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Y3 Lecture week V > Glomerulonephritis (1) > Flashcards

Glomerulonephritis (1) Flashcards

1
Q

Membranous glomerulonephritis

  • population profile
  • presentation (2)
A

Membranous glomerulonephritis

  • the commonest cause of glomerulonephritis in adults
  • presents with: proteinuria or nephrotic syndrome
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2
Q

Causes of membranous glomerulonephritis

A
  • idiopathic
  • infections: hepatitis B, malaria, syphilis
  • malignancy: lung cancer, lymphoma, leukaemia
  • drugs: gold, penicillamine, NSAIDs
  • autoimmune diseases: systemic lupus erythematosus (class V disease), thyroiditis, rheumatoid
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3
Q

Management of membranous glomerulonephritis

A

Management of membranous glomerulonephritis

  • immunosuppression: a combination of corticosteroid + another agent such as chlorambucil is often used
  • blood pressure control: ACE inhibitors have been shown to reduce proteinuria
  • consider anticoagulation
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4
Q

Nephritic syndrome

Basic presentation

A

Nephritic syndrome

  • inflammation of glomeruli
  • increased BP
  • cola-coloured urine (haematuria)
  • Berger’s disease (IgA nephropathy) -> the most common cause of primary glomerulonephritis
  • oliguria
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5
Q

Nephrotic syndrome

A

Nephrotic syndrome

  • hypoalbuminemia
  • hyperlipidaemia
  • peripheral oedema
  • massive proteinuria
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6
Q

What’s seen on renal biopsy of membranous glomerulonephritis?

A

Renal biopsy demonstrates:

  • electron microscopy: the basement membrane is thickened with subepithelial electron dense deposits. This creates a ‘spike and dome’ appearance
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7
Q
A
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8
Q

What is glomerulonephritis (in general)?

A

Glomerulonephritis

  • immune-mediated injury (that affects mainly glomerular tissue)
  • inflammation of the glomerulus and other components of the kidney -> inflammation of the nephron

*3rd commonest cause of renal failure in Europe, commonest worldwide

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9
Q

Which part of the kidney does the actual filtration?

A
  • endothelial cells (sitting on basement membrane) -> capillaries
  • epithelial cells - podocytes (help in filtration)
  • Mesangial cells -> produce collagen and hold capilaries in space
  • basement membrane

* all these components can be affected by inflammation

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10
Q

What are the components of the filtration barrier?

A
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11
Q

Primary vs Secondary glomerulonephritis

A
  • Primary - problem starts in the kidney itself e.g. autoimmune
  • Secondary - disease elsewhere in the body, but kidney is injured as a result of that (e.g. SLE -> Lupus nephritis)
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12
Q

Infective vs non-infective glomerulonephritis

(examples)

A
  • infective: HIV, Streptococcal, viruses, bacteria, parasites
  • non-infective: minimal change disease, focal segmental glomerulosclerosis, SLE etc. (idiopathic, systemic inflammatory diseases, drugs, malignancy, hereditary, infiltrative disease)
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13
Q

Nephrotic vs Nephritic

A
  • Nephrotic -> problem is about the loss of protein in the urine (hypoalbuminaemia + proteinuria)
  • Nephritic -> blood in the urine (haematuria)
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14
Q

Signs of Nephritic syndrome

A

Nephritic syndrome

  • haematuria

- proteinuria (not massive one)

- oliguria

-hypertension

*the above is TETRAD of Nephritic syndrome

HTN - as oliguria and fluid retention

  • dysmorphic red cells -> abnormally shaped red cells (as they are squeezed through the filtration barrier - normally not passed through it)
  • red cell casts -> RBCs get packed in the renal tubules and casts are formed
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15
Q

Signs of nephrotic syndrome

A

Nephrotic syndrome

  • heavy proteinuria >3.5g/day
  • hypoalbuminemia
  • oedema
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16
Q

Is it nephrotic syndrome if the proteinuria is less than 3.5 g / day?

A

No, it must be more than 3.5g/day

17
Q

3 components that are essential to classify the presentation as nephrotic syndrome

A

Nephrotic syndrome

  • proteinuria of >3.5 g a day
  • hypoalbuminemia
  • oedema

*all 3 components necessary for classification of nephrotic syndrome

18
Q

What are different classification of glomerulonephritis (based on structural histological appearance)?

