Glomerulonephritis Flashcards
What is meant by Nephritis?
Inflammation of the kidneys
What is Nephritic syndrome?
A group of symptoms, NOT a diagnosis, it simply means there is a clinical picture of having inflammation of their kidney
No set criteria
List 4 features of Nephritic syndrome
- Haematuria (microscopic or macroscopic)
- Oliguria
- Proteinuria < than 3g/24 hours (any more = nephrotic syndrome)
- Fluid retention
What is Nephrotic syndrome?
Refers to a group of symptoms without specifying the underlying cause
Has a set criteria
What 4 criteria comprise Nephrotic syndrome
- Peripheral oedema
- Proteinuria > 3g/24 hrs
- Serum albumin < 25g / L
- Hypercholesterolaemia
What is Glomerulonephritis?
An umbrella term for conditions that cause inflammation of or around the glomerulus and nephron
List 4 types of Glomerulonephritis
- Post streptococcal GN → self limiting disease with good prognosis
- Membranoproliferative GN
- IgA Nephropathy → most common biopsy diagnosis
- Rapidly Progressive GN (2) → most common biopsy diagnosis
What is Interstitial nephritis?
Term to describe a situation where there is inflammation of the space between cells and tubules (the interstitium) within the kidney
NOT the same as glomerulonephritis
What is Glomerulosclerosis?
The pathological process of scarring of the tissue in the glomerulus
NOT a diagnosis in itself, more a term to describe damage and scarring by other diagnoses
Most treatment of glomerulonephritis are what?
usually immunosuppression based
When/how does Post streptococcal GN (PSGN) occur?
1 – 3 weeks after a β-haemolytic streptococcus infection,
ie. tonsillitis by Streptococcus pyogenes
Pathogenesis of PSGN
Immune complex (IgG, IgM and C3) deposition in the glomeruli
Leads to an acute deterioration in renal function, causing AKI
Light microscopy changes of PSGN
Diffuse proliferative glomerulonephritis with prominent endocapillary proliferation with neutrophils
In what clinical scenario would we have a high suspicion of PSGN
Evidence of recent tonsillitis caused by streptococcus.
ie. history of tonsillitis, (+) throat swab results, anti-streptolysin antibody titres on blood test
Clinical presentation of PSGN?
Can range from asymptomatic microscopic haematuria to nephritic syndrome
Blood findings of PSGN?
- low C3
- raised ASO titre
Management of PSGN
Management is supportive, ~80% make a full recovery
- Antibiotics
- Antihypertensives and diuretics for complications ie. HTN and oedema
What is Membranoproliferative glomerulonephritis (MPGN)?
A pattern of glomerular injury on kidney biopsy with characteristic light microscopic changes:
- hypercellularity
- thickening of GBM
Histological lesion are a not specific disease, need exploration of cause
Pathogenesis of MPGN
Thickened GMB:
- deposition of immune complexes and/or complement factors
- Interposition of mesangial cells and other cellular elements between GBM and endothelial cell
- new basement membrane formation
Hypercellularity:
- Proliferation of mesangial cells and influx of circulating monocytes
- Leads to lobular appearance of glomerular tuft
Classification of MPGN? (2)
- Types I, II, III - based on EM findings
2.
- Immune complex mediated (Infections ie. Hep B&C, SLE)
- Complement mediated
- Not related to immune complexes or complements
Treatment and prognosis of MPGN
- Treat cause if found – infections, Myeloma etc
- Immunosuppression with aggressive disease
- Can recur after kidney transplantation
IgA Nephropathy is also known as what?
Berger’s disease
What condition is related to IgA Nephropathy?
Henoch-Schonlein Purpura (which is an IgA vasculitis)
Pathogenesis of IgA Nephropathy
IgA deposits in nephrons of the kidney and causes inflammation (nephritis)
What is the pathognomonic finding on renal biopsy of IgA Nephropathy?
Histology will show “IgA deposits and glomerular mesangial proliferation”
In which age group is IgA nephropathy most prevelant?
In teenagers or young adults
Clinical presentation(s) of IgA Nephropathy?
- One or recurrent episodes of gross hematuria, often with an URTI mostly in younger people (40-50%)
- Microscopic hematuria and mild proteinuria (30-40%)
- Nephrotic syndrome or an acute, rapidly progressive glomerulonephritis (<10%)
Clinical Associations with IgA Nephropathy
- Cirrhosis and other forms of severe liver disease
- Coeliac disease
- HIV Infection
Diagnosis of IgA Nephropathy?
- Kidney biopsy
- Serum IgA levels
- Skin biopsy – non specific
Treatment of IgA Nephropathy
Mild – BP control with ACE-I/ARBs
Moderate - Severe disease – Immunosuppression
List the 2 Rapidly Progressive Glomerulonephritises (RPGN)
- ANCA associated vasculitis
- Anti-GBM Disease
Clinical Presentation of RPGN
Commonly progressive renal impairment, aggressive course needing dialysis
Rarely asymptomatic (SLE, ANCA) with urinary abnormalities (Haematuria and/or proteinuria) or indolent course with maintained renal functions
TF is this
What is ANCA?
Antineutrophil Cytoplasmic Antibodies
- circulating autoantibodies (IgG) against cytoplasm of the neutrophils
- IIF patterns: cytoplasmic (cANCA) and perinuclear (pANCA)
Anti-GBM disease is also know as what?
Goodpasture’s
Compare Goodpasture’s syndrome vs disease
Goodpasture’s syndrome - RPGN with lung haemorrhage
Goodpature’s disease - RPGN with lung haemorrhage and anti-GBM antibodies
What are Anti-GBM antibodies?
Antibodied directed against an antigen intrinsic to GBM
Treatment of RPGN
- Steroids
- Immunosuppression - Cyclophosphamide, Azathioprine, Rituximab
- Plasma exchange
- Dialysis
Blood findings of PSGN?
low C3
raised ASO titre
