glomerular disease Flashcards

1
Q

what happens to the glomerulus in nephrotic syndrome

A

basement membrane becomes very permeable to protein and protein leaks into the urine

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2
Q

presentation of nephrotic syndrome

A

proteinuria
hypoalbuminemia
oedema

can also have hypertension, hypercoagulability, hyperlipidaemia

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3
Q

general management of nephrotic syndrome

A

high dose steroids
low salt diet
diuretics
albumin infusions if needed

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4
Q

what is the most common cause of nephrotic syndrome

A

minimal change disease

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5
Q

how does minimal change disease present

A

usually presents after an illness like gastroenteritis
oedema ascites
small pleural effusions

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6
Q

investigations in minimal change disease

A

bloods for low albumin <12mg/mmol

urine dipstick -

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7
Q

what will a urine dipstick in minimal change disease show

A

protein 3+

blood 2+

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8
Q

management of minimal change disease

A

prednisolone for 8 weeks

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9
Q

what should you use if the minimal change disease relapses >4x a year

A

immunosuppressants

  • cyclosporin
  • tacrolimus
  • rituximab
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10
Q

if the minimal change disease is not responding to steroids what other diagnosis should you consider

A

focal segmental glomerulosclerosis

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11
Q

is focal segmental glomerulosclerosis nephritic or nephrotic

A

nephrotic

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12
Q

what age group is most likely to be effected by focal segmental glomerulosclerosis

A

young adults

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13
Q

what can cause FSG

A

HIV
alport’s syndrome
sickle cell anaemia

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14
Q

investigations for FSG

A

renal biopsy

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15
Q

management of FSG

A

ACEi/BP control
supportive
may need transplant

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16
Q

what is Alport syndrome

A

congenital X linked defect in type IV collagen

17
Q

what group does alports syndrome normally affect

A

young males

18
Q

pathophysiology of alports syndrome

A

defect in type IV collagen causes a defective GBM

19
Q

presentation of alport’s syndrome

A

microscopic haematuria
progressive renal failure
bilateral sensineural deafness

20
Q

management of alports

A

transplant

21
Q

what is nephritic syndrome

A

inflammation in nephrons

22
Q

presentation of nephritic syndrome

A

haematuria
less proteinuria than in nephrotic syndrome
reduced kidney function

23
Q

pathogen in post infectious glomerulosclerosis

A

usually group A strep

24
Q

pathophysiology of post infectious glomerulosclerosis

A

strep antigens deposit in glomerulus and antibodies form complexes
initiates immune response in kidney resulting in tissue injury
nephritis

25
investigations in post infectious glomerulonephritis
throat swab for tonsillitis | blood test for antibodies
26
management of post-infectious glomerulonephritis
it is self limiting so most of the time it just needs supportive management antibiotics if needed diuretics and anti-hypertensives to stop overload
27
pathophysiology of IgA nephropathy
immune complex formation in circulation | complexes deposit in the kidneys and cause inflammation and injury
28
presentation of IgA nephropathy
nephritic syndrome 1-2 days after UTI older children
29
biopsy results in IgA nephropathy
IgA deposits and glomerular mesangial proliferation
30
urine dipstick findings in IgA nephropathy
macroscopic haematuria | proteinuria
31
management of IgA nephropathy
ACEi in mild disease supportive treatment immunosuppression - cyclophosphamide steroids
32
what is henoch-schonlein purpura
a variant of IgA nephropathy
33
pathophysiology in HSP
small vessel vasculitis with IgA deposits
34
presentation of HSP
``` 5-15 year olds 1-3 days after a trigger like URTI purpuric rash with 1 of: - abdominal pain - arthritis or arthralgia - renal involvement - biopsy showing HSP ```
35
biopsy findings in HSP
IgA deposits | glomerular mesangial proliferation
36
management of HSP
treat symptoms glucocorticoids for GI involvement immunosuppression with cyclophosphamide
37
what should be screened for long term in HSP
hypertension | proteinuria