Clinical Glomerular Disease Flashcards
What is glomerulonephritis?
- A group of inflammatory disorders of the disease and are responsible for almost 30% of ESRD.
- They are classified based on morphology and the majority are attributed to autoimmune aetiologies
What are the features of glomerulonephritis?
- Haematuria
- Proteinuria
- Hypertension
- Renal insufficiency
How does macroscopic haematuria present?
Tea or cola coloured or frank blood
How does microscopic haematuria present?
> 5 RBC per high power field
In what syndrome does haematuria present more often?
Nephritic> nephrotic
What can the source of haematuria be?
- Kidneys
- Ureters
- Bladder
- Prostate
- Urethra
How does haematuria present in glomerulonephritis?
Persistent microscopic haematuria. Microscopy shows dysmorphic RBC (Mickey mouse like)
How does proteinuria present in glomerulonephritis?
Persistent, proteinuria of more than 1 gram /mmol creatinine.
How can proteinuria be investigated?
Urine protein creatinine ratio or 24 hour urine collection
What is considered hypertension?
> 140/80mmHg
Does proteinuria occur more in nephrotic or nephritic syndrome?
Equal
Does hypertension occur more in nephrotic or nephritic syndrome?
Nephritic> nephrotic
What are the features of nephritic syndrome?
- Active urine sediment: haematuria, dysmorphic RBCs and cellular casts
- Hypertension
- Renal impairment
What are the features of nephrotic syndrome?
- Oedema
- Proteinuria >3.5 g/day
- Hypoalbuminemia
- Hyperlipidemia
What can cause nephrotic syndrome?
Primary (idiopathic) glomerular disease or secondary glomerular disease
What is the differential diagnosis for nephrotic syndrome?
- Congestive heart failure (JVP raised, normal albumin, minimal proteinuria)
- Hepatic disease (abnormal LFTs, no proteinuria)
What can glomerulonephritis be classified according to?
- Aetiology
- Primary vs secondary (kidneys alone or multisystem disease)
- Morphological
What is the aetiology of glomerulonephritis?
- Autoimmune
- Infection
- Malignancy
- Drugs
- Others
What is proliferative glomerulonephritis?
Excessive numbers of cells in glomeruli. These include infiltrating leucocytes
What is non-proliferative glomerulonephritis?
Glomeruli look normal or have areas of scarring. They have normal numbers of cells
Define diffuse glomerulonephritis.
> 50% of glomeruli affected
Define focal glomerulonephritis.
<50% of glomeruli affected
Define global glomerulonephritis.
All the glomerulus affected
Define segmental glomerulonephritis
Part of the glomerulonephritis
What glomerulonephritis presents with urinary sediment abnormalities?
IgA nephropathy
What glomerulonephritis presents with proteinuria?
IgA nephropathy
What types of glomerulonephritis present with nephrotic syndrome?
- Minimal change disease
- Membranous nephropathy