Glomerular Disease Flashcards
What is nephrotic syndrome?
Presence of Protein in the urine >3.5g/day
How does nephrotic syndrome occur?
Increased permeability of serum protein through the damaged basement membrane
What are three common causes of primary nephrotic syndrome?
Minimal Change Disease
Focal segmental glomerulosclerosis
Membranous Nephropathy
What is Minimal change disease:
- Epidemiology
- Presentation
- Management
- Children 1-8 years
- Follows recent viral illness, facial oedema
- Tx with Fluid rest and corticosteroid
What is Focal segmental glomerulonsclerosis:
- Pathology
- Presentation
- Management
- Primary = no identifiable cause and Secondary = injury to podocytes due to viruses and toxins.
Presents - HTN, oedema, frothy urine
Mx - Furosemide, statins and BP control with ACE Symptomatic + coritcosteroids.
What is Membranous Nephropathy :
- Definition
- Causes
- Presentation
- Management
Chronic immune mediated glomerular disease of the BM
Primary is idiopathic and secondary can be due to:
- NSAIDS, Malignancy, Infection (Hep B and Syph), AI
Presents HTN and oedema
Mx - ACE, Furosemide, Low Na+ and Steroids
What are secondary causes of nephrotic syndrome?
DM and amyloidosis Drugs: Lithium, RA Malignancy Pre-eclampsia Infection: HIV, Hep B and Malaria
What are complications of nephrotic syndrome?
Increase in clotting factors
Increased risk of Strep infection
Hyperlipidemia - Increased production by liver to increase oncotic pressure
What is nephritic syndrome?
Large pores in podocytes allowing blood and protein leakage
What are 3 primary causes of nephritic syndrome?
IgA nephropathy
Post-infectious glomerulonephritis
Rapidly progressive glomerulonephritis
What is post infectious glomerulonephritis:
- Pathophysiology
- Presentation and epidemiology
- Management and Diagnosis
Microbial antigens bind to glomerular basement membrane and activate compliment. Immune complex deposition results in glomerular damamge
Presents weeks after a streptococcal infection e.g. URTI or Impetigo
Common in 5-15 YO
Diagnosed with hypocomplimentemia and treatment is supportive
What is IgA nephropathy:
- Pathophysiology
- Presentation and epidemiology
- Management
Renal IgA deposits
Occurs 1-2 days post URTI and occurs in teens- late thirties
ACE and ARB mx
What is Rapidly Progressive Glomerulonephritis?
Acute nephritic syndrome with progression to renal failure within weeks - months . There is formation of crescents as a part of a necrotising histological response
How does Rapidly Progressive Glomerulonephritis present?
Fatigue, weakness, fever, nausea and haematuria
What conditions can cause Rapidly Progressive Glomerulonephritis?
Wegeners
Goodpastures
SLE
What is the management of Rapidly Progressive Glomerulonephritis?
Corticosteroids and Cyclophamide
What is Good pastures syndrome?
AI Autoantibodies against type IV collagen present in the kidneys and lungs. Present as pulmonary haemorrhage (Haemoptysis) anaemia and haematuria).
What is presentation of Nephritic syndrome in general?
Azotaemia - high nitrogen Oliguria Haematuria Proteinuria HTN
What are secondary causes of nephritic syndrome?
Membranoproliferative glomerulonephritis and Henoch-schloen purpura
What is Henoch-schloen purpura and how does it present?
Systemic vasculitis. IgA deposition in the skin and kidney
Presents with arthralgia, haematuria, purpuric rash and abdominal pain
What can cause Membranoproliferative glomerulonephritis?
SLE
HEP B/C
What is granulomatosis with polyangiitis?
Characterised by ELK involvement - ENT, Lungs and Kidneys. cANCA - positive RPGN
What are typical features of granulomatosis with polyangiitis?
Haemoptysis
Haematuria
Otitis, Epistaxis and sinusitis
Conjunctivitis and episcleritits
What is management of asymptomatic patients or patients with no organ damage with granulomatosis with polyangiitis?
Methotrexate
What is management of symptomatic patients with granulomatosis with polyangiitis?
Cyclophosphamide and adjunct prednisolone
What are examples of mixed nephrotic and nephritic syndrome?
Alport Syndrome
Membranoproliferative glomerulonephritis
What is alport syndrome?
X linked dominant
Type IV collagen defect which affects the eyes, ears and kidney basement membrane
What is the presentation of Alport Syndrome?
Protein and haematuria
Sensioneural deafness
Lens abnormalities
What is management of Alport syndrome?
ACE to control HTN and slow disease progression
