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FINALS RENAL + UROLOGY > Glomerulonephritis > Flashcards

Glomerulonephritis Flashcards

1
Q

what is glomerulonephritis

A

damage to the glomeruli (filtration) of the kidneys

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2
Q

triad of nephrotic syndrome

A

proteinuria (>3g/day) // hypoalbuminaemia (<30g/L) // oedema

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3
Q

how does nephrotic syndrome predispose thrombosis

A

loss of antithrombin III, protein C+S, rise in fibrinogen

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4
Q

how does nephrotic syndrome predispose preclinical hypothyroid

A

loss if thyroxine-binding globulin –> loss of total (not free) thyroxine levels

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5
Q

what conditions are considered nephrotic syndromes

A

minimal change, membranous, focal segmental, amyloid, diabetic nephropathy

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6
Q

who is minimal change disease most common in

A

kids (75% of cases)

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7
Q

causes minimal change disease

A

usually idiopathic - occasionally drugs eg NSAIDs, rifampicin, hodgkins lymphoma, mono

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8
Q

symptoms minimal change disease

A

nephrotic (proteinuria, hypoalbumin, oedema) // normotension

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9
Q

what protein is lost in minimal change disease

A

albumin + transferrin only

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10
Q

biopsy minimal change disease

A

light microsopy = normal // electron = fusion of podocytes + effacement of foot process

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11
Q

prognosis minimal change disease

A

good prognosis, most stop before adulthood //

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12
Q

mx minimal change disease

A

1 = oral steroids // 2 = cyclophosphamide

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13
Q

who usually gets FSGS

A

young adults

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14
Q

causes FSGS

A

idiopathic // IgA nephropathy // HIV // heroin // Alport’s // sickle cell

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15
Q

biopsy FSGS

A

light = sclerosis + hyalinosis (ronseal appearance) // electron = effacement of foot process

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16
Q

mx FSGS

A

steroids +/- Ciclosporin

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17
Q

effect of renal transplant on FSGS

A

high rate recurrence

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18
Q

prognosis FSGS

A

10% resolve spontaneously // 50% ESRF in 10 years

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19
Q

who gets membranous glomerulonephritis

A

most common glomerulonephritis in adults

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20
Q

causes membranous glomerulonephritis

A

idiopathic - phospholipidase A2 antibodies // Heb B, malaria, syphilis // cancer eg prostate, lung, blood // drugs eg gold, penicillamine, NSAID // SLE, thyroid, RA

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21
Q

biopsy membranous glomerulonephritis

A

electron = thickened membrane ‘spike and dome’ // immune complex in basement

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22
Q

mx membranous glomerulonephritis

A

all on ACEi or ARB // immunosuppression eg steroid + cyclophosphamide // maybe anti-coag

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23
Q

prognosis membranous glomerulonephritis

A

3rd commonest cause ESRF

24
Q

good prognostic factors membranous glomerulonephritis

A

female, young, asymptomatic proteinuria

25
Q

complications of nephrotic syndrome(5)

A

thromboembolism (lost antithrombin III) eg PE or renal // hyperlipidaemia –> stroke // CKD // infection (Ig loss) // hypocalcaemia

26
Q

symptoms nephritic syndrome

A

haematuria, + hypertension!!! // protein, oliguria

27
Q

conditions nephritic syndrome

A

IgA, rapidly progressing, anti-GBM, ANCA vasculitis, HSP, alport’s

28
Q

most common cause glomerulonephritis worldwilde

A

IgA nephropathy (nephritic) aka bergers

29
Q

symptoms IgA nephropathy

A

macrosopic haematuria in young people 1-2 days after URTI // males // proteinuria or renal failure rare

30
Q

assoc conditions IgA nephropathy

A

alcoholic cirrhosis, coeliac, HSP

31
Q

pathology IgA nephropathy

A

deposit IgA immune complex in mesangial // overlap with HSP

32
Q

biopsy IgA nephropathy

A

immunofluorescence IgA + C3

33
Q

good prognsis IgA nephropathy

A

frank haematuria

34
Q

bad prognosis IgA nephropathy

A

male, proteinurea, hypertension, smoking, hyperlipidaemia

35
Q

prognosis IgA nephropathy

A

25% –> ESRF

36
Q

what is rapidly progressive glomerulonephritis

A

rapid loss of renal function + epithelial crescents

37
Q

what can cause rapidly progressive glomerulonephritis

A

Goodpastures // ANCA+ eg MPA and GPA // SLE //

38
Q

symptoms rapidly progressive glomerulonephritis

A

nephritic: haematuria + red cell casts, hypertension, oliguria, proteins

39
Q

mx rapidly progressive glomerulonephritis

A

steroids + immunosuppression eg Cyclophosphamide, azathioprine

40
Q

what is anti-glomerular basement membrane (anti-GBM) disease aka Goodpastures

A

small vessel vasculitis –> pulm haemorrhage + rapid glomerulonephritis

41
Q

what type of hypersensitivity is ant-GBM and what immune cells are involed

A

type II // antibodies to collagen IV

42
Q

RF anti-GBM

A

young males, 20-30 or 60-70 // HLA DR2 (SLE, narcolepsy)

43
Q

symptoms anti-GBM

A

pulm haemorrhage // AKI + nephritis –> haematuria + proteinurea

44
Q

biopsy + bloods anti-GBM

A

biopsy = IgG in basement membrane // bloods = raised transfer factor

45
Q

mx anti-GBM

A

plasma exchange // steroids // cyclophospamide

46
Q

RF pulm haemorrhage in anti-GBM

A

smoking // LRTI // pulmonary oedema // inhaled hydrocarbons // young males

47
Q

symptoms Membranoproliferative glomerulonephritis

A

proteinurea, haematuria, mixed picture

48
Q

most common type Membranoproliferative glomerulonephritis

49
Q

causes Membranoproliferative glomerulonephritis

A

cryoglobulinaemia, hep C

50
Q

biopsy type 1 Membranoproliferative glomerulonephritis

A

electron = subendothelial + mesangial immune deposits –> tram track

51
Q

biopsy Membranoproliferative glomerulonephritis type 2

A

low C3, C3b nephritic factor // intramembranous immune complexes

52
Q

symptoms Membranoproliferative glomerulonephritis type 2

A

no subcut fat on their face

53
Q

cause type 3 Membranoproliferative glomerulonephritis

54
Q

mx Membranoproliferative glomerulonephritis

55
Q

what causes Post-streptococcal glomerulonephritis

A

srep pyogenes –> 1-2 weeks –> immune complex deposits in glomeruli

56
Q

symptoms Post-streptococcal glomerulonephritis

A

malaise // visiable haematuria // proteinuria // hypertension // oligouria

57
Q

bloods Post-streptococcal glomerulonephritis

A

low C3 // raised anti-strep O

FINALS RENAL + UROLOGY (16 decks)

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