Glomerular Disease Flashcards
What is glomerulonephritis?
Inflammation of the glomerulus
Responsible for 15% end stage kidney disease
How is glomerulonephritis diagnosed?
Often relies on kidney biopsy and classified following findings
What are features of glomerulonephritis?
Harmaturia
Proteinurea
Hypertension
Renal impairment
What is a nephritic state?
Active urine sediment dysmorphic rbcs cellular casts
Hypertension
Renal impairment
Nephrotic syndrome
Odema
Nephrotic range proteinuria:3.5g per day or 350mg/mmol creatinine
Hypoalbuminemia
Dyslipidaemia
What can glomerulonephritis be separated into?
Proliferation and non proliferation
What is proliferation glomerulonephritis?
Excessive numbers of cells in glomeruli these include infiltrating leukocytes
Non proliferative glomerulonephritis?
Glomeruli look normal or have areas of scarring
They have normal numbers of cells
Diffuse
> 50% glomeruli affected
Focal
<50% glomeruli affected
Global
All glomeruli affected
Segmental
Part of the glomerulus affected
What is the most common cause of glomerulonephritis?
IgA nephropathy
What is IgA nephropathy characterised by?
IgA deposition in mesangium and mesangial proliferation
When is IgA nephropathy most common?
In 2nd and 3rd decades of life
What is the presentation of IgA nephropathy?
Microscopic haematuria
Microscopic haematuria and proteinuria
Nephrotic syndrome
IgA crescentic glomerulonephritis
What is post streptococcal glomerulonephritis?
Follows 10-21 days after infection typically throat or skin
Most commonly with lancefeild group A streptococci
Genetic predisposition HLA-DR -DP
What is Anti GBM disease?
Rare disease caused by circulating anti GBM
Around 10-20% of crecentix glomerulonephritis
How does anti GMB disease present?
Nephritis
Nephritis lung haemorrhage
How is Anti GBM disease diagnosed?
Two peaks 3rd decade and and 6/7th decade of life
Diagnosed by demonstrating anti-GBM antibodies in serum and kidney
What is treatment for anti-GBM disease?
Aggressive immune suppression steroid plasma exchange and chclophophamide
Summarise proliferative glomerulonephritides?
Present with nephritic state
Haematuria
Variable proteinuria
Hypertension
Renal impatiente
Rapid decline in function that leads to dialysis
Early diagnosis necessary to save nephrons
Non proliferative glomerulonephritis?
Minimal change disease
Focal and segmental glomerulonephritis
Membranous nephropathy
Nephrotic syndrome management?
treat oedema: salt and fluid restriction and loop diuretics
Hypertension use renin angiotensisn aldosterone blockade
Reduce risk of thrombosis heparin or warfarin
Reduce infective risk pneumococcal vaccine
Treat dyipidaemia
Specific therapy towards cause of non proliferative glomerulonephritis