[8] Glomerulonephritis Flashcards
What is glomerulonephritis?
A group of disorders resulting from glomerular damage
What can glomerulonephritis lead to?
Proteinuria, with or without haematuria
AKI or end-stage renal failure
How might glomerulonephritis present?
Asymptomatic haematuria
Nephrotic syndrome
Nephritic syndrome
What are the causes of glomerulonephritis?
Idiopathic Immune Infection Drugs Amyloid
What are the immune causes of glomerulonephritis?
SLE
Goodpastures
Vasculitis
What are the infectious causes of glomerulonephritis?
HBV
HCV
Strep
HIV
What drugs can cause glomerulonephritis?
Penicillamine
Gold (?????)
What investigations should be done into glomerulonephritis?
Blood
Urine
Imaging
What basic bloods should be done in glomerulonephritis?
FBC
U&E
ESR
What other bloods should be done in glomerulonephritis?
Complement
Antibodies
Serum protein electrophoresis and Ig
Bloods to look for infection
What Abs should be looked for in glomerulonephritis?
ANA
dsDNA
ANCA
GBM
What bloods should be done to look for infection in glomerulonephritis?
ASOT (looks for strep)
HBV and HCV serology
What urine testing should be done in glomerulonephritis?
Dipstick
Spot PCR
MCS
Bence-Jones protein
What imaging should be done in glomerulonephritis?
CXR
Renal US, with or without biopsy
What may be found on CXR in glomerulonephritis?
Infiltrates
Give two examples of when infiltrates may be seen on CXR in glomerulonephritis?
Goodpasture’s
Wegener’s
What is involved in the general management of glomerulonephritis?
Refer to nephrologist
Rx HTN aggressively, including ACEi and ARA
What BP should be aimed for in glomerulonephritis?
<130/80
What are the causes of asymptomatic haematuria?
IgA nephropathy
Thin BM disease
Alport’s syndrome
Who does IgA nephropathy most common present in?
Young males
How does IgA nephropathy commonly present?
Episodic macroscopic haematuria occuring a few days after a URTI, with rapid recovery between attacks
What is found on blood testing in Iga nephropathy?
Increased IgA
What can IgA nephropathy occassionally lead to?
Nephritic syndrome
What is found on biopsy in IgA nephropathy?
IgA deposition in mesangium
How is IgA nephropathy managed?
Steroids or cyclophosphamide if decreased renal function
What is the prognosis of IgA nephropathy?
20% develop end-stage renal failure after 20 years
What is the inheritance pattern of thin BM disease?
Autosomal dominant
What is the risk of end-stage renal failure in thin BM disease?
Very small
What is the inheritance pattern of Alport’s syndrome?
85% of cases are X-linked
How does thin BM disease present?
Persistent, asymptomatic microscopic haematuria
What are the features of Alport’s syndrome?
Haematuria and proteinuria lead to progressive renal failure
Sensorineural deafness
Lens dislocation and cataracts
Retinal ‘flecks’
How does Alports syndrome present in females?
With haematuria only
What are the features of nephritic syndrome?
Haematuria and red cell casts Proteinuria Hypertension Oedema Oliguria and progressive renal impairment
Is the haematuria macroscopic or microscopic in nephritic syndrome?
Can be either
Where is oedema common in nephritic syndrome?
Periorbital
What are the causes of nephritic syndrome?
Proliferative/post-streptococcal
Crescentic/RPGN
Who is proliferative/post-streptococcal nephritic syndrome most common in?
Young children
How does proliferative/post-streptococcal nephritic syndrome present?
Malaise and nephritic syndrome with smoky urine developing 1-2 weeks after sore throat or skin infection
What is found on blood testing in proliferative/post-streptococcal nephritic syndrome?
Increased ASOT (titre for strep) Decreased C3
What is found on biopsy in proliferative/post-streptococcal nephritic syndrome?
IgG and C3 deposition
How is proliferative/post-streptococcal nephritic syndrome managed?
Supportive treatment
What is the prognosis of proliferative/post-streptococcal nephritic syndrome?
95% of children make a full recovery, but a minority develop RPGN
What is the importance of crescenteric/RPGN?
It is the most aggressive form of GN, which can lead to end-stage renal failure in days
What are the types of RPGN?
Type 1 - Anti-GBM (Goodpasture’s)
Type 2 - Immune complex deposition
Type 3 - Pauci immune
What % of cases of RPGN are type 1?
5%
What happens in Goodpasture’s?
There are antibodies to non-collagenous domain of type 4 collagen
What are the features of Goodpasture’s?
Haematuria and haemoptysis
What does the CXR show in Goodpasture’s?
