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
What can minimal change disease be secondary to?
Malignancy
26
What is the treatment of minimal change disease?
High dose steroids- prednisolone 1mg/kg for up to 8 weeks
27
What is crescentic glomerulonephritis?
Group of conditions that demonstrate glomerular crescents on kidney biopsy. It is an aggressive disease which may process to ESRF
28
What are the common causes of crescentic GN?
*  ANCA vasculitis *  Goodpastures syndrome *  Lupus nephritis *  Infection associated *  Henoch Schonlein nephritis