Glomerulonephritis Flashcards

1
Q

What is glomerulonephritis (GN) (a.k.a. nephritic syndrome)?

A

Glomerular injury

Applies to a group of disease that are generally, but not always, characterised by inflammatory changes in the glomerular capillaries and the glomerular basement membrane (GBM)

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2
Q

What diseases are included in GN?

A
  • membranous GN
  • minimal change disease
  • focal segmental glomerulosclerosis
  • IgA nephropathy
  • forms of rapidly progressive GN (vasculitis and anti-GBM disease a.k.a., Good Pastures|)
  • lupus nephritis (due to SLE)
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3
Q

Which countries is IgA nephropathy most common in?

A

Developed

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4
Q

Does IgA nephropathy present more in younger or older patients?

A

Presents at any age

Peaks in 2nd and 3rd decade

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5
Q

Which ethnicity is at increased risk of IgA nephropathy?

A

East Asians/Chinese

Caucasians

Rare in African and Caribbean groups

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6
Q

What % of people with IgA nephropathy present with visible haematuria with an URTI (synpharingitic haematuria)?

A

40-50%

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7
Q

What % of people with IgA nephropathy present with dipstick abnormalities detected at routine medical checks?

A

20-30%

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8
Q

What % of people with IgA nephropathy present with rapidly progressive GN (i.e., nephritic syndrome)?

A

10%

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9
Q

What % of IgA nephropathy is familial?

A

10%

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10
Q

What condition causes nephritic syndrome in younger patients?

A

HSP

Can also present with:
- rash
- arthralgia
- abdominal pain +/- bloody diarrhoea
- renal disease

Looks like IgA on biopsy - hence called IgA vasculitis

Age > 8 at presentation more likely to develop renal involvement

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11
Q

What does minimal change disease (MCD) typically present as?

A

Nephrotic syndrome

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12
Q

What % of children and what % of adults with nephrotic syndrome have MCD?

A

90% children

10% adults

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13
Q

What is the onset of MCD?

A

Rapid

Occurs in days to 1-2 weeks

Large urinary protein losses

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14
Q

Is MCD mainly primary or secondary?

A

Mainly primary

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15
Q

Name some secondary causes of MCD?

A

NSAIDs

Cancer

Drugs

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16
Q

How is renal function affected by MCD?

A

Usually normal

17
Q

What does focal segmental glomerular sclerosis (FSGS) present as?

A

Nephrotic syndrome

18
Q

What % of people with FSGS also have haematuria?

A

50%

19
Q

Name some causes of secondary FSGS?

A

Obesity

HIV

Heroin

Reduced nephron mass

20
Q

Which type of FSGS can be acute?

A

Primary

(secondary = sub-acute)

21
Q

What Tx can primary FSGS respond to?

A

Steroids

Tacrolimus

22
Q

What % people with membranous nephropathy present with nephrotic syndrome?

A

30%

23
Q

Which racial group does membranous nephropathy affect?

A

All

24
Q

Which gender does membranous nephropathy affect more?

A

Male more than females

25
Q

Which antibody is associated with membranous nephropathy?

A

PLA2R antibody

26
Q

What % of membranous nephropathy cases are primary?

A

75%

27
Q

Name some causes of secondary membranous nephropathy

A

NSAIDs

Malignancy

Hepatitis B

Gold

Penicillamine

28
Q

What is the Tx for membranous nephropathy?

A

Lifestyle
- low-salt and low-protein diet

Medications
- ACEis/A2RBs
- statin
- furosemide +/- hydrochlorothiazide
- corticosteroid + cytotoxic or immunosuppressive therapy e.g., tacrolimus
- treatment of underlying cause

29
Q

What causes lupus nephritis?

A

SLE

30
Q

What is SLE?

A

Autoimmune condition

Can be ANA +ve

Relapses and remissions

31
Q

Which gender and ethnicity is SLE more common in?

A

Women

South-East Asian

32
Q

What % of SLE cases have renal involvement?

A

50%

33
Q

Which other symptoms can present in SLE?

A

A multi-system disease

  • arthritis/arthralgia
  • fatigue
  • photosensitive skin rash
  • butterfly rash and red patches
  • heart
  • lungs = pleuritis, pneumonitis, PE, pulmonary haemorrhage
  • GI = mouth and nose ulcers, severe abdo pain
  • haem = anaemia, high BP
  • TED
  • neuropsychiatric
  • eyes
  • spleen
  • bones
34
Q

What investigations can be done in GN?

A

Baseline bloods
- U&Es
- eGFR
- LFTs
- lipid profile
- bone
- TFTs
- FBC
- clotting screen

Virology
- hep B, C
- HIV

Cryoglobulin (abnormal proteins in blood causing it to clump together at temperatures below 37)

Immunoglobulins

Serum Protein Electrophoresis

Serum Free light chains

C3/C4

ANA

anti-dsDNA

24 hour urine or nowadays UPCR

Renal USS

Renal biopsy

Podocin/nephrin sequence analysis

PLA2R antibody

Blood sugars

35
Q

Sources

A

https://bestpractice.bmj.com/topics/en-gb/941/treatment-algorithm#patientGroup-0-0

https://bestpractice.bmj.com/topics/en-gb/207

https://bestpractice.bmj.com/patient-leaflets/en-gb/html/3000007/Glomerulonephritis

BSMS Year 3 Intrinsic Renal disease 03.04.2020 lecture