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Renal > Glomerular Disease (Clinical) > Flashcards

Glomerular Disease (Clinical) Flashcards

1
Q

What is glomerulonephritis? How is it classified?

A
  • Group of immune mediated disorders that affect the glomeruli
  • Classified based on kidney biopsy findings
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2
Q

What are some features of glomerulonephritis?

A
  • Haematuria (visible / non-visible)
  • Proteinuria (low grade or nephrotic)
  • Hypertension
  • Renal impairment
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3
Q

What are some features of nephritic syndromes?

A
  • Haematuria
  • Mild proteinuria
  • Hypertension
  • Renal impairment (low urine volume)
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4
Q

What are some features of nephrotic syndromes?

A
  • Severe proteinuria (>3.5g/day or 350mg/mmol creatinine, urine may look frothy)
  • Hypoalbuminaemia
  • Oedema
  • Hyperlipidaemia
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5
Q

Why is there hyperlipidaemia associated with nephrotic syndrome?

A

liver increases production in response to hypoalbuminaemia, excess production of lipids is a side effect

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6
Q

What are the two major types of glomerulonephritis? Difference between the two?

A
  • Proliferative: excessive number of cells in the glomeruli, include invading leukocytes
  • Non-proliferative: glomeruli look normal or have areas of scarring, normal cell number
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7
Q

List some descriptive terminology used when describing glomerulonephritis

A

Diffuse: >50% of glomeruli affected

Focal: <50% of glomeruli affected

Global: all the glomerulus affected

Segmental: part of the glomeruli affected

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8
Q

What is the most common cause of glomerulonephritis? Mechanism?

A

IgA Nephropathy

  • Characterized by IgA deposition in the mesangium & mesangial proliferation.
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9
Q

Who tends to be affected by IgA nephropathy?

A

Most common in 2nd and 3rd decade of life with males more commonly affected

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10
Q

How does IgA nephropathy mediated glomerulonephritis tend to present?

A
  • Microscopic haematuria.
  • Microscopic haematuria + proteinuria
  • Nephrotic syndrome
  • IgA crescentic glomerulonephritis
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11
Q

What is post-infectious glomerulonephritis? What type of bacteria tend to cause it?

A

Glomerulonephritis occurring typically 10-21 days past a throat or skin infection

  • Most commonly with Lancefield group A Streptococci.
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12
Q

How does post-infectious glomerulonephritis tend to present?

A
  • Nephritic syndrome (high RBC in urine)

- Oedema / hypertension

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13
Q

How does crescentic glomerulonephritis tend to present?

A

++ Nephritic syndrome

Slight nephrotic syndrome

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14
Q

What is anti-GBM disease?

A

Anti-Glomerular Basement Membrane disease is an autoimmune disease where autoantibodies attack the capillaries in the kidneys &/or lungs

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15
Q

How does anti-GBM disease present? How is it diagnosed?

A

Presents as nephritic syndrome (may also have lung haemorrhage - Goodpasture’s syndrome)

  • Diagnosed by detected anti-GBM antibodies in the serum & kidney
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16
Q

How is anti-GBM disease treated?

A
  • aggressive immunesuppression
  • steroid, plasma exchange
  • cyclophosphamide (immunosuppressant)
17
Q

What are some examples of non-proliferative glomerulonephritis?

A

Minimal Change Disease

Focal and segmental glomerulonephritis

Membranous Nephropathy

18
Q

How does non-proliferative glomerulonephritis tend to present as a whole?

A
  • Nephrotic syndromes
19
Q

What are some general measures taken to treat nephrotic syndromes?

A
  • Treat oedema: salt and fluid restriction and loop diuretics.
  • Hypertension: use Renin-Angiotensin-Aldosterone-blockade.
  • Reduce risk of thrombosis: Heparin or Warfarin.
  • Reduce risk of infection e.g. pneumococcal vaccine.
  • Treat dyslipidemia e.g. statins
20
Q

What is the most common glomerulonephritis in children?

A

Minimal Change Disease Non-Proliferative Glomerulonephritis

21
Q

How does Minimal Change Disease glomerulonephritis tend to present?

A

++ Nephrotic Syndrome

classic triad: proteinuria, hypoalbuminaemia, oedema, +/- hyperlipidaemia

22
Q

How is Minimal Change Disease glomerulonephritis treated?

A

Steroids (tends to cure proteinuria):

Prednisolone – 1mg/kg for up to 16 weeks.
Once remission achieved , slow taper over 6 months.
Initial relapse treated with further steroid course.

23
Q

What is the prognosis like for minimal change disease glomerulonephritis?

A
  • Tends to be favourable, with steroid treatment the risk of end stage disease is low
24
Q

What are Focal and segmental glomerulonephritis (FSGS)? Prognosis?

A
  • Not a single disease, rather a syndrome with multiple causes.
  • Pathology is focal and segmental sclerosis (scarring) in the glomerulus.
  • Prognosis is poor as generally steroid resistant with high chance of progression to end stage kidney disease
25
Q

How does Focal and segmental glomerulonephritis (FSGS) tend to present? Treatment options?

A

Presents with nephrotic syndrome

  • Treat with steroids and hope for even partial remission
26
Q

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

A

Membranous Nephropathy glomerulonephritis

  • Most cases are idiopathic
27
Q

Describe the pathophysiology of membranous nephropathy glomerulonephritis?

A

Membranous nephropathy is deposition of immune complexes on the glomerular basement membrane (GBM) with GBM thickening

28
Q

What are some diagnostic markers for membranous nephropathy?

A
  • Anti-phospholipase A2 receptor (PLA2R) antibody positive in 70% of idiopathic cases
  • Thrombospondin type 1 domain containing 7A (THSD7A) in ~2%.
29
Q

Treatment for membranous nephropathy glomerulonephritis? Prognosis?

A
  • Immunosuppression and steroids
  • A third resolve spontaneously, good prognosis for those whose proteinuria resolves w treatment
  • 25% on dialysis at 10 years, can recur in transplants
30
Q

What is the most important investigation when it comes to differentiating different types of glomerulonephritis?

A
  • Renal biopsy

- Urine & blood tests also useful for detecting nephrotic vs. nephritic but histology confirms diagnosis often

Renal (30 decks)

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