Dr Pickering teaching - Glomerulonephritis Flashcards
Signs of glomerular disease
- Haematuria - cola coloured, pink
- Proteinuria - frothy/bubbly
- Decreased filtration of toxins - buildup
- Water retention - oedema
- Na+ retention
- AKI can present
3 causes of blood and protein in urine
- Bladder cancer
- Glomerulonephritis
- UTI - would get leukocytes too
How do you know if haematuria is from glomerulus or further down like bladder/urethra?
- Dysmorphic (or crenated) cells if GN cause
- Red cell casts if GN cause
Nephrotic syndrome triad (+others)
- Oedema
- Proteinuria (more than 3g in 24hrs)
- Hypoalbuminaemia (less than 30g/L)
Others:
* hyperlipidaemia
* increase risk clots - loss fibrinolytic protein (antithrombin protein C and S)
* immunosupressed - loss of immunoglobulins
Nephritic syndrome triad
- Haematuria
- Proteinuria (less than 3g in 24hrs)
- Hypertension
- +/- oedema
- Albumin usually preserved
Examples of nephritic syndromes presentation causes
- RPGN
- IgA nephropathy
- Alport syndrome
Examples of nephrotic/nephritic syndrome combo
- Diffuse proliferative GN
- Membranoproliferative GN
- Post-streptococcal GN
Examples of nephrotic syndromes presentation causes - typically
Not always the case of how they present but majority of the time
- Minimal change disease
- Membranous GN
- FSGS
- Amyloidosis
- Diabetic nephropathy
What is the only nephrotic syndrome which causes AKI usually?
Minimal change disease
Diagnosis - gold standard for GN
Biopsy
Most common nephrotic syndrome in adults cause
Membranous glomerulonephritis - can be primary or secondary
Secondary triggers inc diabetes, drugs, malignancy of solid organ, lupus
Dr Pickerings table 1
Dr Pickering table 2
What to suspect if urine dip is majority/just protein?
- Diabetes
- Amyloidosis
- Myeloma
What to think if just blood in urine drip mainly?
RPGN:
Eg
* ANCA +ve vasculitis
* SLE
* Anti GBM (Goodpastures)
What is usually present RPGN causes of blood in urine?
- Constitutional symptoms - fever, weight loss, night sweats
- Skin involvement
- Joint involvement
- Goodpastures - lungs involved –> haemoptysis
- ANCA +ve - hearing/URT symptoms and LRT symptoms
Serology for RPGN
- ANCA
- Anti dsDNA, ANA
- Anti GBM
Light microscope for RPGN
- Cresents
- Fibrinoid necrosis
- Inflammation
Treatment for RPGN
- Steroids
- Cyclophosphamide
Management diabetic nephropathy
- ACEi/ARB
- Control BP
- SGLT2 inhibitors
- Lifetstyle advice
- Address CVD risk - this is the thing that KILLS people
Presentation of diabetic nephropathy
- Microalbuminuria
- Macro
- CKD
- The ESRF
- Decreased eGFR
- Preserved albumin
- No oedema
Classical telltale sign on light microscope of DM nephropathy
- Kimmelsteil Wilson nodules
- Thickened membranes
