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Week 12 - Nephrology and urology > Glomerulonephritis > Flashcards

Glomerulonephritis Flashcards

1
Q

What is glomerulonephritis?

A

Inflammatory disease involving the glomerulus (in the renal cortex)

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2
Q

What are the targets for injury within the glomerulus?

A
  • Parietal epithelial cell
  • Podocytes
  • mesangial cell
  • Endothelial cell
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3
Q

What tests are carried out on a kidney biopsy?

A
  • Light microscopy using H&E staining - looks at the tubules and interstitium
  • Immunofluorescence
  • Electron microscopy to look at the ultrastructure
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4
Q

Describe membranoproliferative histology of glomeruli

A

Loads of nuclei, very congested

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5
Q

Describe FSGS

A
  • Focal segmental glomerular sclerosis

* Not all of the glomeruli will be affected and not the whole glomerulus

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6
Q

What are the 6 clinical presentations of the disruption of the glomerular filtration barrier?

A
  1. Incidental finding of urinary abnormalities with or without impaired kidney function
  2. Visible haematuria
  3. Synpharyngitic (sore throat and visible haematuria) - classical of IgA nephropathy
  4. Nephritic syndrome
  5. Nephrotic syndrome
  6. Acutely unwell with rapidly progressive glomerulonephritis
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7
Q

Clinically define nephrotic syndrome

A

Need all 3 of:
•Oedema
•3.5g proteinuria per 24 hours (urine PCR>300)
•Serum albumin <30

May also have hyperlipidaemia (by product of the liver producing more albumin to compensate for the loss)

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8
Q

What are the risks of nephrotic syndrome?

A
  • Risk of venous embolism

* Increased risk of infection (loose immunoglobulins in the urine)

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9
Q

Clinically define nephritic syndrome

A
  • Hypertension
  • Blood and protein in the urine
  • Declining kidney function
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10
Q

What is the most common cause of primary glomerulonephritis?

A

Bergers disease (IgA nephropathy) causing nephritic syndrome

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11
Q

What is the mechanism of nephrotic syndrome?

A
  • Injury to podocytes

* change to the architecture: scarring, deposition of matrix or other elements

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12
Q

What is the mechanism of nephritic syndrome?

A
  • Inflammation
  • Reactive cell proliferation
  • Breaks in the GBM
  • Crescent formation
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13
Q

What are the causes of glomerular disease?

A 
Glomerular disease is a spectrum, going from nephrotic syndrome to nephritic syndrome in terms of likelihood: 
•Minimal change nephropathy 
•FSGS 
•Membranous nephropathy 
•Diabetic nephropathy 
•Amyloidosis 
•MCGN 
•IgA nephropathy 
•Post-streptococcal glomerulonephritis 
•small vessel vasculitis 
•Anti-GBM disease

SLE causes both

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14
Q

What can IgA nephropathy be secondary to?

A
  • Henoch Schonlein purpura
  • Cirrhosis
  • Coeliac disease
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15
Q

What is IgA nephropathy?

A
  • Abnormal/overproduction of IgA1, IgA I/C
  • Mesangial IgA, C3 deposition
  • Mesangial proliferation
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16
Q

what are the clinical signs of IgA nephropathy?

A
  • Haematuria
  • Hypertension
  • Proteinuria
17
Q

What is membranous glomerulonephritis?

A
  • Deposits in the membrane
  • IC in the basement membrane/sub-epithelial space
  • Anti-phospholipase A2 receptor antibody in 70%
18
Q

What can membranous glomerulonephritis occur secondary to?

A
  • Malignancy
  • Drugs
  • Connective tissue disease
19
Q

What is the presentation of membranous glomerulonephritis?

A

Nephrotic syndrome

20
Q

Describe the prognosis of membranous glomerulonephritis

A
  • 1/3 remits and gets better
  • 1/3 will progress to end stage renal failure in 1-2 years
  • 1/3 will be persistent and will have proteinuria
21
Q

What is the treatment of membranous nephropathy?

A
  • Treat the underlying disease if secondary
  • Supportive non-immunological- ACEi, statin, diuretics, salt retention
  • Specific immunotherapy: steroids, alkylating agents, alternative agents (rituximab,anti-CD-20 MAb), Cyclosporin
22
Q

What is the most common form of glomerulonephritis in children?

A

Minimal change disease

23
Q

What does minimal change disease result in?

A

Nephrotic syndrome

24
Q

What is the pathogenesis of minimal change disease?

A
  • T cell, cytokine mediated

* Targets glomerulus epithelial cell, basement membrane changes (foot process fusion)

25
Q

What can minimal change disease be secondary to?

A

Malignancy

26
Q

What is the treatment of minimal change disease?

A

High dose steroids- prednisolone 1mg/kg for up to 8 weeks

27
Q

What is crescentic glomerulonephritis?

A

Group of conditions that demonstrate glomerular crescents on kidney biopsy. It is an aggressive disease which may process to ESRF

28
Q

What are the common causes of crescentic GN?

A
  • ANCA vasculitis
  • Goodpastures syndrome
  • Lupus nephritis
  • Infection associated
  • Henoch Schonlein nephritis

Week 12 - Nephrology and urology (14 decks)

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