Glomerular Disease Flashcards
What are the typical features of glomerulonephritis?
Haematuria
Proteinuria
Hypertension
Renal insufficiency
How can haematuria present?
Macroscopic (frank, tea colored)
Microscopic
Transient or persistent
How does haematuria typically present in glomerulonephritis?
Persistent, microscopic haematuria Dysmorphic RBC (mickey-mouse like)
What is defined as microscopic haematuria?
> 5 RBC per high power field
Haematuria is more common in which glomerulonephritidies?
Nephritic > nephrotic
How can proteinuria present?
Glomerular or Tubular
Albumin or proteinuria
Persistent or transient
How does proteinuria typically present in glomerulonephritis?
Persistent
Proteinuria >1g/mmol creatinine
Proteinuria is more common in which glomerulonephritidies?
Nephritis = Nephrosis
How is proteinuria measured?
24hr urine collection
Urine protein creatinine ratio
Hypertension is more common in which glomerulonephritidies?
Nephritic > Nephrotic
What is a nephritic state?
Active urine sediment: Haematuria Dysmorphic RBCs Cellular casts Hypertension Renal impairment
What is nephrotic syndrome?
Oedema Proteinuria >3.5g/day Hypoalbuminaemia Hyperlipidaemia Primary or secondary
How does congestive heart failure presentation differ from nephrotic syndrome?
Normal albumin
Raised JVP
No proteinuria
How does hepatic disease present differently to nephrotic syndrome?
Abnormal LFTs
No proteinuria
What are the different types of glomerulonephritis?
Proliferative
Non-proliferative
What is diffuse glomerulonephritis?
> 50% glomeruli affected
What is focal glomerulonephritis?
<50% of glomeruli affected
What is global glomerulonephritis?
all of the glomerulus is affected
What is segmental glomerulonephritis?
part of the glomerulus is affected
Post-infective nephritis is what type of glomerulonephritis?
Diffuse proliferative glomerulonephritis
Mesangial IgA disease is what type of glomerulonephritis?
Focal proliferative glomerulonephritis
Post-infective glomerulonephritis is typically due to what?
Group A strep
Post-infective glomerulonephritis typically presents how?
10-21 days post throat/skin infection
Dark urine
Elevated BP
How is post-infective glomerulonephritis treated?
?Antibiotics
Loop diuretics
Vasodilators
How does IgA nephropathy typically present?
20/30s
Haematuria + proteinuria
Nephrotic syndrome
What is IgA nephropathy?
Autoimmune glomerulonephritis due to IgA deposits in mesangium + mesangial proliferation
How is IgA nephropathy treated?
ACE-I for BP control
What are the main types of crescentic glomerulonephritis?
ANCA-associated
Anti-GBM nephritis
Goodpasture’s syndrome
IgA vasculitis
Post-infection
SLE
What are the causes of ANCA-associated glomerulonephritis?
(Anti-neutrophil cytoplasmic antibody)
- Microscopic polyangiitis
- Granulomatosis with polyangitis (Wegeners)
- Eosinophilic granulomatosis with polyangitis
What is anti-GBM disease?
Circulating anti glomerular basement membrane antibodies
How does anti-GBM typically present?
Nephritis
or
Nephritis with lung haemorrhage (Goodpasture’s syndrome)
30/60/70s
How is anti-GBM diagnosed?
Anti-GBM antibodies in serum and kidney
How is anti-GBM treated?
Aggressive immunosuppression:
Steroid
Plasma exchange
Cyclophosphamide
How are Crescentic glomerulonephritidies Managed?
Immunosuppression: Corticosteroids Plasma exchange Cytotoxic B-cell therapy Complement inhibitors
What is the prognosis of Crescentic glomerulonephritidies?
Good if treatment started early
How do Crescentic glomerulonephritidies present?
Nephritic syndrome (blood on dipstick, variable proteinuria)
What is proliferative glomerulonephritis?
Excessive cells in glomeruli including infiltarting leucocytes
What is non-proliferative glomerulonephritis?
Normal looking glomeruli, my have scarring
What are the main types of non-proliferative glomerulonephritidies?
Minimal Change disease
Focal and segmental glomerulonephritis
Membranous nephropathy
What is the general management for nephrotic syndrome?
Treat oedema Hypertension Thrombosis risk - Heparin/warfarin Infection risk - vaccines Dyslipidaemia - statins Specific therapy towards cause
How is oedema treated in nephrotic syndrome?
Salt and Fluid restriction
Loop diuretics
What risks are associated with nephrotic syndrome
Thrombosis
Infection
What ins minimal change nephrotic syndrome?
Non-proliferative glomerulonephritis
More common in children
Rapid onset oedema
Proteinuria revered with steroids
What is the rate of relapse in minimal change nephrotic syndrome patients?
2/3 of patients relapse
What is the specific therapy for minimal change disease?
Prednisolone - 1mg/kg up to 16 weeks Remission - 6month taper Initial relapse wither steroids Subsequent relapses: - Cyclophosphamide - Ciclosporin - Tacrolimus - Mycophenolate mofetil - Rituximab
What is the prognosis of minimal change disease?
Good prognosis
Low risk of ESRD
Steroid toxicity
How does Focal and Segmental glomerulonephritis present?
Nephrotic syndrome
Distinct patterns in pathology
Steroid resistant
What is the prognosis of Focal and Segmental glomerulonephritis?
Poor - high change of progression to ESRD
How is Focal and Segmental glomerulonephritis treated?
Treat nephrotic syndrome Trail of steroids Cyclosporin Cyclophosphamide Rituximab
How does Membranous Nephropathy present?
Most common cause of nephrotic syndrome in adults
Occur in isolation
What is the most common cause of nephrotic syndrome in adults?
Membranous nephropathy
Which serological markers are seen in membranous nephropathy?
Anti-phospholipase A2
Thrombospondin type 1
What are the secondary causes of Membranous Nephropathy?
Malignancies
SLE
Rheumatoid arthritis
NSAIDs, gold, penicillamine
What is the histological presentation of Membranous Nephropathy?
Spikes around deposits on glomeruli
What is the treatment for Membranous Nephropathy?
General measures for nephrotic syndrome 6months Immunosuppression if symptomatic Cyclophosphamide + steroids Ciclosporin Rituximab
When is immunosuppression indicated in Membranous Nephropathy?
If symptomatic with nephrotic syndrome
Rising proteinuria
↓renal function
What is the prognosis of Membranous Nephropathy?
1/3 spontaneous resolution
Resolved proteinuria = good prognosis
25% dialysis @10y
Can recur in renal transplants
What is the key investigation in non-proliferative glomerulonephritis?
Renal biopsy - find cause
General measures for nephrotic syndrome in all cases
