glomerulonephritis Flashcards
what is glomerulonephritis
immune-mediated disease of the kidneys affecting the glomeruli
what cells surround the capillaries
podocytes
what can disruption of the capillary wall cause
haematuria and/or proteinuria
what type of lesion does damage to endothelial or mesangial cells lead to
proliferative lesion and red cells in urine
what does damage to podocytes lead to
non-proliferative lesion and protein in urine
what happens when endothelial cells are attacked
vasculitis
diagnosis of GN
- clinical presentation
- blood tests
- examine urine (urinalysis, urine microscopy etc)
- kidney biopsy
presentation of GN
- haematuria
- proteinuria/albuminuria
- AKI/CKD
- hypertension
- nephrotic and nephretic syndrome
what is nephretic syndrome
- acute decline in kidney function
- oliguria
- oedema caused by fluid retention
- hypertension
- active urinary sediment
what is nephrotic syndrome
- proteinuria
- hypoalbuminaemia
- oedema
- hypercholesterolaemia
- usually normal renal function
complications of nephrotic syndrome
- infections
- renal vein thrombosis
- pulmonary emboli
- volume depletion may lead to AKI
two types of GN
primary - autoimmune
secondary - caused by infection or drugs, or part of a systemic disease
what does it mean if GN is crescentic
presence of crescents - extracapillary proliferation of inflammatory cells within Bowman’s space
non-immunosuppressive treatment of GN
- anti-hypertensive
- ACE inhibitors/ARBs
- SGLT2i
- diuretics
- statins
- anticoagulants in nephrotic with hypoalbuminaemia
immunosuppressive treatment of GN
- corticosteroids
- alkylating agents
- calcineurin inhibitors
- anti-proliferatives
- plasmapheresis
- IV immunoglobin
- monoclonal antibodies
treatment of nephrotic patients
- fluid restriction
- salt restriction
- diuretics
- ACE inhibitors/ARBS
- consider anticoagulation
- IV albumin (only if volume deplete)
- statins
what are the different types of primary GN
- minimal change
- FSGS
- membranous
- membranoproliferative
- IgA nephropathy
features of minimal change nephropathy
- children
- only seen on electromicroscopy
- oral steroids treatment
- cyclophosphamide for steroid resistant
- doesn’t cause progressive renal failure
what is FSGS
focal segmental glomerulosclerosis
- commonest cause in adults
- primary, secondary or genetic
- medium response to steroids (60%)
secondary causes of membranous nephropathy
- infections
- connect tissue diseases (lupus)
- malignancies
- drugs (gold/penicilliamine)
what is seen on renal biopsy in membranous nephropathy
subepithelial immune complex deposition in the basement membrane
features of IgA nephropathy
- commonest in world
- asymptomatic microhaematuria +/- non-nephrotic range proteinuria
- macroscopic haematuria after resp/GI infection
- can cause AKI/CKD
what disease is IgA nephropathy associated with
henoch-Schonlein purpura
treatment for IgA nephropathy
- BP control
- ACEis and ARBs
- fish oil
how quick is the deterioration in rapidly progressive glomerulonephritis
days/weeks
what can RPGN be divided into
ANCA positive and ANCA negative
ANCA positive types of RPGN
- granulomatosis with polyangiitis
- microscopic polynagitis
ANCA negative RPGN
- goodpasture’s/ANti-GBM disease
- Henoch Sholein purpura/IgA
- systemic lupus erythematosus
treatment for RPGN
IMMUNOSUPPRESSION
- steroids and cytotoxics or anti B cell antibody
- steroids and azathioprine as maintenance for at least years to prevent relapse
