Glomerulonephritis Flashcards
Outline the function and the structure of the glomerulus?
A semi-permeable membrane used as a filter between the blood in capillaries and the the inter-tubular fluid.
Capillaries –> Basement Membrane –> Podocytes
Define the term glomerulonephritis?
Glomerulonephritis includes a range of immune-mediated disorders that cause inflammation within the glomerulus.
Describe the following terms with regard to glomerulonephritis: diffuse, focal and segmental?
Diffuse: affecting all glomeruli
Focal: affecting some of the glomeruli
Segmental: only affects part of an affected glomeruli
Describe the basic pathology of glomerulonephritis?
Immunological attack by antibodies or T cells.
The glomerulus responds to the attack in one of 3 ways:
Capillary
a) endothelial proliferation
b) proliferation of mesangial cells
c) capillary wall necrosis
BM thickening
Deposition of podocytes in the bowman’s capsule
Describe the different causes of antigens being present on the glomerulus?
Neoplasm SLE Goodpasture's Amyloid Infection Diabetes
Henoch Schnolein Purpura
What are the causes of glomerulonephritis and which are most common in children and adults?
- IgA Nephropathy (including HSP)
- SLE
- Anti Glomerular basement membrane disease (Goodpastures)
- Proliferative (post infective)
- Rapidly Progressing
- Minimal Change disease
- Membranous
- Focal segmental
- Membranoproliferative
In children: Minimal Change Disease
In adults: IgA nephropathy
Describe the clinical presentation of glomerulonephritis?
AKI CKD Asymptomatic haematuria Nephrotic Syndrome -Proteinuria -Oedema -Hyperlipidaemia -Hypoalbuminaemia
Nephritic Syndrome
- Haematuria
- mild proteinuria
- HTN
- Fluid retention
- oliguria
How does IgA nephropathy present?
1-2 days post URTI
Leads to nephritic syndrome presentation
Renal biopsy shows IgA deposits
Treatment is supportive with steroids if severe
How does anti-GBM/Goodpasture’s disease present?
Macroscopic haematuria followed by oliguria
Respiratory symptoms:
- Dyspnoea
- Cough
- Haemoptysis
What is the pathophysiology in Goodpasture’s diseaseand how is it treated?
It is an autoimmune disease driven by anti glomerular basement membrane autoantiboidies (anti GBM).
These attack the basement membrane in both the kidneys and lungs.
Urgent treatment is needed with:
- Steroids
- Plasma exchange (to remove circulating anti GBM)
- Dialysis may be needed
Describe the clinical presentation of post strep glomerulonephritis?
1-2wks post strep infection
Nephritic syndrome symptoms
Outline the investigations which should be done in suspected glomerulonephritis?
Bedside:
- BP
- Urine dip and cytology
Bloods:
- FBC, LFTs, CRP, U/E’s, albumin, lipids
- urine protien:creatinine ration
Imaging:
- Renal USS and biospy
- CXR
Renal biopsy: except in the mildest cases or in nephrotic syndrome in children. (needed for diagnosis)
How do you manage glomerulonephritis generally?
Symptomatic:
- Control oedema with diuretics
- BP control with ACEi or angiotensin II receptor antagonists.
Depending on type and degree of histological finding:
Immunosupressants: (except in proliferative)
- Corticosteroids
- Cyclophosphosphamide
IV Ig
What is rapidly progressive glomerulonephritis?
A glomerulonephritis which progresses to renal failure within days to weeks.
It is usually in the context of a nephritic syndrome*
On renal biopsy it is often associated with extensive glomerular crescent formation.
(if the question asks about cresenteric glomerulonphritis thing of rapidly progressive)
*Haematuria
Proteinuria (not as high as nephrotic)
HTN
Oliguria
What are features of minimal change disease?
Presents with nephrotic syndrome
Normal light microscopy
Electron microscopy shows podocyte fusion
Treatment with steroids and cyclophosphamide if relapsing
