Glomerular Disease Flashcards
A young man develops macroscopic haematuria 1-2 days after URTI?
IgA nephropathy
Definition of Glomerulonephritis?
Immune mediated disease of the kidneys affecting the glomeruli. There is disruption somewhere in the 3 layered barrier of the glomerulus leading to haematuria/ and or proteinuria.
Damage to endothelial or mesangial cells results in a ___1_____ and ___2______
Damage to the podocytes leads to a ____3______ and _____4_____
1) proliferative lesion
2) haematuria
3) non-proliferative lesion
4) proteinuria
How can glomerulonephritis be classified?
By clinical syndrome
By histological classification
By cause
What are the 5 clinical syndromes glomerulonephritis can cause?
1) Asymptomatic proteinuria or haematuria
2) Acute glomerulonephritis/ acute nephritic syndrome
3) Chronic glomerulonephritis
4) Rapidly progressive glomerulonephritis
5) Nephrotic syndrome
GLOMERULONEPHRITIS CLINICAL SYNDROME
Asymptomatic proteinuria or haematuria?
Just have the proteinuria or haematuria and this signals mild glomerular damage
GLOMERULONEPHRITIS CLINICAL SYNDROME
Acute glomerulonephritis/ Nephritic Syndrome?
Haematuria, acute fall in GFR, Na+ and H2O retention and hypertension. Oedema but less so than nephrotic.
GLOMERULONEPHRITIS CLINICAL SYNDROME
Chronic Glomerulonephritis?
Slow progressive damage, proteinuria, haematuria, hypertension
GLOMERULONEPHRITIS CLINICAL SYNDROME
Rapidly progressive glomerulonephritis?
Very rapid renal failure, oliguria, haematuria, proteinuria, usually without other symptoms of nephritic syndrome (ie hypertension and oedema)
GLOMERULONEPHRITIS CLINICAL SYNDROME
Nephrotic syndrome?
Consists of heavy proteinuria leading to hypoalbuminaemia and oedema
4 histological classifications of glomerulonephritis explain?
1) Proliferative or Non-proliferative
- presence or absence of proliferation of mesangial cells
2) Focal or diffuse
- < or > 50% glomeruli affected
3) Global or segmental
> all or part of glomerulus affected
4) Crescenteric
> presence of crescents which are epithelial cell extra capillary proliferations
3 types of non-proliferative glomerulonephritis?
1) Minimal change glomerulonephritis
2) Focal segmental glomerulosclerosis
3) Membranous glomerulonephritis
4 types of proliferative glomerulonephritis?
1) IgA nephropathy
2) Post infectious Glomerulonephritis
3) Membranoproliferative glomerulonephritis
4) Rapidly progressive glomerulonephritis
Minimal change glomerulonephritis presents as ______
nephrotic syndrome
Minimal change glomerulonephritis accounts for ____ of all nephrotic syndrome in kids and ______
80% in children
20% in adults
Does minimal change glomerulonephritis cause progressive renal failure?
No
Describe histology of minimal change glomerulonephritis?
No abnormalities on light microscopy but electron microscopy reveals abnormal fused podocytes
No abnormalities on light microscopy but electron microscopy reveals abnormal fused podocytes
Minimal change glomerulonephritis
Focal segmental glomerulosclerosis presents as ____
nephrotic syndrome
Non proliferative glomerulonephritis usually present as ____
nephrotic syndrome
Focal segmental glomerulosclerosis is associated with ____
HIV, obesity, kidney reflux disease, heroin use and gene mutations
_____ of focal segmental glomerulosclerosis progress to renal failure
50%
Treatment of focal segmental glomerulosclerosis?
Prolonged steroids can help but 50% still progress to renal failure
Membranous glomerulonephritis presents as _____
It is ____ progressive
nephrotic syndrome
slowly
Membranous glomerulonephritis causes?
usually idiopathic but can be associated with heptatits B/ parasites, SLE, malignancies, penicillamine
Describe microscopy of membranous glomerulonephritis?
Immune complex deposition and complement activation against the glomerular basement membrane proteins results in microscopically thickened glomerular basement membrane. Immunofluorescene shows IgG uptake
_____ of membranous glomerulonephritis progresses to end stage renal disease
30%
Treatment of membranous glomerulonephritis?
Steroids, alkylating agents, B cell monoclonal antibodies
What is the most common glomerulonephritis?
IgA nephropathy (a sort of non-systemic form of HSP)
IgA nephropathy presents as ______
nephritic syndrome
IgA nephropathy often occurs ____
24-48hrs after an URTI
IgA nephropathy on biopsy?
Mesangial cell proliferation and expansion of light microscopy with IgA deposits in mesangium on IF.
Management of IgA nephropathy?
No specific management, lower BP with ACEi/ ARB potentially steroids, many people have recurrence even after transplant
When does post infectious glomerulonephritis usually occur?
Typically occurs 2 weeks after an infection usually strep pyogenes
Treatment of post infectitious glomerulonephritis?
Only need supportive treatment usually recovers
Membranoproliferative glomerulonephritis presents with _____
combined nephritic and nephrotic syndrome
What happens in membranoproliferative glomerulonephritis? Histology?
Subendothelial deposition of immune complexes
Thickened basement membrane and mesangium
Causes of membranoproliferative glomerulonephritis?
SLE or hepatitis
Treatment and prognosis of membranoproliferative glomerulonephritis?
Has poor prognosis need to treat underlying cause
What conditions present as rapidly progressive glomerulonephritis?
All can present but
Vasculitis ANCA +ve GPA, EGPA and MPA
Goodpastures
only present as rapidly progressing
other common are SLE and HSP
Rapidly progressive glomerulonephritis results in _____
rapid progression to renal failure over weeks
Immune complexes can be a cause of glomerulonephritis but where can we get circulating immune complexes from?
Auto-immune diseases e.g. SLE
Infection- hepatitis, bacteria, HIV
Drugs- gold penicillamine
Cancer often lymphomas
Complications of nephrotic syndrome?
Pulmonary emboli
Infection (loss of immunoglobulins)
Renal vein thrombosis (loss of clotting factors)
Hypovolaemia
Treatment of nephrotic syndrome?
Fluid + salt restriction
Diuretic
ACE inhibitor
IV albumin if hypovolaemia
Minimal change nephropathy can occur after _____ or ______
infection or allergic reaction
