Glomerulonephritis Flashcards
Definition of glomerulonephritis
Normally means inflammation of glomeruli
Generally caused by immunologic rxn
Major clinical manifestation of glomerular injury
Proteinuria
Hematuria
Decreased GFR
Sodium retention
2 main syndromes by which glomerulonephritis present
Nephrotic syndrome
Nephritic syndrome
What is nephrotic syndrome
Protein wasting secondary to diffuse glomerular damage with proteinuria >3.5g/day , Hypoalbuminemia and edema
What is nephritic syndrome
Set of clinical manifestation with hematuria and at least one the folllowing - oliguria, hypertension, high BUN, decreased GFR
Main causes of primary glomerulonephritis ( immune response to something )
Acute glomerulonephritis
Postinfectious glomerunephritis
Post streptococcus glomerulonephritis
Infectious glomerulonephritis
Membranoproliferative glomerulonephritis
Rapidly progressive glomerulonephritis
Idiopathic membranous glomerulonephritis
Immune globulin A IgA nephropathy
Chronic glomerulonephritis
Focal glomerular sclerosis
Types of glomerulonephritis
Primary - occur on its own
Secondary - occurs afeter disease like lupus, diabetes, etc
Main cause of secondary glomerulonephritis
Good pasture syndrome
Hemolytic uremic syndrome
Polyarteritis
Progressive systemic sclerosis
SLE
Wegeners granulomatosis
Thrombocytopenic purpura
Postpartum renal failures
Main area of glomerulus affected when presents with nephrotic syndrome
Podocyte
Type of histological classification leading to glomerulonephritis with nephrotic syndrome
Minimal change
Focal segmental glomerulosclerosis
Membranous nephropathy
Main cause of nephrotic syndrome
Minimal change disease
Dominant cause of idiopathic nephrotic syndrome in childhood
Pathogenesis of minimal change nephropathy
Unknown but might be due to factors causing podocyte injury
Risk factors minimal change
Atopy
Drugs NSAIDs
Hematological
Malignancies
Histological presentation of minimal change
Fusion of podocytes in electron microscopy
Presentation minimal change
Severe nephrotic syndrome
Management minimal change
High dose glucocorticoid
Population more at risk of focal segmental glomerulosclerosis
West African because carry more apolipoprotein L1 gene variant
Histology focal segmental glomerulosclerosis
Segmental scar in some glomeruli so need a lot of sample to see it and not mix it with minimal change
Podocytes foot fusion when primary focal segmental glomerulosclerosis
Is there immune deposit in focal segmental glomerulosclerosis
Yes in the focal scars , and are non specific
Causes of secondary focal segmental glomerulosclerosis
Healing of previous local injury
HIV infection
Heroin misuse
Morbid obesity
Chronic hypertension
Presentation of focal segmental glomerulosclerosis
Primary FSGS presents as idiopathic nephrotic syndrome but less responsive to treatment than minimal change, may progress to renal impairment, can recur after transplantation
Secondary FSGS presents with variable proteinuria and outcome
Most common cause of nephrotic syndrome in Caucasian adult
Membranous nephropathy
Pathogenesis Membranous nephropathy
Antibodies mostly autoantibodies directed at antigens expressed on podocyte surface including M type phospholipase A2 receptor 1
Prognosis of Membranous nephropathy
1/3 recover spontaneously
1/3 remainin nephrotic state
1/3 progressive CKD
Dx due to glomerulonephritis leading to mild nephritic syndrome
IgA nephropathy
Mesangiocapillary glomerulonephritis
Main presentation of patient with mild nephritic syndrome
Non visible hematuria
Modest proteinuria
Slow progressive course of renal dx
Main way of detection of IgA nephropathy
During routine exam
Type of immune deposits in IgA nephropathy
Mesangial IgA and C3
Variant of IgA nephropathy common in children
Henoch-schonlein purpura
What is Henoch-schonlein purpura
systemic vasculitis due to infectious trigger
Henoch-schonlein purpura tetras symptom
Petechiae task on buttock and lower leg
Abdominal pain
Arthralgia
Renal dx with visible or non visible haematuria with or without proteinuria
Prognosis of Henoch-schonlein purpura
Good with spontaneous resolution
Second name of mesangiocapillary glomerulonephritis
membranoproliferative glomerulonephritis
Renal biopsy findings in membranoproliferative glomerulonephritis
Increased mesangial cells
Thickening of glomerular capillary walls
Typical presentation of membranoproliferative glomerulonephritis
Proteinuria
Haematuria
Two main type of membranoproliferative glomerulonephritis
Immunoglobulin deposition from deposition of circulating immune complexes or planted antigens
Complement component deposited
Associated risk factor to immunoglobulin type of membranoproliferative glomerulonephritis
Infection
Autoimmunity
Monoclonal gammopathies
Associated risk factors in complement type of membranoproliferative glomerulonephritis
Complement gene mutation
C3 nephritic factor
Partial lipodystrophy
Diseases leading to rapidly progressive glomerulonephritis
Focal necrotising glomerulonephritis
Diffuse proliferative glomerulonephritis
Anti glomerular basement membrane dx
Characteristics of rapidly progressive glomerulonephritis
Rapid loss o renal function over days to weeks
Hypertension
Oedema
Non visible haematuria
Proteinuria
