Glomerulonephritis Flashcards
what is glomerulonephritis
damage to the glomeruli (filtration) of the kidneys
triad of nephrotic syndrome
proteinuria (>3g/day) // hypoalbuminaemia (<30g/L) // oedema
how does nephrotic syndrome predispose thrombosis
loss of antithrombin III, protein C+S, rise in fibrinogen
how does nephrotic syndrome predispose preclinical hypothyroid
loss if thyroxine-binding globulin –> loss of total (not free) thyroxine levels
what conditions are considered nephrotic syndromes
minimal change, membranous, focal segmental, amyloid, diabetic nephropathy
who is minimal change disease most common in
kids (75% of cases)
causes minimal change disease
usually idiopathic - occasionally drugs eg NSAIDs, rifampicin, hodgkins lymphoma, mono
symptoms minimal change disease
nephrotic (proteinuria, hypoalbumin, oedema) // normotension
what protein is lost in minimal change disease
albumin + transferrin only
biopsy minimal change disease
light microsopy = normal // electron = fusion of podocytes + effacement of foot process
prognosis minimal change disease
good prognosis, most stop before adulthood //
mx minimal change disease
1 = oral steroids // 2 = cyclophosphamide
who usually gets FSGS
young adults
causes FSGS
idiopathic // IgA nephropathy // HIV // heroin // Alport’s // sickle cell
biopsy FSGS
light = sclerosis + hyalinosis (ronseal appearance) // electron = effacement of foot process
mx FSGS
steroids +/- Ciclosporin
effect of renal transplant on FSGS
high rate recurrence
prognosis FSGS
10% resolve spontaneously // 50% ESRF in 10 years
who gets membranous glomerulonephritis
most common glomerulonephritis in adults
causes membranous glomerulonephritis
idiopathic - phospholipidase A2 antibodies // Heb B, malaria, syphilis // cancer eg prostate, lung, blood // drugs eg gold, penicillamine, NSAID // SLE, thyroid, RA
biopsy membranous glomerulonephritis
electron = thickened membrane ