Glomerulonephritis Flashcards
Chronic glomerulonephritis is the most common cause of end-stage renal failure (chronic kidney disease). True/False?
False
2nd most common, after diabetic nephropathy
Glomerulonephritis is caused by infection. True/False?
False
Immune-mediated destruction with secondary tubulointerstitial damage
Which aspects of the immune system cause glomerulonephritis?
Antibodies
T-cell mediated
Inflammatory cells, mediators, complement
Which part of the glomerulus is disrupted in glomerulonephritis?
Disruption of glomerular basement membrane and/or podocytes, leading to leakage of protein/blood
The site and type of injury determines the clinical presentation of glomerulonephritis. Damage to endothelial/mesangial cells leads to what?
Proliferative lesion, causing haematuria
The site and type of injury determines the clinical presentation of glomerulonephritis. Damage to podocytes leads to what?
Non-proliferative lesion, causing proteinuria
What might be found on urinalysis in glomerulonephritis?
Proteinuria
Haematuria
What might be found on urine microscopy in glomerulonephritis?
Dysmorphic RBCs
RBC casts
Lipiduria
What ratio is measured over 24 hours to quantify proteinuria?
Urine protein : creatinine ratio
What is the definitive investigation for glomerulonephritis?
Kidney biopsy
Microalbuminuria is low amounts of albumin in the urine and is an early sign of what?
Diabetic nephropathy
How much protein is classed as heavy proteinuria?
1-3 g/day
What is meant by “red cell casts”?
Red cells stuck with other cells in a matrix formed by Tamm-Horsfall protein
List the components that define nephrotic syndrome
Proteinuria over 3 g/day
Hypoalbuminaemia
Oedema
Hypercholesterolaemia
Renal function is usually normal in nephrotic syndrome. True/False?
True
List the components that define nephritic syndrome
Acute renal failure
Oliguria
Oedema
Haematuria
List the main complications of nephrotic syndrome
Pulmonary emboli
Infection
Renal vein thrombosis
Hypovolaemia
The majority of glomerulonephritis is idiopathic. True/False?
True
List non-idiopathic causes of glomerulonephritis
Drugs Malignancy ANCA-vasculitis SLE Goodpasture's syndrome
Once renal biopsy is taken, what histological investigations may be done on the biopsy?
Light microscopy
Immunofluorescence
Electron microscopy
What is meant by focal and diffuse glomerulonephritis?
Focal = less than 50% glomeruli affected Diffuse = more than 50% glomeruli affected
What is meant by crescentic glomerulonephritis?
Presence of crescents - epithelial cell extra-capillary proliferation
What are the principal aims of glomerulonephritis treatment? (RRP)
Reduce proteinuria
Reverse nephrotic syndrome
Preserve renal function
What is the target BP for glomerulonephritis with and without proteinuria?
Less than 130/80 if no proteinuria
Less than 120/75 if proteinuria
Which class of drug may help control BP in glomerulonephritis?
ACE inhibitors
Also consider diuretics/statins
Outline medical management of glomerulonephritis
Corticosteroid (prednisolone oral/methylprednisolone IV) Azathioprine Cyclophosphamide Cyclosporin IV immunoglobulin Plasmapharesis
Outline management of nephrotic syndrome
Fluid + salt restriction
Diuretic
ACE inhibitor
IV albumin if hypovolaemia
What is the commonest type of idiopathic glomerulonephritis in children?
Minimal-change nephropathy
normal renal biopsy
Which interleukin might be associated with minimal-change nephropathy?
IL-13
What is the commonest glomerulonephritic cause of nephrotic syndrome in adults?
Focal segmental glomerulonephritis
What is focal segmental glomerulonephritis associated with?
HIV Heroin use Obesity Reflux Nephropathy
What is the 2nd commonest glomerulonephritic cause of nephrotic syndrome in adults?
Membranous nephropathy, involving immune-complex deposition at basement membrane
What is membranous nephropathy associated with?
Infection (hep B)
CTDs
Malignancy
Drugs - gold, penicillamine
Which antibody is present in over 70% of primary membranous nephropathy?
Anti-PLA2r antibody
What is the commonest type of glomerulonephritis in the world?
IgA nephropathy involving mesangial proliferation with IgA deposits
Which skin condition is associated with IgA nephropathy?
Henoch-Schonlein Purpura
Rapidly progressive glomerulonephritis involves rapid deterioration in renal function over days/weeks. What are the 2 main classifications and their causes?
ANCA-positive (vasculitis - GPA/MPA)
ANCA-negative (Goodpasture’s, Henoch-Schonlein, SLE)
Which antibody is associated with Goodpasture’s disease?
Anti-GBM (anti-glomerular-basement-membrane)