Infiltrates
How is Goodpasture’s managed?
Plasmapheresis and immunosuppression
What % of cases of RPGN are due to immune complex deposition?
45%
What causes immune complex deposition RPGN?
It is a complication of anny immune complex deposition, e.g. Berger’s, post-strep, endocarditis, SLE
What % of cases of RPGN are Pauci immune?
50%
What causes cANCA +ve Pauci immune RPGN?
Wegener’s
What causes pANCA +ve Pauci immune RPGN?
Microscopic polyangiitis
Churg-Strauss
What are the features of nephrotic syndrome?
Proteinuria
Hypoalbuminaemia
Oedema
What is the diagnostic criteria for proteinuria in nephrotic syndrome?
PCR >300mg/mM, or 3g/24 hours
What is considered to be hypoalbuminaemia in nephrotic syndrome?
<35g/L
Where does oedema develop in nephrotic syndrome?
Periorbital
Genital
Ascites
Peripheral
What is the consequence of the oedema in nephrotic syndrome?
Often intravascularly depleted, with decreased JVP
What are the potential complications of nephrotic syndrome?
Infection
VTE
Hyperlipidaemia
Why is there an increased risk of infection in nephrotic syndrome?
Decreased Ig
Decreased complement activity
What is the risk of VTE in nephrotic syndrome?
Up to 40%
What is the result of the risk of hyperlipidaemia in nephrotic syndrome?
You should check lipids
Which nephrotic syndrome patients should have a biopsy?
All adults
What should be done before biopsy in children with nephrotic syndrome?
Give steroids and see if they help (children mostly have minimal change glomerulonephritis)
What are the causes of nephrotic syndrome?
Minimal change glomerulonephritis Membranous nephropathy FSGS Membranoproliferative/mesangiocapillary GN Secondary to system disease
What systemic diseases might nephrotic syndrome be secondary to?
Diabetes mellitus
SLE
Amyloidosis
What kind of nephrotic syndrome is produced in diabetes mellitus?
Glomerulosclerosis
What kind of nephrotic syndrome is produced in SLE?
Membranous
What is the most common cause of nephrotic syndrome in children?
Minimal change glomerulonephritis
What is minimal change glomerulonephritis associated with?
URTI
What is found on biopsy in minimal change glomerulonephritis?
Normal light microscopy
Fusion of podocytes on electron microscopy
How is minimal change glomerulonephritis managed?
Steroids
What is the prognosis of minimal change glomerulonephritis?
1% progress to end-stage renal failure
What % of cases of adult nephrotic syndrome are caused by membranous nephropathy?
20-30%
What is membranous nephropathy associated with?
Cancer
Autoimmune disease
Infections
Drugs
What cancers is membranous nephropathy associated with?
Lung
Colon
Breast
What autoimmune diseases is membranous nephropathy associated with?
SLE
Thyroid disease
What infections is membranous nephropathy associated with?
HBV
What drugs is membranous nephropathy associated with?
Penicillamine
Gold
What is found on biopsy in membranous nephropathy?
Subepithelial immune complex deposits
How is membranous nephropathy managed?
Immunosuppression if renal function declines
What is the prognosis of membranous nephropathy?
40% spontaneous remission
Which race is FSGS most common in?
Afro-Caribbeans
What are the categories of FSGS?
Idiopathic
Secondary
What might FSGS be secondary to?
Vesicoureteral reflux
Berger’s
HIV
Sickle-cell disease
What is found on biopsy in FSGS?
Focal scarring
IgM deposition
How is FSGS managed?
Steroids, or cyclophosphamide/ciclosporin
What is the prognosis of FSGS?
30-50% progress to end-stage renal failure
Can FSGS reoccur in transplants?
Yes
Is membranoproliferative/mesangiocapillary GN common?
No, it is rare
Does membranoproliferative GN cause nephritic or nephrotic syndrome?
Can be either
What other conditions is membranoproliferative GN associated with?
HBV
HCV
Endocarditis
What is the prognosis of membranoproliferstive GN?
50% progress to end-stage renal failure
What needs to be monitored in nephrotic syndrome?
U&E
BP
Fluid balance
Weight
How is nephrotic syndrome managed?
Treat underlying cause
Management of symptoms and complications
How is oedema caused by nephrotic syndrome managed?
Salt and fluid restriction
Furosemide
How is proteinuria caused by nephrotic syndrome managed?
ACEi / ARA
How is hyperlipidaemia caused by nephrotic syndrome managed?
Statins
How is VTE caused by nephrotic syndrome managed?
Tinzaparin
idk what this is but the notes are like 6 years old so probs just normal management now idk xo