Glomerulonephritis Flashcards
What is glomerulonephritis (GN)?
An autoimmune condition that targets the glomerulus
Mediated by antibodies
Why do patients, in general, present with haematuria and proteinuria?
Link to damage to the glomerules
Haematuria -> damage to the endothelial/mesangium cells (proliferative)
Proteinuria -> damage to the podocytes/basement membrane (non-proliferative)
What are the 2 important drugs used in HTN management in patients with GN?
What is the other drug used to manage?
- Statin - reduce hypercholestremia (present in nephrotic syndrome)
- ACEi - help to reduce proteinuria (can induce AKI but important for management of chronic kidney conditions)
Steroids
What is the buzzword on renal biopsy for rapidly progressive glomerulonephritis?
Crescentic glomerulonephritis
think of the moon quickly changing
RBC analysis on haematuria is rarely used now but why are dysmorphic RBC a sign of glomerular dysfunction as opposed to the blood being from a bleed further down the urinary system?
Dysmorphic RBC -> squeezed through the glomeruli
What does proteinuria do to the blood?
Causes hypoalbuminaemia (albumin is the main protein found in the blood)
Causes hypercholestermia
How much protein needs to be found in the blood before it is defined as nephrotic syndrome?
3g/day
In nephrotic syndrome the patient is often urinating normally so why do they get such significant oedema?
Significant protein loss reduces BP -> body retains H20 and Na+ to try increase BP
How does glomerulonephritis present?
Proteinuria and microscopic haematuria
~Nephritic and nephrotic syndrome
- more commonly nephrotic syndrome
HTN
If steroids aren’t tolerated or aren’t sufficient what other drug may be offered?
Monoclonal antibodies
What is the most common cause of NEPHROTIC SYNDROME to affect children?
If a child presents with nephrotic syndrome what should be done immediately?
Minimal change disease
Give steroids - assume it is minimal change
What is the most common cause of NEPHROTIC SYNDROME in adults?
Focal segmental glomerulosclerosis
What is IgA nephropathy also known as?
What is seen on histology?
Berger’s disease
- most common cause of PRIMARY GN
IgA deposits and glomerular mesangial proliferation
A patient presents to clinic with haemoptysis and acute renal failure. You suspect this could be a condition assoc. with antibodies. What antibodies would you be looking for?
Suspect Goodpasture’s or Granulomatosis with polyangiitis
Goodpastures - anti-GBM
GPA - cANCA +ve
Are patients with post streptococcal glomerulonephritis most likely to present with nephrotic or nephritic syndrome?
Nephritic
The most common type of GN overall on histology shows ‘IgG and complement deposits on the basement membrane”.
What is this condition?
Membranous glomerulonephritis
How may the urine appear if there is high concentrations of protein in it?
Frothy
What 3 things does nephrotic syndrome predispose a patient to?
HTN
High cholesterol
Thrombosis
Vasculitis can cause glomerulonephritis. What are the two types which can cause and their associated antibodies?
GPA = cANCA
Microscopic polyangittis - pANCA
How will GPA/sarcoidosis appear on renal biopsy?
Granulomas
What Ig is associated with Goodpastures?
Linear IgG on immunofluorescence
What presents with ‘spikes on silver stain’?
Membranous glomerulonephritis
IgA neuropathy most commonly occurs in kids and young males following what?
URTI
GI viral infection
What appears as tram tracks on silver staining?
Membranoproliferative
What kind of GN NEEDS electron microscopy for diagnosis?
Membranous
What are the two types of GN that are associated with sore throats?
Which one will present at the same time as throat symptoms and which one will present after?
IgA nephropathy - present at same time as sore throat
Post-streptococcal GN - present several days/weeks after
