Glomerulonephritis Flashcards
What is glomerulonephritis (GN) (a.k.a. nephritic syndrome)?
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)
What diseases are included in GN?
- 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)
Which countries is IgA nephropathy most common in?
Developed
Does IgA nephropathy present more in younger or older patients?
Presents at any age
Peaks in 2nd and 3rd decade
Which ethnicity is at increased risk of IgA nephropathy?
East Asians/Chinese
Caucasians
Rare in African and Caribbean groups
What % of people with IgA nephropathy present with visible haematuria with an URTI (synpharingitic haematuria)?
40-50%
What % of people with IgA nephropathy present with dipstick abnormalities detected at routine medical checks?
20-30%
What % of people with IgA nephropathy present with rapidly progressive GN (i.e., nephritic syndrome)?
10%
What % of IgA nephropathy is familial?
10%
What condition causes nephritic syndrome in younger patients?
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
What does minimal change disease (MCD) typically present as?
Nephrotic syndrome
What % of children and what % of adults with nephrotic syndrome have MCD?
90% children
10% adults
What is the onset of MCD?
Rapid
Occurs in days to 1-2 weeks
Large urinary protein losses
Is MCD mainly primary or secondary?
Mainly primary
Name some secondary causes of MCD?
NSAIDs
Cancer
Drugs
How is renal function affected by MCD?
Usually normal
What does focal segmental glomerular sclerosis (FSGS) present as?
Nephrotic syndrome
What % of people with FSGS also have haematuria?
50%
Name some causes of secondary FSGS?
Obesity
HIV
Heroin
Reduced nephron mass
Which type of FSGS can be acute?
Primary
(secondary = sub-acute)
What Tx can primary FSGS respond to?
Steroids
Tacrolimus
What % people with membranous nephropathy present with nephrotic syndrome?
30%
Which racial group does membranous nephropathy affect?
All
Which gender does membranous nephropathy affect more?
Male more than females
Which antibody is associated with membranous nephropathy?
PLA2R antibody
What % of membranous nephropathy cases are primary?
75%
Name some causes of secondary membranous nephropathy
NSAIDs
Malignancy
Hepatitis B
Gold
Penicillamine
What is the Tx for membranous nephropathy?
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
What causes lupus nephritis?
SLE
What is SLE?
Autoimmune condition
Can be ANA +ve
Relapses and remissions
Which gender and ethnicity is SLE more common in?
Women
South-East Asian
What % of SLE cases have renal involvement?
50%
Which other symptoms can present in SLE?
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
What investigations can be done in GN?
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
Sources
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
