause renal failure?

A

Widespread sclerosis which doesn’t resolve

40
Q

What type of glomerulonephritis is caused by immune complex deposition in the basement membrane?

A

Membranous nephropathy

41
Q

What are some causes of membranous nepropathy?

A

Infection

SLE

Malignancy

Drugs (remember gold and penicillamine used to treat CTD and are nephrotoxic)

42
Q

Which antibody is associated with membranous nephropathy?

A

Anti-PLA2r antibody

43
Q

What is the commonest form of glomerulonephritis?

A

IgA nephropathy

44
Q

What is the common presentation of IgA nephropathy?

A

Haematuria after a viral infection

45
Q

What type of vasculitis is IgA nephropathy associated with?

A

Henoch Schonlein purpura

purple, non-blanching rash on posterior thighs, abdominal pain, arthritis

46
Q

What is seen on renal biopsy of IgA nephropathy?

A

IgA

Proliferation of mesangial cells

47
Q

Which cells proliferate in IgA nephropathy?

What symptoms are produced?

A

Mesangial cells

Haematuria

48
Q

What type of glomerulonephritis causes very rapid renal failure?

What diseases is it associated with?

A

Rapidly progressive glomerulonephritis (RPGN)

Small vessel vasculitis (ANCA positive)

Goodpasture’s syndrome

SLE

Henoch Schonlein purpura

(all ANCA negative)

49
Q

How do ANCA positive vasculitidies cause RPGN?

A

ANCA activates neutrophils, causing inflammation

50
Q

What derm presentation of vasculitis may be seen in RPGN?

A

Non-blanching purpuric rash

51
Q

What is Goodpasture’s syndrome?

A

Type II hypersensitivity disease caused by production of autoantibodies for Type IV collagen

52
Q

Where is Type IV collagen found?

A

Kidneys (glomerular basement membrane)

Lungs

53
Q

Untreated Goodpasture’s syndrome causes which type of GN?

A

Rapidly progressing glomerulonephritis

54
Q

How is RPGN treated?

A

Immunosuppression

55
Q

In smokers / hypoxic presentation, renal failure and a vasculitic rash, suspect ___.

A

Goodpasture’s syndrome

causing RPGN

56
Q

IgA nephropathy causes (nephrotic / nephritic) syndrome.

A

NEPHRITIC syndrome

The most common primary GNs tend to cause a nephrotic syndrome

Renal Week 2 2017/18 (11 decks)

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