Glomenerulonephritis lecture notes Flashcards
What is glomerulonephritis
Broad term refers to group of parenchymal kidney disease (inflammation and damage to glomeruli)
What are signs of glomerulonephritis?
Declining renal function
Hypertension
Haematuria
Proteinuria
Glomerulonephritis causes 25% of ____
End stage kidney failure
Glomerulonephritis is usually i______ mediated
immunologically
What is deposited along the basement membrane attracting inflammatory cells? (Check this)
Immunoglobulins
Signs of acute nephritic syndrome there is…
AKI
Haematuria
And often proteinuria
Oliguria
Hypertension
Fluid overload
What are conditions that cause acute nephritic syndrome?
ANCA associated vasculitis
Goodpasture’s disease
SLE
Post-streptococcal infection
Crescentic IgA nephropathy
R__ c___ c___ on urine microscopy indicates glomerular bleeding, always in acute nephritic syndrome
Red cell clasts
What are signs of fluid retention?
Weight gain
Pulmonary oedema
Peripheral oedema
Raised JVP
Orthopnea
SOB
Hypertension
What does ANCA stand for?
Antineutrophil cystoplasmic antibodies
What is ANCA-AAV?
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.
What is a sign on the hands of ANCA-associated vasculitis?
splinter haemorrhages
How do you treat ANCA-associated vasculitis?
Immunosuppression:
steroids
Cyclophosphamide
Rituximab
plamsa exchange
What are 2 types of large vessel vasculitis?
Takayasu arteritis
Giant cell arteritis
What are 2 types of medium vessel vasculitis?
Polyarteritis nodosa
Kawasaki disease
Who is most at risk of ANCA-AAV?
Caucasians 50-80 y/o
How do you diagnose ANCA?
Serum ANCA
What would a biopsy of ANCA-AAV show?
Segmental glomerular necrosis with crescent formation.
Active lesions
Fibrosis
Tubular atrophy
What is the most common cause of glomerulonephritis in the world?
IgA nephropathy
Abnormality in IgA glycosylation leads to deposition in nephron membrane (mesangium).
How do you diagnose IgA nephropathy?
Biopsy:
Diffuse mesangial IgA deposits
Often will find subendothelial and subepithelial deposits
How do you treat IgA nephropathy?
Supportive therapy first
Possibly steroids
Budesonide recently recommended by NICE
What does SLE stand for?
Systemic Lupus Erythematosus
What characterises SLE?
Serology:
Low complement levels of C3 and C4
Anti-nuclear antibody positive
Double stranded DNA antibody positive
What are some presentations of SLE?
Renal impairment
Rash
Arthralgia
Neurological symptoms
Pericarditis
Pneomonitis
What is treatment for SLE?
Immunosuppression
Steroids
Cyclophosphamide
Mycophenolate
Mofetil
Rituximab
Who is most at risk of SLE?
Females, 15-40 y/o
African Americans, Afro-Carribeans, Hispanics, Asians
What is Goodpasture’s syndrome also known as?
Anti-glomerular basement membrane disease
What is the serology in Goodpasture syndrome?
Anti-glomerular basement membrane antibodies
What is haemoptysis?
Coughing up blood
How do you treat Goodpasture syndrome?
Remove antibody by plasma exchange whilst using immunosuppression via steroids.
Aggressive treatment, not best outcome.
What is the systemic form of IgA nephropathy called?
Henoch Schonlein purpura?
What is the characteristic triad of Henoch Schonlein purpura?
Purpuric rash, abdominal pain, AKI
Henoch Schonlein purpura is often s___ l____ but 1/3 wrelapse with some progressing to CKD
self-limiting
How do you treat Henoch Schonlein purpura?
Supportive
Steroids
What is the presentation triad for glomerulonephritis nephrotic syndrome?
Heavy proteinuria
Hypoalbuminaemia
Oedema
What are primary causes of nephrotic syndrome?
Minimal change (children and adults)
Membranous (Caucasian adults)
Focal Segmental Glomerulosclerosis
How do you establish the cause for nephrotic syndrome?
Renal biopsy
What are secondary causes of nephrotic syndrome?
Diabetes
Amyloid
Infections
SLE
Drugs
malignancy
What other investigations would be taken for nephrotic syndrome?
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
What are supportive treatments for nephrotic syndrome?
Control fluid state:
diuretics, ACEi/ARBs, spironolactone
Statins
Anticoagulation (lose coagulation factors)
Possibly prophylactic antibiotics
Membranous nephropathy is thickening of the glomerular c____ wall with IgG complement deposits in sub-epithelial surface causing leaky glomerulus
capillary
What can be used for higher risk membranous nephropathy?
Steroids
Why is it called minimal change disease?
Biopsy appears normal on light microscop
What does minimal change disease show on electron microscopy?
Fused podocytes
How do you treat minimal change disease?
Steroids
Second line = tacrolimus, cyclosporin, cyclophospharmide or rituximab
Would you take a biopsy if incidentally found haematuria on dipstick?
No unless there signs of impaired kidney function or significant proteinuria
What can cause asymptomatic urinary abnormalities?
Type IV collagen variants, inherited.
IgA
Thin membrane disease
What are some causes of CKD?
IgA nephropathy
Membranous
Diabetes
Mesangiocapillary GN
HIV associated nephropathy
Alports
