Glomerulonephritis Flashcards
What is the definition of nephrotic syndrome?
Proteinuria >3.5g/24 hours
Hypoalbuminaemia <30g/L
Peripheral oedema
What is the definition of nephritis syndrome?
Haematuria
Hypertension
Oliguria
What are the potential causes of nephrotic syndrome?
Minimal change disease Focal segmental glomerulonephropathy Membranous glomerulonephropathy Thin basement membrane disease Fibronectin glomerulonephropathy
What are the potential causes of nephritic disease?
IgA nephropathy Goodpastures syndrome Membranoproliferative glomerulonephropathy Post-infectious glomerulonephropathy Granulomatosis with polyangiitis
What are the specific complications associated with nephrotic syndrome?
Thromboembolism
Risk of infection
What are the potential complications of glomerulonephropathy?
Risk of infection Hypervolaemia Hypertension Hypercholesterikaemia Hypercoagulability CV disease AKI CKD End stage renal disease
What is Rapidly progressive glomerulonephritis?
Acute nephritic syndrome alongside formation of crescents (due to the thrombosis and rupture of glomerular capillaries compressing surrounding glomerular structures)
What age group of patients is most likely to have rapidly progressing glomerulonephritis?
20 - 50 years
What investigations should be conducted for glomerulonephritis?
Bloods - U&Es, glucose, ANA, anti-dsDNA, ANCA, complement, Hep B/C, HIV, paraprotein, anti-GBM antibodies, anti-steptolysin O antibody,
Urinalysis - protein, blood
Urine protein creatinine ratio
Urine microscopy
Renal ultrasound
What management strategies form part of the basic treatment of glomerulonephritis?
ACEi/ARB
VTE prophylaxis
Fluid / salt restriction or sometimes diuretics
Treatment of the underlying cause
What is the most common cause of nephrotic syndrome in children?
Minimal change disease
What findings will be seen on immunofluorescence, light microscopy and electron microscopy in minimal change disease?
Immunofluoresence and light microscopy - unremarkable
Electron microscopy - fusion of podocyte foot processes
How is minimal change disease managed?
Nutritional support
Salt and fluid restriction
Corticosteroids
If steroids fail, rituximab
What findings will be seen on immunofluorescence, light microscopy and electron microscopy in focal segmental glomerulosclerosis?
Immunofluoresence and light microscopy - unremarkable
Electron microscopy - segmental scarring of certain glomeruli and fusion of podocyte fusion processes
What is the management official segmental glomerulosclerosis?
Generally supportive
Steroids in some patients
What are the potential causes of focal segmental glomerulosclerosis?
Primary - genetic mutations
Secondary - HIV, lupus, reflux nephropathy
What is the most common cause of nephrotic syndrome in adults?
Focal segmental glomerulosclerosis
What age group of patients are most commonly affected by membranous glomerulonephritis?
Age 30-50 years
What are the potential causes of membranous glomerulonephritis?
Idiopathic
Hep B
Malaria
Lupus
What findings will be seen on immunofluorescence, light microscopy and electron microscopy in membranous glomerulonephritis?
Microscopy - thickening glomerular basement membrane
Immunofluorescence - diffuse uptake of IgG
How is membranous glomerulonephritis managed?
Steroids for progressive disease
Supportive care
What is the most common type of nephritic syndrome in adults?
IgA nephropathy
How long after an upper respiratory tract infection does IgA nephropathy usually present?
24-48 hours
What findings will be seen on immunofluorescence, light microscopy and electron microscopy in IgA nephropathy?
Microscopy - increase numbers of mesangial cells
Immunohistochemistry - IgA deposition within mesangial cells
What is the management of IgA nephroapthy?
Supportive care
Steroids
Immunosuppressants in some cases
How long after upper respiratory tract infection does post-strep glomerulonephritis usually present?
2 weeks later
What investigations findings are typically seen in post-strep glomerulonephritis?
Diffuse proliferative and exudative glomerular histology
Dominant C3 staining and subepithelial humps
Raised serum strep titres
What is the management of post-strep glomerulonephritis?
Mostly supportive (it is usually self-limiting)
What conditions are associated with membranoproliferazive glomerulonephritis?
Hep C
Autoimmune disease e.g. SLE
What investigations findings are typically seen in membranoproliferative glomerulonephritis?
Thickening basement membrane and mesangium
Tram tracking appearance
Subendothelial deposition of IgG
How is membranoproliferative glomerulonephritis managed?
Steroids in children
Antiplatelets in adults
What respiratory complications can occur in Goodpasture’s syndrome?
Pulmonary haemorrhage
What investigations findings are typically seen in goodpastures syndrome?
Serum anti-GBM antibodies
IgG deposits along basement membrane on immunohistochemistry
How is good pastures syndrome managed?
High dose immunosuppression - steroids and cyclophosphamide +/- plasmapheresis
What investigations findings are typically seen in granulomatosis with polyangiitis?
Positive c-ANCA
Leukocytoclastic vasculitis with necrosis and granulomatous inflammation
How is granulomatosis with polyangiitis managed?
Immunosupression induction with high dose steroids and Rituximab / cyclophosphamide
Maintenance therapy - steroids, methotrexate
What investigations findings are typically seen in microscopic polyangiitis?
Positive p-ANCA antibodies
Anaemia
How is microscopic polyangiitis managed?
Long term steroids / cyclophosphamide
