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ANKI Infectious Diseases > [8] Glomerulonephritis > Flashcards

[8] Glomerulonephritis Flashcards

1
Q

What is glomerulonephritis?

A

A group of disorders resulting from glomerular damage

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2
Q

What can glomerulonephritis lead to?

A

Proteinuria, with or without haematuria

AKI or end-stage renal failure

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3
Q

How might glomerulonephritis present?

A

Asymptomatic haematuria
Nephrotic syndrome
Nephritic syndrome

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4
Q

What are the causes of glomerulonephritis?

A 
Idiopathic
Immune
Infection
Drugs
Amyloid
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5
Q

What are the immune causes of glomerulonephritis?

A

SLE
Goodpastures
Vasculitis

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6
Q

What are the infectious causes of glomerulonephritis?

A

HBV
HCV
Strep
HIV

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7
Q

What drugs can cause glomerulonephritis?

A

Penicillamine

Gold (?????)

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8
Q

What investigations should be done into glomerulonephritis?

A

Blood
Urine
Imaging

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9
Q

What basic bloods should be done in glomerulonephritis?

A

FBC
U&E
ESR

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10
Q

What other bloods should be done in glomerulonephritis?

A

Complement
Antibodies
Serum protein electrophoresis and Ig
Bloods to look for infection

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11
Q

What Abs should be looked for in glomerulonephritis?

A

ANA
dsDNA
ANCA
GBM

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12
Q

What bloods should be done to look for infection in glomerulonephritis?

A

ASOT (looks for strep)

HBV and HCV serology

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13
Q

What urine testing should be done in glomerulonephritis?

A

Dipstick
Spot PCR
MCS
Bence-Jones protein

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14
Q

What imaging should be done in glomerulonephritis?

A

CXR

Renal US, with or without biopsy

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15
Q

What may be found on CXR in glomerulonephritis?

A

Infiltrates

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16
Q

Give two examples of when infiltrates may be seen on CXR in glomerulonephritis?

A

Goodpasture’s

Wegener’s

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17
Q

What is involved in the general management of glomerulonephritis?

A

Refer to nephrologist

Rx HTN aggressively, including ACEi and ARA

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18
Q

What BP should be aimed for in glomerulonephritis?

A

<130/80

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19
Q

What are the causes of asymptomatic haematuria?

A

IgA nephropathy
Thin BM disease
Alport’s syndrome

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20
Q

Who does IgA nephropathy most common present in?

A

Young males

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21
Q

How does IgA nephropathy commonly present?

A

Episodic macroscopic haematuria occuring a few days after a URTI, with rapid recovery between attacks

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22
Q

What is found on blood testing in Iga nephropathy?

A

Increased IgA

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23
Q

What can IgA nephropathy occassionally lead to?

A

Nephritic syndrome

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24
Q

What is found on biopsy in IgA nephropathy?

A

IgA deposition in mesangium

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25
Q

How is IgA nephropathy managed?

A

Steroids or cyclophosphamide if decreased renal function

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26
Q

What is the prognosis of IgA nephropathy?

A

20% develop end-stage renal failure after 20 years

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27
Q

What is the inheritance pattern of thin BM disease?

A

Autosomal dominant

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28
Q

What is the risk of end-stage renal failure in thin BM disease?

A

Very small

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29
Q

What is the inheritance pattern of Alport’s syndrome?

A

85% of cases are X-linked

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30
Q

How does thin BM disease present?

A

Persistent, asymptomatic microscopic haematuria

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31
Q

What are the features of Alport’s syndrome?

A

Haematuria and proteinuria lead to progressive renal failure
Sensorineural deafness
Lens dislocation and cataracts
Retinal ‘flecks’

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32
Q

How does Alports syndrome present in females?

A

With haematuria only

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33
Q

What are the features of nephritic syndrome?

A 
Haematuria and red cell casts
Proteinuria 
Hypertension
Oedema
Oliguria and progressive renal impairment
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34
Q

Is the haematuria macroscopic or microscopic in nephritic syndrome?

A

Can be either

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35
Q

Where is oedema common in nephritic syndrome?

A

Periorbital

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36
Q

What are the causes of nephritic syndrome?

A

Proliferative/post-streptococcal

Crescentic/RPGN

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37
Q

Who is proliferative/post-streptococcal nephritic syndrome most common in?

A

Young children

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38
Q

How does proliferative/post-streptococcal nephritic syndrome present?

A

Malaise and nephritic syndrome with smoky urine developing 1-2 weeks after sore throat or skin infection

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39
Q

What is found on blood testing in proliferative/post-streptococcal nephritic syndrome?

A 
Increased ASOT (titre for strep)
Decreased C3
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40
Q

What is found on biopsy in proliferative/post-streptococcal nephritic syndrome?

A

IgG and C3 deposition

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41
Q

How is proliferative/post-streptococcal nephritic syndrome managed?

A

Supportive treatment

42
Q

What is the prognosis of proliferative/post-streptococcal nephritic syndrome?

A

95% of children make a full recovery, but a minority develop RPGN

43
Q

What is the importance of crescenteric/RPGN?

A

It is the most aggressive form of GN, which can lead to end-stage renal failure in days

44
Q

What are the types of RPGN?

A

Type 1 - Anti-GBM (Goodpasture’s)
Type 2 - Immune complex deposition
Type 3 - Pauci immune

45
Q

What % of cases of RPGN are type 1?

A

5%

46
Q

What happens in Goodpasture’s?

A

There are antibodies to non-collagenous domain of type 4 collagen

47
Q

What are the features of Goodpasture’s?

