Glomerular Disease Flashcards
What is glomerulonephritis and what structures can it damage
Inflammation of the glomeruli
Can damage capillary endothelium, GBM, mesangial cells and/or podocytes
What are the clinical presentations of glomerulonephritis
Asymptomatic proteinuira/haematuria - IgA, SLE, FSGS
Chronic glomerulonephritis - IgA, SLE, any treated GN
Acute glomerulonephritis - IgA, SLE, post-infectious, ANCA-vasculitis
Rapidly progressive glomerulonephritis - ANCA-vasculitis, Goodpasture’s, post-infectious, SLE
Nephrotic syndrome - minimal changes, SLE, membranous, FSGS
What is nephrotic syndrome and what features are associated with it
Podocyte, subepithelial or GBM damage causing distruption to the glomerular filtration barrier. Nephrotic syndrome is the triad of:
- Proteinuira > 250mg/mmol
- Hypoalbuminaemia
- Oedema
Other features include:
- High cholesterol
- Hypercoagulable
- BP often normal but can be high or low
- Can become immunocompromised
Name some causes of nephrotic syndrome
Minimal change disease
Membranous nephropathy
Focal segmental glomerulosclerosis
Diabetes
SLE
Connective tissue disorders
What is the treatment for nephrotic syndrome
Large dose of diuretics - treat oedema
Restrict salt and water - treat oedema
ACE-inhibitor - anti-proteinuria
Treat underlying condition - also helps to treat hypercholesterolaemia
What is nephritic syndrome and what features are associated with it
Inflammation of the glomerulus/kidneys that disrupts the GBM. Have triad of:
- Haematuria
- Decreased GFR
- Hypertension
Other features include:
- Some proteinuria
- Inflammatory response and damage to glomerulus
- Onset may be acute or rapidly progressive (RPGN)
Name some causes of nephritic syndrome
Anti-GBM disease/Goodpasture’s
ANCA-assocaited vasculitis
IgA purpura
Post-infectious
Lupus/SLE
Name some conditions that can present as either nephrotic or nephritic syndrome
IgA purpura
Post-infectious
Lupus/SLE
What is the management for nephritic syndrome
BP control and decrease proteinuria - ACE-I or AIIR if renal function allows it
Restrict salt to control BP
Large dose of diuretics to treat oedema - only if renal function OK
Treat underlying cause
Dialysis
Decrease risk of cardiovascular problems - stop smoking, statins, etc
Describe minimal change glomerulonephritis
Common in childhood/adolescence
Have heavy proteinuria/nephrotic syndrome
There is loss of the foot processes of podocytes -> no filters -> proteinuria - must be diagnosed using electron microscopy
Patient will respond to steroids -> suggests immune component to the condition
Usually no progression to renal failure
What is FSGS
Focal segmental glomerulosclerosis
Condition causing scarring of the glomeruli
Caused by circulating factor damaging podocytes
Affects only some glomeruli, some parts of the glomerulus
Occurs in adults and causes nephrotic syndrome
Less responsive to steroids
Causes glomerulosclerosis -> can progress to renal failure
Describe membranous glomerulonephritis
Commonest cause of nephrotic syndrome
Immune complexes are found in glomerulus - antigen is found in glomerulus and then antibodies (IgG) are produced against the antigen
IgG is filtered and binds to antigen -> causes immune response
Membranes look thick histologically and have immune deposits of IgG in the glomerulus with immune response against podocytes
Describe IgA nephropathy
Commonest GN and can occur at any age
Classically present with visible/invisible haematuria
IgA is deposited in the mesangium -> causes mesangial damage which results in damage to glomerulus
Histological features and course of the disease are variable
Can have proteinuria
Most progress to renal failure
Describe two hereditary nephropathies
Thin GBM nephropathy (benign familial nephropathy) - thin GBM causes isolated haematuria. Has benign course so does not cause renal failure
Alport syndrome - X-lined disease causing abnormal collagen IV. Associated deafness (sensory organs contain collagen IV). Progress to renal failure
Describe ANCA-associated vasculitis
Anti-neutrophil cytoplasmic antibody
Granulomatosis with polyangiits
Affects small arterioles
Caused by circulating antibodies against WBC but does not cause immune deposits in the kidney
Causes endothelial damage
Often have systemic symptoms, e.g. fatigue, arthralgia, myalgia, weight loss
