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Renal > 4.8: Glomerulonephritis > Flashcards

4.8: Glomerulonephritis Flashcards

1
Q

Name some glomerular diseases?

A

Glomerulonephritis

Diabetic Nephropathy

Transplant Glomerulopathy

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2
Q

True or False:

Chronic Glomerulonephritis is the 2nd most common cause of end stage renal disease failure after diabetes?

A

TRUE

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3
Q

How can glomerulonephritis present?

A

Chronic - Most common

Acute - very agressive, reversible

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4
Q

What is glomerulonephritis?

A

Immune Mediated disease of the kidneys affecting the glomeruli (with secondary tubulointerstitial damage)

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5
Q

Describe the pathogenesis of glomerulonephritis?

A

Humoral - Driven by antibodies. Caused by circulating immune complexes

Cell-Mediated (T cells)

Can also be caused by inflammatory cells, mediators and complement

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6
Q

Describe what happens when there is disruption of the glomerular capillary wall?

A

Leads to haematuria and proteinuria

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7
Q

Describe the lesion and urine if there is:

  • Endothelial/Mesangial Cell Damage
  • Podocyte Damage
A

Endothelial/Mesangial cell damage leads to PROLIFERATIVE lesion and RED CELLS in urine

Podocyte damage leads to NON PROLIFERATIVE lesion and PROTEIN in urine

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8
Q

Describe the clinical presentation of glomerulonephritis?

A

Asymptomatic Microscopic haematuria

Painless macroscopic haematuria

Proteinuria

Hypertension

Impaired Renal Function (GFR)

Nephrotic Syndrome

Nephritic Syndrome

Nephrotic-Nephritic Syndrome

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9
Q

Describe nephritic syndrome?

A

Haematuria

Red Cell Casts

Proteinuria (Small amount)

Hypertension

Reduced urine output

PROLIFERATIVE PROCESS

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10
Q

Describe nephrotic syndrome?

A

Hypoalbuminaemia

Proteinuraeia (>3g/day)

Oedema

Hyperlipidaemia

NON PROLIFERATIVE PROCESS

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11
Q

Complications of nephrotic syndrome?

A

Infections

Renal Vein Thrombus

Pulmonary Emboli

Volume Depletion (due to over aggressive use of diuretics)

Vitamin D Deficient

Sub clinical Hypothyroidism

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12
Q

What are the causes of glomerulonephritis?

A

Most common = Idiopathic

Secondary glomerulonephritis is less common but can be caused by:

  • Infections
  • Drugs
  • Malignancy
  • Systemic Disease (Vasculitis)
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13
Q

How is glomerulonephritis classified?

A

By aetiology or by histology (from renal biopsy)

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14
Q

Describe the different histological classifications of glomerulonephritis?

A

Proliferative or Non Proliferative

Focal/Diffuse (< or > 50% glomeruli affected)

Global/Segmental (All or parts of glomeruli affected)

Crescentic (Presence of crescents)

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15
Q

What are the two types of treatment for glomerulonephritis?

A

Non-Immunosuppressive

Immunosupressive Means

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16
Q

Describe non-immunosuppressive treatment of glomerulonephritis?

A
  • Lower BP using anti-hypertensives

(Target is less than 130/80)

  • ACE Inhibitors or ARBs (these also reduce proteinuria)
  • Diuretics
  • Statins
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17
Q

Describe immunosuppressive treatments of glomerulonephritis?

A
  • Corticosteroids (Oral Prednisolone)
  • Azathioprine
  • Cyclophosphamide
  • Cylosporin
  • MMF
  • Plasmapharesis (like dialysis)
  • IV Immunoglobulin
18
Q

Describe the treatment of nephrotic patients?

A
  • Fluid Restriction
  • Salt restriction
  • Diuretics
  • ACE Inhibitors and ARBs
  • IV Albumin (if volume depleted)

IMMUNOSUPPRESSION IF TREATMENT ISN’T WORKING

19
Q

What is the main type of glomerulonephritis?

A

Main type is idiopathic

20
Q

What is the commonest cause of nephrotic syndrome in children?

In adults?

A

Minimal Change Syndrome/Nephropathy

Adults: FSGS (Focal Segmental Glomerulosclerosis)

21
Q

Describe minimal change nepropathy?

Diagnosis?

Treatment and Prognosis?

Link to renal failure?

