Glomerular Disease Flashcards
What is the difference between primary and secondary glomerulonephritis?
Primary- only affects the glomerulus
Secondary- other parts of the body are affected
What are the four most common presentations of glomerulonephritis?
Haematuria
Heavy proteinuria (nephrotic syndrome)
Slowly increasing proteinuria
Acute renal failure
What are the main causes of haematuria
Urinary tract infection
Urinary tract stone
Urinary tract tumour
Glomerulopnephritis (less common)
Describe the pathology of IgA nephropathy
The mesangium of the glomerulus becomes clogged up with the IgA antibody, which irritates the mesangial cells and causes them to proliferate- producing more matrix
What are the possible complications of IgA nephropathy?
A small proportion of cases will develop chronic renal failure
What step must always be taken before doing a renal biopsy?
Check the patients clotting
Describe the pathology of membranous glomerulonephritis
IgG depostis itself between the basal lamina and the podocyte but cannot go further and is not filtered into the urine. IgG activates complement (C3), which punches holes in the filter, leading to a leaky filter that allows albumin to be filtered into the urine and results in nephrotic syndrome
Describe the pathology of diabetic nephropathy
Glycated molecules cause matrix deposition in the basal lamina and lead to a thickened but leaky basement membrane and the mesangial matrix compressing the capillaries
What lesions can develop in diabetic nephropathy and how do they develop?
Kimmelsteil-Wilson lesions
Formed by a gross excess of the mesangial matrix forming nodules
What investigations can be done for granulomatosis with polyangiitis?
Serum tests showing presence of anti-neutrophil cytoplasmic antibodies (ANCA)
What are the potential sources of haematuria?
Kidneys Bladder Ureters Urethra Prostate
What are the characteristics of a nephritic state?
Active urine sediment- haematuria, dysmoprhic RBCs
Hypertension
Renal impairment
What are the characterstics of nephrotic syndrome?
Oedema
Proteinuria >3.5g/day
Hypoalbuminaemia
Hyperlipidaemia
What do the terms diffuse, focal, global and segmental mean when referring to glomerulonephritis?
Diffuse- >50% of glomeruli affected
Focal- <50% of glomeruli affected
Global- all of the affected glomerulus is affected
Segmental- only part of the affected glomerulus is affected
What are the characteristics of post-infective glomerulonephritis?
History of infection (usually 10-21 days previous)
Haematuria
Oedema
Hypertension
What investigations can be helpful in post-infective glomerulonephritis?
Urinalysis
Urine microscopy
Full blood count
Describe the management of post-infective glomerulonephritis
Possible antibiotics for the infection
Loop diuretics for the oedema
Vasodilator drugs for hypertension
How does IgA nephropathy present?
Macroscopic haematuria
Microscopic haematuria
Microscopic proteinuria
Nephrotic syndrome
How does anti-glomerular basement membrane disease present?
Nephritis with potential lung haemorrhage (Goodpasture’s syndrome)
Most commonly in 3rd or 6th and 7th decades
How is anti-GBM disease diagnosed?
By demonstrating presence of anti-GBM antibodies in the serum and kidneys
How is anti-GBM disease treated?
Aggressive immune suppression- give steroids, plasma exchange and cyclophosphamide
How is crescentric glomerulonephritis managed?
Immunosuppression via corticosteroids, plasma exchange, cytotoxic, B-cell therapy or complement inhibitors
How is nephrotic syndrome managed?
Treat oedema with salt and fluid restrictions and loop diuretics
Treat hypertension- renin-angiotensin-aldosterone-blockade
Treat dyslipidaemia- statins
Reduce risk of thrombosis- heparin/warfarin
Reduce risk of infection- vaccines
How is minimal change disease managed?
Prednisolone- 1mg/kg for up to 16 weeks
Once in remission, slowly taper over 6 months
Initial relapse treated with course of steroids
Further relapses can be treated with cyclophosphamide, cyclosporin, tacrolimus, mycophenolate mofetil or rituximab
How does focal and segmental glomerulonephritis present?
Patients present with nephrotic syndrome
Pathology reveals focal and segmental sclerosis with distinctive patterns
How is the prognosis for focal and segmental glomerulonephritis?
Generally resistant to steroids so there is a high chance of progression to end stage kidney disease
How is focal and segmental glomerulonephritis managed?
Course of steroids may give partial remission
Can also use cyclosporin, cyclophosphamide, and Rituximab
What are the causes of membranous nephropathy?
Majority idiopathic Malignancies SLE Rheumatoid arthritis Drugs- NSAIDs, gold, penicillamine
What are the serological markers of membranous nephropathy?
Anti-phospholipase A2 receptor (PLA2R)
Thrombospondin type 1 domain containing 7A (THSD7A)
How is membranous nephropathy managed?
General measures for at least 6 months
Immunosuppression if symptomatic nephrotic syndrome, rising proteinuria or decreasing renal function is present
Cyclophosphamide and steroids on alternate months for 6 months
Cyclosporine
Rituximab
