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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
Q

How does IgA nephropathy typically present?

A

20/30s
Haematuria + proteinuria
Nephrotic syndrome

26
Q

What is IgA nephropathy?

A

Autoimmune glomerulonephritis due to IgA deposits in mesangium + mesangial proliferation

27
Q

How is IgA nephropathy treated?

A

ACE-I for BP control

28
Q

What are the main types of crescentic glomerulonephritis?

A

ANCA-associated
Anti-GBM nephritis
Goodpasture’s syndrome

IgA vasculitis
Post-infection
SLE

29
Q

What are the causes of ANCA-associated glomerulonephritis?

A

(Anti-neutrophil cytoplasmic antibody)

  1. Microscopic polyangiitis
  2. Granulomatosis with polyangitis (Wegeners)
  3. Eosinophilic granulomatosis with polyangitis
30
Q

What is anti-GBM disease?

A

Circulating anti glomerular basement membrane antibodies

31
Q

How does anti-GBM typically present?

A

Nephritis
or
Nephritis with lung haemorrhage (Goodpasture’s syndrome)
30/60/70s

32
Q

How is anti-GBM diagnosed?

A

Anti-GBM antibodies in serum and kidney

33
Q

How is anti-GBM treated?

A

Aggressive immunosuppression:
Steroid
Plasma exchange
Cyclophosphamide

34
Q

How are Crescentic glomerulonephritidies Managed?

A 
Immunosuppression:
Corticosteroids
Plasma exchange
Cytotoxic
B-cell therapy
Complement inhibitors
35
Q

What is the prognosis of Crescentic glomerulonephritidies?

A

Good if treatment started early

36
Q

How do Crescentic glomerulonephritidies present?

A 
Nephritic syndrome
(blood on dipstick, variable proteinuria)
37
Q

What is proliferative glomerulonephritis?

A

Excessive cells in glomeruli including infiltarting leucocytes

38
Q

What is non-proliferative glomerulonephritis?

A

Normal looking glomeruli, my have scarring

39
Q

What are the main types of non-proliferative glomerulonephritidies?

A

Minimal Change disease
Focal and segmental glomerulonephritis
Membranous nephropathy

40
Q

What is the general management for nephrotic syndrome?

A 
Treat oedema 
Hypertension 
Thrombosis risk - Heparin/warfarin
Infection risk - vaccines
Dyslipidaemia - statins
Specific therapy towards cause
41
Q

How is oedema treated in nephrotic syndrome?

A

Salt and Fluid restriction

Loop diuretics

42
Q

What risks are associated with nephrotic syndrome

A

Thrombosis

Infection

43
Q

What ins minimal change nephrotic syndrome?

A

Non-proliferative glomerulonephritis
More common in children
Rapid onset oedema
Proteinuria revered with steroids

44
Q

What is the rate of relapse in minimal change nephrotic syndrome patients?

A

2/3 of patients relapse

45
Q

What is the specific therapy for minimal change disease?

A 
Prednisolone - 1mg/kg up to 16 weeks 
Remission - 6month taper
Initial relapse wither steroids
Subsequent relapses:
- Cyclophosphamide
- Ciclosporin
- Tacrolimus
- Mycophenolate mofetil
- Rituximab
46
Q

What is the prognosis of minimal change disease?

A

Good prognosis
Low risk of ESRD
Steroid toxicity

47
Q

How does Focal and Segmental glomerulonephritis present?

A

Nephrotic syndrome
Distinct patterns in pathology
Steroid resistant

48
Q

What is the prognosis of Focal and Segmental glomerulonephritis?

A

Poor - high change of progression to ESRD

49
Q

How is Focal and Segmental glomerulonephritis treated?

A 
Treat nephrotic syndrome
Trail of steroids 
Cyclosporin
Cyclophosphamide
Rituximab
50
Q

How does Membranous Nephropathy present?

A

Most common cause of nephrotic syndrome in adults

Occur in isolation

51
Q

What is the most common cause of nephrotic syndrome in adults?

A

Membranous nephropathy

52
Q

Which serological markers are seen in membranous nephropathy?

A

Anti-phospholipase A2

Thrombospondin type 1

53
Q

What are the secondary causes of Membranous Nephropathy?

A

Malignancies
SLE
Rheumatoid arthritis
NSAIDs, gold, penicillamine

54
Q

What is the histological presentation of Membranous Nephropathy?

A

Spikes around deposits on glomeruli

55
Q

What is the treatment for Membranous Nephropathy?

A 
General measures for nephrotic syndrome 6months
Immunosuppression if symptomatic
Cyclophosphamide + steroids
Ciclosporin
Rituximab
56
Q

When is immunosuppression indicated in Membranous Nephropathy?

A

If symptomatic with nephrotic syndrome
Rising proteinuria
↓renal function

57
Q

What is the prognosis of Membranous Nephropathy?

A

1/3 spontaneous resolution
Resolved proteinuria = good prognosis
25% dialysis @10y
Can recur in renal transplants

58
Q

What is the key investigation in non-proliferative glomerulonephritis?

A

Renal biopsy - find cause

General measures for nephrotic syndrome in all cases

RENAL PATHOLOGY (16 decks)

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