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RENAL PATHOLOGY > Glomerular Disease > Flashcards

Glomerular Disease Flashcards

1
Q

What are the typical features of glomerulonephritis?

A

Haematuria
Proteinuria
Hypertension
Renal insufficiency

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2
Q

How can haematuria present?

A

Macroscopic (frank, tea colored)
Microscopic
Transient or persistent

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3
Q

How does haematuria typically present in glomerulonephritis?

A 
Persistent, microscopic haematuria
Dysmorphic RBC (mickey-mouse like)
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4
Q

What is defined as microscopic haematuria?

A

> 5 RBC per high power field

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5
Q

Haematuria is more common in which glomerulonephritidies?

A

Nephritic > nephrotic

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6
Q

How can proteinuria present?

A

Glomerular or Tubular
Albumin or proteinuria
Persistent or transient

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7
Q

How does proteinuria typically present in glomerulonephritis?

A

Persistent

Proteinuria >1g/mmol creatinine

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8
Q

Proteinuria is more common in which glomerulonephritidies?

A

Nephritis = Nephrosis

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9
Q

How is proteinuria measured?

A

24hr urine collection

Urine protein creatinine ratio

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10
Q

Hypertension is more common in which glomerulonephritidies?

A

Nephritic > Nephrotic

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11
Q

What is a nephritic state?

A 
Active urine sediment:
Haematuria
Dysmorphic RBCs
Cellular casts
Hypertension
Renal impairment
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12
Q

What is nephrotic syndrome?

A 
Oedema
Proteinuria >3.5g/day
Hypoalbuminaemia
Hyperlipidaemia 
Primary or secondary
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13
Q

How does congestive heart failure presentation differ from nephrotic syndrome?

A

Normal albumin
Raised JVP
No proteinuria

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14
Q

How does hepatic disease present differently to nephrotic syndrome?

A

Abnormal LFTs

No proteinuria

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15
Q

What are the different types of glomerulonephritis?

A

Proliferative

Non-proliferative

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16
Q

What is diffuse glomerulonephritis?

A

> 50% glomeruli affected

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17
Q

What is focal glomerulonephritis?

A

<50% of glomeruli affected

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18
Q

What is global glomerulonephritis?

A

all of the glomerulus is affected

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19
Q

What is segmental glomerulonephritis?

A

part of the glomerulus is affected

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20
Q

Post-infective nephritis is what type of glomerulonephritis?

A

Diffuse proliferative glomerulonephritis

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21
Q

Mesangial IgA disease is what type of glomerulonephritis?

A

Focal proliferative glomerulonephritis

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22
Q

Post-infective glomerulonephritis is typically due to what?

A

Group A strep

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23
Q

Post-infective glomerulonephritis typically presents how?

A

10-21 days post throat/skin infection
Dark urine
Elevated BP

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24
Q

How is post-infective glomerulonephritis treated?

A

?Antibiotics
Loop diuretics
Vasodilators

25
How does IgA nephropathy typically present?
20/30s Haematuria + proteinuria Nephrotic syndrome
26
What is IgA nephropathy?
Autoimmune glomerulonephritis due to IgA deposits in mesangium + mesangial proliferation
27
How is IgA nephropathy treated?
ACE-I for BP control
28
What are the main types of crescentic glomerulonephritis?
ANCA-associated Anti-GBM nephritis Goodpasture's syndrome IgA vasculitis Post-infection SLE
29
What are the causes of ANCA-associated glomerulonephritis?
(Anti-neutrophil cytoplasmic antibody) 1. Microscopic polyangiitis 2. Granulomatosis with polyangitis (Wegeners) 3. Eosinophilic granulomatosis with polyangitis
30
What is anti-GBM disease?
Circulating anti glomerular basement membrane antibodies
31
How does anti-GBM typically present?
Nephritis or Nephritis with lung haemorrhage (Goodpasture's syndrome) 30/60/70s
32
How is anti-GBM diagnosed?
Anti-GBM antibodies in serum and kidney
33
How is anti-GBM treated?
Aggressive immunosuppression: Steroid Plasma exchange Cyclophosphamide
34
How are Crescentic glomerulonephritidies Managed?
``` Immunosuppression: Corticosteroids Plasma exchange Cytotoxic B-cell therapy Complement inhibitors ```
35
What is the prognosis of Crescentic glomerulonephritidies?
Good if treatment started early
36
How do Crescentic glomerulonephritidies present?
``` Nephritic syndrome (blood on dipstick, variable proteinuria) ```
37
What is proliferative glomerulonephritis?
Excessive cells in glomeruli including infiltarting leucocytes
38
What is non-proliferative glomerulonephritis?
Normal looking glomeruli, my have scarring
39
What are the main types of non-proliferative glomerulonephritidies?
Minimal Change disease Focal and segmental glomerulonephritis Membranous nephropathy
40
What is the general management for nephrotic syndrome?
``` Treat oedema Hypertension Thrombosis risk - Heparin/warfarin Infection risk - vaccines Dyslipidaemia - statins Specific therapy towards cause ```
41
How is oedema treated in nephrotic syndrome?
Salt and Fluid restriction | Loop diuretics
42
What risks are associated with nephrotic syndrome
Thrombosis | Infection
43
What ins minimal change nephrotic syndrome?
Non-proliferative glomerulonephritis More common in children Rapid onset oedema Proteinuria revered with steroids
44
What is the rate of relapse in minimal change nephrotic syndrome patients?
2/3 of patients relapse
45
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 ```
46
What is the prognosis of minimal change disease?
Good prognosis Low risk of ESRD Steroid toxicity
47
How does Focal and Segmental glomerulonephritis present?
Nephrotic syndrome Distinct patterns in pathology Steroid resistant
48
What is the prognosis of Focal and Segmental glomerulonephritis?
Poor - high change of progression to ESRD
49
How is Focal and Segmental glomerulonephritis treated?
``` Treat nephrotic syndrome Trail of steroids Cyclosporin Cyclophosphamide Rituximab ```
50
How does Membranous Nephropathy present?
Most common cause of nephrotic syndrome in adults | Occur in isolation
51
What is the most common cause of nephrotic syndrome in adults?
Membranous nephropathy
52
Which serological markers are seen in membranous nephropathy?
Anti-phospholipase A2 | Thrombospondin type 1
53
What are the secondary causes of Membranous Nephropathy?
Malignancies SLE Rheumatoid arthritis NSAIDs, gold, penicillamine
54
What is the histological presentation of Membranous Nephropathy?
Spikes around deposits on glomeruli
55
What is the treatment for Membranous Nephropathy?
``` General measures for nephrotic syndrome 6months Immunosuppression if symptomatic Cyclophosphamide + steroids Ciclosporin Rituximab ```
56
When is immunosuppression indicated in Membranous Nephropathy?
If symptomatic with nephrotic syndrome Rising proteinuria ↓renal function
57
What is the prognosis of Membranous Nephropathy?
1/3 spontaneous resolution Resolved proteinuria = good prognosis 25% dialysis @10y Can recur in renal transplants
58
What is the key investigation in non-proliferative glomerulonephritis?
Renal biopsy - find cause | General measures for nephrotic syndrome in all cases

RENAL PATHOLOGY (16 decks)

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