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Renal > Glomerular Nephritis > Flashcards

Glomerular Nephritis Flashcards

1
Q

What are the different glomerular diseases?

A

Diabetic Nephropathy
Glomerulonephritis (GN)
Amyloid/ Light Chain Nephropathy
Transplant Glomerulopathy

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2
Q

What is the 2nd most common cause of end stage renal failure?

A

Chronic GN

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3
Q

What is an important treatable cause of acute renal failure?

A

Acute GN

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4
Q

What is GN?

A

Immune-mediated disease of the kidneys affecting the glomeruli
(with secondary tubulointerstitial damage)

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5
Q

Pathogenesis of GN

A

recognise the kidney as an antigen and self-destruction

Humoral and Cell-mediated

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6
Q

How does the GN affect the barrier?

A

Disruption of the size and the charge selective barrier leading to proteinuria and haematuria

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7
Q

What determines the

A

damage to podocytes : not dramatic inflammatory response, non-proliferative - prevents the albumin from leaking out –> proteinuria

Damage to the endothelial cells –> proliferative lesion and red cells in urine.

Damage to mesangial cells –> inflammation, proliferative lesion and red cells in urine.

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8
Q

24 year old man incidentally found to have ++ blood and + protein on dip, BP 148/92.
Protein quantified at 0.7g/day. Creat 72.
What glomerular cells are most likely to be injured?

A

blood –> mesangial cell

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9
Q

How do we do the diagnosis of GN?

A

CLINICAL PRESENTATION
BLOOD TESTS
EXAMINATION of URINE
-Urinalysis - haematuria, proteinuria
-Urine microsopy - RBC (dysmorphic), RBC & granular casts, lipiduria
-Urine Protein: Creatinine Ratio / 24 hour urine - quantify proteinuria
KIDNEY BIOPSY

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10
Q

What should you think before biopsy?

A

What am i going to treat them with and is it worth it

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11
Q

PC of GN

A

Episodes of Painless macroscopic haematuria

asymptomatic microscopic haematuria

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12
Q

CP of Proteinuria

A 
Microalbuminuria (30-300mg albuminuria/day)
Asymptomatic proteinuria ( 1 g/day)
Heavy proteinuria (1-3 g/day)
Nephrotic syndrome (> 3 g/day))
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13
Q

heavier protein

A

glomerular proteins

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14
Q

Urine microscopy

A

To identify where the blood cells come from

if bleeding from lower tract will look like that -> glomerular bleeding

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15
Q

What is the use of red cell casts?

A

peed out

classic injury to the endothelium or mesangial cells

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16
Q

What is nephritic syndrome?

A 
Acute Renal Failure
Oliguria
Oedema/ Fluid retention 
Hypertension
Active urinary sediment
RBC’s, RBC & Granular Casts - in dipstick

Indicative of a proliferative process
Affecting endothelial cells

oedema - due to fluid retention

17
Q

What is the nephrotic syndrome?

A 
Proteinuria  3 g/day (mostly albumin, also globulins)
Hypoalbuminaemia (<30)
Oedema 
Hypercholesterolaemia
Usually normal renal function

Indicative of a non proliferative process
Affecting Podocytes

oedema - as the protein less and they can’t hold on to water

18
Q

What are the complications of nephrotic syndrome?

A

Infections - loss of opsonising antibodies
Renal vein thrombosis
Pulmonary emboli - thick blood and clots in legs
Volume depletion (overaggressive use of diuretics) - may lead to ARF (pre-renal)

19
Q

How does the presentation of GN differ from a non glomerular disease like Interstitial Nephritis?

A

Shouldn’t see blood or protein in urine

20
Q

How do we classify GN?

A 
AETIOLOGY
Primary  (Idiopathic) - THE MAJORITY(endocarditis)

Secondary caused by eg. infections or drugs associated with eg. malignancies or part of systemic disease eg. ANCA - associated systemic vasculitis, lupus, Goodpastures, HSP

HISTOLOGY

RENAL BIOPSY
Light Microscopy - can stain the different immunoglobulins/ Immunofluorescence/ EM

21
Q

What is the histological classification in GN?

A

Proliferative or non-proliferative (usually refers to presence or absence of proliferation of mesangial cells)

Focal/Diffuse (< or > 50% glomeruli affected)

Global/Segmental (all or part glomerulus affected)

Crescentic (presence of crescents - epithelial cell extracapillary proliferation eg. RPGN in vasculitis)

22
Q

What are the main principals aims for GN treatment?

A

Reduce degree of proteinuria
Induce remission of nephrotic syndrome
Preserve longterm renal function

23
Q

What are the two arms for treatment in GN?

A

NON-IMMUNOSUPPRESSIVE

IMMUNOSUPPRESSIVE
24
Q

What are the non-immunosuppressant treatment of GN?

A 
Anti-hypertensives (target BP <130/80 - <120/75 if proteinuria)
ACE inhibitors/ ARBs
Diuretics
Statins
? Anticoagulants/ Aspirin/ Antiplatelets
? Omega 3 fatty acids/ Fish oil
25
Q

What are the immunosuppression treatments of GN?

A

Drugs
Corticosteroids (Prednisolone po/MethylPred IV)
Azathioprine
Alkylating agents (Cyclophosphamide/ Chlorambucil)
Calcineurin inhibitors (Cyclosporin/Tacrolimus)
Mycophenolate Mofetil (MMF)

Plasmapharesis (TPE-therapeutic plasma exchange)

Antibodies: IV Immunoglobulin
: Monoclonal T or B cell Antibodies

26
Q

What is the major treatment of nephrotic patients?

A 
Fluid restriction
Salt restriction
Diuretics
ACE Inhibitors/ ARBs
? Anticoagulation
IV Albumin (only if volume deplete)
27
Q

What is the most commonest cause of nephrotic syndrome in children?

A

minical change disease

podocytes injury

normal in microscope

responds best to steroids

second line - cyclophosphamide/ CSA

28
Q

Commonest cause of nephrotic syndrome in adults?

A

FSGS - FOCAL SEGMENTAL GLOMERULOSCLEROSIS

Renal biopsy: As its name describes on light microscopy with minimal Ig/ Complement deposition on IF
Remission with prolonged steroids in 60 %
50 % progress to end stage renal failure after 10 years

29
Q

What is the 2nd commonest cause of nephrotic syndrome in adults?

A

membranous nephropathy

30
Q

What is the commonest GN in the world?

A

IgA nephropathy

Mesangial injury

causes renal failure over years

sore throat - darker urine and blood in urine,

if any infection -> it triggers more IgA release, starts in the mesangial cells –> HSPurpura –> the piurple skin patches

31
Q

GPS

A

antibody against the arteriolar endothelium at the base of the lungs

32
Q

74 year old woman. Hypoxic. Haemoptysis. creat 430. blood and protein on dip. Red cell casts on microscopy. Purpuric rash.

Cells affected?
Diagnosis?
What test next?

A

endothelial cells
ANCA positive vasculitis
ANCA test and biopsy

33
Q

Most common cause of end stage renal failure?

A

Diabetic nephropathy

Renal (21 decks)

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