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2a Genitourinary > Glomenerulonephritis lecture notes > Flashcards

Glomenerulonephritis lecture notes Flashcards

1
Q

What is glomerulonephritis

A

Broad term refers to group of parenchymal kidney disease (inflammation and damage to glomeruli)

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2
Q

What are signs of glomerulonephritis?

A

Declining renal function

Hypertension

Haematuria
Proteinuria

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3
Q

Glomerulonephritis causes 25% of ____

A

End stage kidney failure

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4
Q

Glomerulonephritis is usually i______ mediated

A

immunologically

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5
Q

What is deposited along the basement membrane attracting inflammatory cells? (Check this)

A

Immunoglobulins

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6
Q

Signs of acute nephritic syndrome there is…

A

AKI
Haematuria
And often proteinuria
Oliguria
Hypertension
Fluid overload

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7
Q

What are conditions that cause acute nephritic syndrome?

A

ANCA associated vasculitis

Goodpasture’s disease
SLE
Post-streptococcal infection
Crescentic IgA nephropathy

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8
Q

R__ c___ c___ on urine microscopy indicates glomerular bleeding, always in acute nephritic syndrome

A

Red cell clasts

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9
Q

What are signs of fluid retention?

A

Weight gain
Pulmonary oedema
Peripheral oedema
Raised JVP
Orthopnea
SOB
Hypertension

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10
Q

What does ANCA stand for?

A

Antineutrophil cystoplasmic antibodies

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11
Q

What is ANCA-AAV?

A

Anti-neutrophil cytoplasmic antibody-associated vasculitis

Group of autoimmune diseases causing inflammation of blood vessels.

All have presence of antibodies called ANCA in teh blood.

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12
Q

What is a sign on the hands of ANCA-associated vasculitis?

A

splinter haemorrhages

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13
Q

How do you treat ANCA-associated vasculitis?

A

Immunosuppression:
steroids
Cyclophosphamide
Rituximab
plamsa exchange

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14
Q

What are 2 types of large vessel vasculitis?

A

Takayasu arteritis
Giant cell arteritis

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15
Q

What are 2 types of medium vessel vasculitis?

A

Polyarteritis nodosa
Kawasaki disease

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16
Q

Who is most at risk of ANCA-AAV?

A

Caucasians 50-80 y/o

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17
Q

How do you diagnose ANCA?

A

Serum ANCA

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18
Q

What would a biopsy of ANCA-AAV show?

A

Segmental glomerular necrosis with crescent formation.
Active lesions
Fibrosis
Tubular atrophy

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19
Q

What is the most common cause of glomerulonephritis in the world?

A

IgA nephropathy

Abnormality in IgA glycosylation leads to deposition in nephron membrane (mesangium).

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20
Q

How do you diagnose IgA nephropathy?

A

Biopsy:
Diffuse mesangial IgA deposits
Often will find subendothelial and subepithelial deposits

21
Q

How do you treat IgA nephropathy?

A

Supportive therapy first
Possibly steroids
Budesonide recently recommended by NICE

22
Q

What does SLE stand for?

A

Systemic Lupus Erythematosus

23
Q

What characterises SLE?

A

Serology:
Low complement levels of C3 and C4
Anti-nuclear antibody positive
Double stranded DNA antibody positive

24
Q

What are some presentations of SLE?

A

Renal impairment
Rash
Arthralgia
Neurological symptoms
Pericarditis
Pneomonitis

25
Q

What is treatment for SLE?

A

Immunosuppression
Steroids
Cyclophosphamide
Mycophenolate
Mofetil
Rituximab

26
Q

Who is most at risk of SLE?

A

Females, 15-40 y/o
African Americans, Afro-Carribeans, Hispanics, Asians

27
Q

What is Goodpasture’s syndrome also known as?

A

Anti-glomerular basement membrane disease

28
Q

What is the serology in Goodpasture syndrome?

A

Anti-glomerular basement membrane antibodies

29
Q

What is haemoptysis?

A

Coughing up blood

30
Q

How do you treat Goodpasture syndrome?

A

Remove antibody by plasma exchange whilst using immunosuppression via steroids.

Aggressive treatment, not best outcome.

31
Q

What is the systemic form of IgA nephropathy called?

A

Henoch Schonlein purpura?

32
Q

What is the characteristic triad of Henoch Schonlein purpura?

A

Purpuric rash, abdominal pain, AKI

33
Q

Henoch Schonlein purpura is often s___ l____ but 1/3 wrelapse with some progressing to CKD

A

self-limiting

34
Q

How do you treat Henoch Schonlein purpura?

A

Supportive
Steroids

35
Q

What is the presentation triad for glomerulonephritis nephrotic syndrome?

A

Heavy proteinuria
Hypoalbuminaemia
Oedema

36
Q

What are primary causes of nephrotic syndrome?

A

Minimal change (children and adults)

Membranous (Caucasian adults)

Focal Segmental Glomerulosclerosis

36
Q

How do you establish the cause for nephrotic syndrome?

A

Renal biopsy

37
Q

What are secondary causes of nephrotic syndrome?

A

Diabetes
Amyloid
Infections
SLE
Drugs
malignancy

38
Q

What other investigations would be taken for nephrotic syndrome?

A

Serum albumin, creatinine, lipids and glucose, urinalysis

PCR

Serum and urine electrophoresis: amyloid, myeloma

lupus markers (C3,C4, ANA, dsDNA Ab)

Hep B or Hep C antibodies (membranous)

Anti-phospholipase A2 receptor antibody

39
Q

What are supportive treatments for nephrotic syndrome?

A

Control fluid state:
diuretics, ACEi/ARBs, spironolactone

Statins

Anticoagulation (lose coagulation factors)

Possibly prophylactic antibiotics

40
Q

Membranous nephropathy is thickening of the glomerular c____ wall with IgG complement deposits in sub-epithelial surface causing leaky glomerulus

A

capillary

41
Q

What can be used for higher risk membranous nephropathy?

A

Steroids

42
Q

Why is it called minimal change disease?

A

Biopsy appears normal on light microscop

43
Q

What does minimal change disease show on electron microscopy?

A

Fused podocytes

44
Q

How do you treat minimal change disease?

A

Steroids

Second line = tacrolimus, cyclosporin, cyclophospharmide or rituximab

45
Q

Would you take a biopsy if incidentally found haematuria on dipstick?

A

No unless there signs of impaired kidney function or significant proteinuria

46
Q

What can cause asymptomatic urinary abnormalities?

A

Type IV collagen variants, inherited.
IgA
Thin membrane disease

47
Q

What are some causes of CKD?

A

IgA nephropathy
Membranous
Diabetes
Mesangiocapillary GN
HIV associated nephropathy
Alports

48
Q
A

2a Genitourinary (28 decks)

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