Glomerular nephritis Flashcards
Define nephritis
A generic term that means inflammation of the Kidneys
What is nephritic syndrome
A group of symptoms indicating that inflammation has caused damage to the kidneys.
What are the symptoms of Nephritic syndrome
Haematuria
Oliguria
Proteinuria (mild/moderate <3.5g/l/day)
Fluid Retention
What can be found in the active urine sediment in nephritic syndrome
Haematuria
Dysmophic RBC
Cellular casts
What are cellular casts
Urinary casts are tiny tube-shaped particles that can be found when urine is examined under the microscope during a test called urinalysis.
Urinary casts may be made up of white blood cells, red blood cells, kidney cells, or substances such as protein or fat. The content of a cast can help tell your health care provider whether your kidney is healthy or abnormal.
What is the main feature of someone in the nephritic state
Haematuria
What is the pathophysiology of a nephritic syndrome
Neutrophils attack the basement membrane of glomerulus and podocyte processes. The triple flltration barrier is disrupted causing spillage
What is nephrotic syndrome
Nephrotic syndrome is a condition involving the loss of significant volumes of protein via the kidneys (proteinuria) which results in hypoalbuminaemia.
What are the group of symptoms the nephrotic state
Peripheral oedema Proteinuria (frothy urine) Serum Albumin low (hypoalbuminuria) Hypercholesterolaemia Fatigue Poor appetite Recurrent infections Venous/arterial thrombosis
What is the most noticeable feature of nephrotic syndrome
The proteinuria
How high does the protein content in the urine need to be to call it proteinuria
> 3.5g in 24 hrs
How low does the albumin content of the blood need to be to call it hypoalbuminuria
<35g per litre
Is there more oedema in nephritic or nephrotic syndrome
Nephrotic
Why do you get oedema in the nephrotic state
Reduced oncotic pressure
excessive sodium
What is the pathophysiology of nephrotic state
The podocytes shrink making them come apart and spill. Also get some thickening of the basement membrane.
How would you treat oedema in nephrotic syndrome
Salt/fluid restriction and loop diuretics
How would you treat hypertension in nephrotic syndrome
Renin-angiotensin-aldosterone blockade
How would you reduce risk of thrombosis in nephrotic syndrome
Heparin/warfarin
How would you reduce risk of infection in nephrotic syndrome
Pneumaccocal vaccine
How would you treat dyslipidaemia in nephrotic syndrome
Statins
What medications can cause nephrotic syndrome
NSAIDS
Penicilline
Interferon
Captopril
What is glomerular nephritis
Inflammation of or around the glomerulus
What are the sub-types of glomerulonephritis
Proliferative
Non-Proliferative
What is characteristic of proliferative glomerulonephritis
Lots of cells in the the glomeruli , including infiltrating leukocytes
What is charecteristic of non-proliferative glomerulonephritis
Glomeruli looks normal or has areas of scarring. There are normal numbers of cells present
If the non-proliferative glomerulonephritis is diffuse what does that means
> 50% of glomeruli affected
If the non-proliferative glomerulonephritis is focal what does that means
<50% glomeruli affected
If the non-proliferative glomerulonephritis is global what does that means
All of glomerulus affected
If the non-proliferative glomerulonephritis is segemental what does that means
Part of glomerulus is affected
What are the Proliferative glomerulonephritises
IgA nephropathy
Post streptococcal glomerulonephritis
Crescentic Glomerulonephritis
Membranoproliferative Glomerulonephritis
What does IgA nephropathy show on histology
IgA deposits and glomerular Mesangial proliferation
What is the presentation of IgA nephropathy
Microscopic haematuria
Microscopic proetinuria
Nephritic syndrome
What age in IgA nephropathy most common
In 20s
What sex is IgA nephropathy more common
Males
Is IgA nephropathy common?
Yes - its the most common cause of primary glomerulonephritis.