A

Haematuria and haemoptysis

48
Q

What does the CXR show in Goodpasture’s?

A

Infiltrates

49
Q

How is Goodpasture’s managed?

A

Plasmapheresis and immunosuppression

50
Q

What % of cases of RPGN are due to immune complex deposition?

A

45%

51
Q

What causes immune complex deposition RPGN?

A

It is a complication of anny immune complex deposition, e.g. Berger’s, post-strep, endocarditis, SLE

52
Q

What % of cases of RPGN are Pauci immune?

A

50%

53
Q

What causes cANCA +ve Pauci immune RPGN?

A

Wegener’s

54
Q

What causes pANCA +ve Pauci immune RPGN?

A

Microscopic polyangiitis

Churg-Strauss

55
Q

What are the features of nephrotic syndrome?

A

Proteinuria
Hypoalbuminaemia
Oedema

56
Q

What is the diagnostic criteria for proteinuria in nephrotic syndrome?

A

PCR >300mg/mM, or 3g/24 hours

57
Q

What is considered to be hypoalbuminaemia in nephrotic syndrome?

A

<35g/L

58
Q

Where does oedema develop in nephrotic syndrome?

A

Periorbital
Genital
Ascites
Peripheral

59
Q

What is the consequence of the oedema in nephrotic syndrome?

A

Often intravascularly depleted, with decreased JVP

60
Q

What are the potential complications of nephrotic syndrome?

A

Infection
VTE
Hyperlipidaemia

61
Q

Why is there an increased risk of infection in nephrotic syndrome?

A

Decreased Ig

Decreased complement activity

62
Q

What is the risk of VTE in nephrotic syndrome?

A

Up to 40%

63
Q

What is the result of the risk of hyperlipidaemia in nephrotic syndrome?

A

You should check lipids

64
Q

Which nephrotic syndrome patients should have a biopsy?

A

All adults

65
Q

What should be done before biopsy in children with nephrotic syndrome?

A

Give steroids and see if they help (children mostly have minimal change glomerulonephritis)

66
Q

What are the causes of nephrotic syndrome?

A 
Minimal change glomerulonephritis 
Membranous nephropathy
FSGS
Membranoproliferative/mesangiocapillary GN
Secondary to system disease
67
Q

What systemic diseases might nephrotic syndrome be secondary to?

A

Diabetes mellitus
SLE
Amyloidosis

68
Q

What kind of nephrotic syndrome is produced in diabetes mellitus?

A

Glomerulosclerosis

69
Q

What kind of nephrotic syndrome is produced in SLE?

A

Membranous

70
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal change glomerulonephritis

71
Q

What is minimal change glomerulonephritis associated with?

A

URTI

72
Q

What is found on biopsy in minimal change glomerulonephritis?

A

Normal light microscopy

Fusion of podocytes on electron microscopy

73
Q

How is minimal change glomerulonephritis managed?

A

Steroids

74
Q

What is the prognosis of minimal change glomerulonephritis?

A

1% progress to end-stage renal failure

75
Q

What % of cases of adult nephrotic syndrome are caused by membranous nephropathy?

A

20-30%

76
Q

What is membranous nephropathy associated with?

A

Cancer
Autoimmune disease
Infections
Drugs

77
Q

What cancers is membranous nephropathy associated with?

A

Lung
Colon
Breast

78
Q

What autoimmune diseases is membranous nephropathy associated with?

A

SLE

Thyroid disease

79
Q

What infections is membranous nephropathy associated with?

A

HBV

80
Q

What drugs is membranous nephropathy associated with?

A

Penicillamine

Gold

81
Q

What is found on biopsy in membranous nephropathy?

A

Subepithelial immune complex deposits

82
Q

How is membranous nephropathy managed?

A

Immunosuppression if renal function declines

83
Q

What is the prognosis of membranous nephropathy?

A

40% spontaneous remission

84
Q

Which race is FSGS most common in?

A

Afro-Caribbeans

85
Q

What are the categories of FSGS?

A

Idiopathic

Secondary

86
Q

What might FSGS be secondary to?

A

Vesicoureteral reflux
Berger’s
HIV
Sickle-cell disease

87
Q

What is found on biopsy in FSGS?

A

Focal scarring

IgM deposition

88
Q

How is FSGS managed?

A

Steroids, or cyclophosphamide/ciclosporin

89
Q

What is the prognosis of FSGS?

A

30-50% progress to end-stage renal failure

90
Q

Can FSGS reoccur in transplants?

A

Yes

91
Q

Is membranoproliferative/mesangiocapillary GN common?

A

No, it is rare

92
Q

Does membranoproliferative GN cause nephritic or nephrotic syndrome?

A

Can be either

93
Q

What other conditions is membranoproliferative GN associated with?

A

HBV
HCV
Endocarditis

94
Q

What is the prognosis of membranoproliferstive GN?

A

50% progress to end-stage renal failure

95
Q

What needs to be monitored in nephrotic syndrome?

A

U&E
BP
Fluid balance
Weight

96
Q

How is nephrotic syndrome managed?

A

Treat underlying cause

Management of symptoms and complications

97
Q

How is oedema caused by nephrotic syndrome managed?

A

Salt and fluid restriction

Furosemide

98
Q

How is proteinuria caused by nephrotic syndrome managed?

A

ACEi / ARA

99
Q

How is hyperlipidaemia caused by nephrotic syndrome managed?

A

Statins

100
Q

How is VTE caused by nephrotic syndrome managed?

A

Tinzaparin

idk what this is but the notes are like 6 years old so probs just normal management now idk xo

ANKI Infectious Diseases (19 decks)

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