A

Commonest cause of renal nephropathy in children

Diagnosis: Has no changes on biopsy

On electron microscopy there is foot process fusion

94% will achieve complete remission with steroids alone

Some can be steroid resistant/relapse and need Cyclophosphamide

DOES NOT CAUSE PROGRESSIVE RENAL FAILURE

22
Q

What does this photo show?

A

Fusion of the foot processes on electron microscopy

Seen in minimal change nepropathy

23
Q

Describe FSGS?

Seen in who?

Diagnosis?

Treatment?

A

Focal Segmental Glomerulosclerosis

Commonest cause of nephrotic syndrome in adults

Can be primary (most common) or secondary (Eg: HIV, Obesity, Heroin Use)

Renal biopsy shows minimal immunoglobulin and complement deposition on immunflurosence

Remission with steroids

Some will progress to end stage renal failure

24
Q

What does this photo show?

A

Focal Segmental Glomerulosclerosis

There is a pink sclerotic patch in the glomerulus (red circle)

Focal = Only one glomeruli out of the two is affected (right hand side glomeruli)

Segmental - just one part of glomerulus affected

25
Q

Differences and similarilties between minimal change nepropathy and focal segmental glomerulosclerosis?

  • Proliferative or non proliferative?
  • Which part of the glomerular barrier do they affect?
  • Are they progressive or non progressive?
A

Both non-proliferative

Both affect the epithelial part of barrier

FSGS progressive decline in renal function unlike minimal change

  • FSCG –> Renal Failure
  • Minimal Change does NOT progress to renal failure
26
Q

True or false:

67% of FSGS patients have increased suPAR levels?

A

TRUE

67% of adults with focal segmental glomerulosclerosis have increased suPAR levels

27
Q

What is the 2nd commonest cause of nephrotic syndrome in adults?

A

Membranous Nephropathy

28
Q

Describe membranuos nephropathy?

Cause?

Biopsy?

Treatment?

Prognosis?

A

2nd commonest cause of adult neprothic syndrome (most common cause in UK)

Can be primary or secondary (Hep B, Parasite, Lupus, Malignancy, Drugs)

BIOPSY: Immune complexes in the basemement mebrane

Treatment: Steroids/Alkylating Agents

Prognosis - 30% progress to end stage renal failure

29
Q

True or false:

Anti-PLA2r is the antibody present in over 70% of cases of SECONDARY membranous nephropathy?

A

FALSE

Anti-PLA2r is the antibody seen in over 70% of cases of PRIMARY membranous nephropathy

30
Q

What does this photo show?

A

Membranous Nepropathy

There is thickening of the basement membrane caused by immune complex deposition

31
Q

What is the commonest glomerulonephritis in the world?

A

IgA Nephropathy

32
Q

Describe IgA Nephropathy?

How does it present?

AKI or CKD?

Cutaneous Symptoms?

Prognosis?

Treatment?

A

Commonest glomerulonephritis in the world

May be asymptomatic, microscopic haematuria or macroscopic haematuria

Can cause AKI but more commonly CKD

Henoch-Shconlein Purpura

25% process to renal failure

Good BP control with ACEIs, ARBs

33
Q

Describe rapidly progressive glomerulonephritis?

Symptoms?

Biopsy?

A

Treatable cause of acute renal failure

Rapid deterioation over days/weeks

Symptoms include active urinary sediment (red cells)

Biopsy shows granular crescents

34
Q

What are the two types of rapidly progressive glomerulonephritis?

A

ANCA-Positive

ANCA-Negative

ANCA = Anti-Neutrophil Cytoplasmic Antibodies

35
Q

Name some ANCA positive diseases?

Name some ANCA negative disease?

A

ANCA positive = Vasculitis (Wegner’s Granulomatosis, Microscopic Polyangiitis)

ANCA Negative = Goodpastures, Henoch Schloein Purpura/IGA, SLE

36
Q

How are ANCA antibodies detected?

A

Indirect immunofluoresence

37
Q

What does this photo show?

A

Compression of a glomerulus by inflammation crescent

Can lead to glomerular necrosis

Seen in rapidly progressive glomerulonephritis

38
Q

What kind of rash is this? (Non-blanching)

A

Vasculitis Rash

Non-Blanching Rash

39
Q

Describe Goodpastures Syndrome?

What antibodies are seen?

A

Called renal-pulmonary disease

Anti-GBM antibodies (Glomerular basemement membrane antibodies)

40
Q

Treatment of rapid progressive glomerulonephritis?

A

Immunosuppression

  • Steroids (IV Methylprednisolone)
  • Cyclophosphamide)

Renal (34 decks)

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