A
  • focal -> if less than 50% of glomerulus is affected
  • global -> if the whole capillaries are affected
  • segmental -> if part of the capillary bed affected
19
Q

Focal segmental glomerulonephritis

  • what syndrome does it cause
  • population presentation
A

Focal segmental glomerulosclerosis

  • cause of nephrotic syndrome and chronic kidney disease
  • young adults
  • high recurrence in renal transplants
20
Q

Causes of focal segmental glomerulonephritis

A

Causes of focal segmental glomerulonephritis

  • idiopathic
  • secondary to other renal pathology e.g. IgA nephropathy, reflux nephropathy
  • HIV
  • heroin
  • Alport’s syndrome
  • sickle-cell
21
Q

Membranoproliferative glomerulonephritis

  • what is it known as
  • what syndrome does it present as
  • what happens
A

Membranoproliferative glomerulonephritis

  • also known as mesangiocapillary glomerulonephritis
  • may present as nephrotic syndrome, haematuria or proteinuria
  • poor prognosis

Immune deposits in the glomerulus

22
Q

General pathophysiology of glomerulonephritis

A

Immune response against the kidney cells - deposition of antigens/antibodies -> inflammation

  • Antigen - antibody complex -> start of complement response -> membrane-atack complex produced -> cellular destruction
  • chemotaxis factors produced -> neutrophils, cytokines etc -> damaging to the cells

*depends on what parts of the nephron is affected -> different presentation due to different cells being affected

23
Q

What is the main aim of treatment of glomerulonephritis?

A

We want to stop the scar to be formed in the glomerulus

*as result of every inflammatory process -> fibrosis and a scar formed (once the scar has formed = no way back)

* if the scar is already formed = sclerosis (scar tissue)

24
Q

What’s the ‘crescent’?

A

Crescent

Capillaries are squeezed towards the end -> nephron would not recover

25
Q

What is the ‘fluffy’/ ‘foam’ urine sign of?

A

Proteinuria - proteins make urine fluffy

26
Q

Extrarenal symptoms of glomerulonephritis

*consider different body systems

A
  • Constitutional: fever, weight loss, fatigue
  • Eye: uveitis, retinitis
  • ENT: sore throat, sinusitis, oral ulcers
  • skin: rash
  • MSK: arthralgia, arthritis, myalgia
  • GIT: diarrhoea, colitis
  • Chest: haemoptysis, nodules
  • Heart: murmurs, pericarditis
  • Nervous system: peripheral neuropathy, seizures
  • thrombo-embolic complications
27
Q

What are the features of uraemia?

A

Uraemia:

  • nausea and vomiting
  • alerted consciousness
  • chest pain (due to uremic pericarditis)
  • anorexia
  • metallic taste in the mouth
  • rash
  • altered sleep pattern
28
Q

Why does uraemia happen? (in the picture of kidney problems)

A

uraemia - happens in extreme situation e.g. oliguria -> toxins stay back in the blood (instead of being excreted)

29
Q

Investigations for glomerulonephritis (1st line)

A
  • urine dipstick -> check for haematuria and proteinuria, SG - if urine is concentrated or dilute
  • urine microscopy -> red morphology and casts
  • ACR/PCR/24 hr Pr -> to assess a degree of proteinuria
  • eGFR, U&E -> markers of kidney function
  • FBC and bone profile -> to indicate it is acute or chronic
  • CRP and ESR -> acute phase markers
  • immunological and serological screen -> look for antibodies
  • USS kidney
  • kidney biopsy -> definitive way to find out what’s happening inside the kidney
30
Q

What is the max upper range of protein in a healthy:

  • men
  • lady
A
  • Men: 2.5/L
  • Women: 3.5/L (in pregnancy more is allowed)
31
Q

Other/extra investigations in glomerulonephritis

A
  • serum C3 and C4 complement levels -> low complement level in the serum as used up for complement response (so inflammation is going on)
  • different antibodies: antineutrophil cytoplasmic autoantibodies, anti-glomerular basement membrane (GBM) autoantibodies, antinuclear antibodies, anti-dsDNA antibodies, anti-streptolysin O antibody, anti-DNAse

*different antibodies in different causes of glomerulonephritis

  • serology for hep C, hep B, HIV
  • serum free light chains and serum immunofixation - myeloma (?)
  • blood cultures - to role out infections
32
Q

What are anti-glomerular basement membrane (GBM) autoantibodies suggestive of?

A

anti-glomerular basement membrane (GBM) autoantibodies = Goodpasture’s disease

(renal failure + pulmonary haemorrhage

33
Q

What are anti-nuclear antibodies suggestive of?

A

antinuclear antibodies = Lupus

34
Q

Anti- dsDNA antibodies are found in what?

A

Anti- double stranded DNA antibodies = found in Lupus

35
Q

Anti-streptolysin O antibody and anti-DNAse antibodies are found in what?

A

Anti-streptolysin O antibody and anti -DNAse antibodies = post-streptococcal glomerulonephritis

36
Q

Antineutrophil cytoplasmic autoantibodies are found in what?

A

antineutrophil cytoplasmic antibodies = in vasculitis

37
Q

Serum free light chains are found in what?

A

Myeloma

38
Q
A

Y3 Lecture week V (21 decks)

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