Glomerulonephritis Flashcards
What is glomerulonephritis?
Inflammatory disease involving the glomerulus (in the renal cortex)
What are the targets for injury within the glomerulus?
- Parietal epithelial cell
- Podocytes
- mesangial cell
- Endothelial cell
What tests are carried out on a kidney biopsy?
- Light microscopy using H&E staining - looks at the tubules and interstitium
- Immunofluorescence
- Electron microscopy to look at the ultrastructure
Describe membranoproliferative histology of glomeruli
Loads of nuclei, very congested
Describe FSGS
- Focal segmental glomerular sclerosis
* Not all of the glomeruli will be affected and not the whole glomerulus
What are the 6 clinical presentations of the disruption of the glomerular filtration barrier?
- Incidental finding of urinary abnormalities with or without impaired kidney function
- Visible haematuria
- Synpharyngitic (sore throat and visible haematuria) - classical of IgA nephropathy
- Nephritic syndrome
- Nephrotic syndrome
- Acutely unwell with rapidly progressive glomerulonephritis
Clinically define nephrotic syndrome
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)
What are the risks of nephrotic syndrome?
- Risk of venous embolism
* Increased risk of infection (loose immunoglobulins in the urine)
Clinically define nephritic syndrome
- Hypertension
- Blood and protein in the urine
- Declining kidney function
What is the most common cause of primary glomerulonephritis?
Bergers disease (IgA nephropathy) causing nephritic syndrome
What is the mechanism of nephrotic syndrome?
- Injury to podocytes
* change to the architecture: scarring, deposition of matrix or other elements
What is the mechanism of nephritic syndrome?
- Inflammation
- Reactive cell proliferation
- Breaks in the GBM
- Crescent formation
What are the causes of glomerular disease?
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
What can IgA nephropathy be secondary to?
- Henoch Schonlein purpura
- Cirrhosis
- Coeliac disease
What is IgA nephropathy?
- Abnormal/overproduction of IgA1, IgA I/C
- Mesangial IgA, C3 deposition
- Mesangial proliferation
what are the clinical signs of IgA nephropathy?
- Haematuria
- Hypertension
- Proteinuria
What is membranous glomerulonephritis?
- Deposits in the membrane
- IC in the basement membrane/sub-epithelial space
- Anti-phospholipase A2 receptor antibody in 70%
What can membranous glomerulonephritis occur secondary to?
- Malignancy
- Drugs
- Connective tissue disease
What is the presentation of membranous glomerulonephritis?
Nephrotic syndrome
Describe the prognosis of membranous glomerulonephritis
- 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
What is the treatment of membranous nephropathy?
- 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
What is the most common form of glomerulonephritis in children?
Minimal change disease
What does minimal change disease result in?
Nephrotic syndrome
What is the pathogenesis of minimal change disease?
- T cell, cytokine mediated
* Targets glomerulus epithelial cell, basement membrane changes (foot process fusion)