What is the age range for post infectious glomerulonephritis
Under 30 years old
What infection is post infectious glomerulonephritis common after
Lancefield group A streptococci
What syndrome for post infectious glomerulonephritis develop
Nephritic
What is the prognosis like for post infectious glomerulonephritis
Usually get a full recovery
What can cause crescentic glomerulonephritis
Anti-neutrophil cytoplasmic antibody (anca) associated
Anti-glomerular basement membrane
Others
what are the subtypes of Anti-neutrophil cytoplasmic antibody (anca) associated
Microscopic polyangiitis
Granulomatosis with polyangitits
Eosinophilic granulomatosis with polyangitis.
What is Granulomatosis with polyangitits
Granulomatosis with polyangiitis (GPA) is a rare condition where the blood vessels become inflamed. It mainly affects the ears, nose, sinuses, kidneys and lungs. Anyone can get it, including children, but it’s most common in adults and older people
What is Good pastures syndrome
Anti-glomerular basement membrane nephritis with lung haemorrhage.
What happens in Anti-glomerular basement membrane disease
Antibodies attack the basement membrane in the lungs and kidneys leading to bleeding from the lungs, glomerulonephritis and kidney failure.
What % of crescentic GN is v caused by Anti-glomerular basement membrane
10-20%
What is treatment for Anti-glomerular basement membrane disease
Aggressive immunosuppression
Steroids
Plasma exchange and cyclophosphamide.
What are the non-proliferative glomerulonephritis
Minimal change disease
Focal and Segmental glomerulonephritis
Membranous nephropathy
What age group is minimal change disease common
Children
What is presenting symptoms of minimal change disease
Sudden onset of Oedema
Histologically what is observed in minimal change disease
Not much seen on light microscopy
No immunodeposits
Podocytes are shrunken with smaller processes that are less interdigitated.
What is treatment for minimal change disease
Prednisolone (1mg/kg) for up to 16 weeks
What do you treat an intial relapse with in minimal change disease
Prednisolone
What do you treat an 2nd and subsequent relapse with in minimal change disease
Cyclophosphamide
Cyclosporin
Tacrolimus
Rituximab
What is the prognosis for minimal change disease
Favourable, despite the relapsing nature of the condition.
What is focal/segmental glomerulonephritis
A syndrome describing a sclerosis of the kidney presenting with Nephrotic syndrome
How do you treat focal/segmental glomerulonephritis
Steroids (but they dont usually work)
Cyclosporin, Cyclophosphamide, Rituximab
What is the main cause of membranous nephropathy
Usually ideopathic
Is membranous nephropathy common?
Its the most common nephrotic syndrome in adults
How do you identify membranous nephropathy
Serological markers:
Anti phospholipase A2 receptor (PLA2r) - +ve in 70% cases
Thrombospondin type 1 domain in 2%
What are less common causes of membranous nephropathy
Malignancies
SLE
Rheumatoid arthritis
Drugs: NSAID, Gold, Penicillamine
What is treatment for membranous nephropathy
General measures…? for 6 monthes
immunosupression
Wheh should you use immunosuppresion in membranous nephropathy
If symptomatic nephrotic syndrome with rising proteinuria or deteriorating renal function
What is the prognosis of membranous nephropathy
Resolves spontaeously in 1/3
Good if treated patients whose proteinuria resolves
25% are on dialysis in 10 years
How does reduced oncotic pressure in nephrotic syndrome cause oedema
Hypoalbuminemia reduces the capillary oncotic pressure and the imbalance of Starling’s forces leads to interstitial leakage of fluid and decreased circulating volume. The under-fill theory proposes that the decreased circulating volume leads to renal hypoperfusion and activation of the renin-angiotensin-aldosterone system (RAAS) Stimulation causes avid sodium and water reabsorption
Why do you get excessive sodium retention in nephrotic syndrome
Excessive sodium retention occurs in some individuals with nephrotic syndrome in the absence of activation of the renin-angiotensin-aldosterone system, suggesting an intrinsic defect in sodium excretion by the kidney.
