[Glomerulonephritides] Flashcards
Glomeruli
Nephrons
glomeruli damage
compensatory BP rise
Proteinuria
Haematuria
(mild –> nephrotic/macroscopic)
Hypertension
urine dipstick findings (2)
Renal function impaired
proteinuria (3.5g/day)
> 3.5g/day
normal or raised (mild)
normal or raised (mild)
normal/mild raised BP
normal/mild raised GFR
>3.5g/day protein
Moderate/severely raised BP
Moderate/severely raised GFR
Haematuria
Blood
mild to macro
Nephrotic
Nephritic syndrome
Mesangiocapillary GN
Mesangium
Basement membrane
Immune complex mediated
Complement mediated
classical
C
alternative
proliferated mesangium
thickened basement membrane
complement stains
light chains
Ig stains
ACEi/ARB
T
steroids
+-
cyclophosphamide
(immunosuppression)
Yes
rapid deterioration of renal function
mesangiocapillary GN
IgA nephropathy
IgA nephropathy
Haematuria
marked nephritic in fewer
relapsing and remitting (rapid recovery between attacks)
men
young
Western young man with attacks of haematuria
mesangial
mesangial proliferation
IgA
C3
ACEi/ARB
marked decline in renal function
Mesangiocapillary GN
Membranous GN
Minimal change
Focal segmental glomerularsclerosis
Diabetes
Amyloid
SLE (class 5)
Hepatitis B and C
B
C
V (5)
1 to 4
abnormal protein in fibrillar form
glomerular lesions
antigen deposition on glomerulus
host reaction
immune complex deposition
SLE (1-4) Vasculitis Anti-GBM Cryoglobulinaemia Post-streptococcal
post-streptococcal
antigen deposition on glomerulus
host reaction
immune complex deposition
raised ASOT
raised C3
Not required usually
95% recover with supportive Tx
Cure infection!
anti-streptolysin O
(o = oxygen labile)
An antibody against streptolysin O: an antigen produced by group A streps
beta-haemolysis (RBC haemolysis full)
a diffuse
proteins which become insoluble at lower temperature
Immunoglobulins
Goodpastures disease
type IV collagen
IV (4)
Renal glomerulus
Lung tissue
pulmonary haemorrhage
smokers
nephritic/haematuria
AKI (within days)
plasma exchange (removes antibodies) \+ steroids \+- cyclophosphamide
adds alkyl group to DNA - prevent synthesis
nitrogen mustard alkylating agent
ANCA +ve
anti-neutrophil cytoplasmic antibody
neutrophils
neutrophil
Henloch-Schonlein purpura
small vessel vasculitis
small vessel vasculitis
extensor surfaces
legs
extensor surface purpura
polyarthritis (can be flitting)
Abdominal pain (GI bleed)
nephritis
IgA depostion
identical to IgA nephropathy
ACEi
steroids
+-
cyclophosphamide
if progressive renal dysfunction
anti-GBM anti-dsDNA (SLE) ANA (SLE) ANCA (vasculitis) Anti-HCV (Hep C)
HBsAg (Hep B surface antigen)
Multiple myeloma
it is a light chain
renal biopsy
no need in Post-strep
1g/day
<75
ACEi/ARB
GN!
days
Crescents affecting most glomeruli
3
Immune complex (47%)
Pauci-immuni (50%)
Anti-GBM (3%)
IgA
HSP
Post-strep
SLE
pauci immune
T
pulmonary haemorrhage
yes
IV steroids
+
cyclophosphamide
+- plasma exhange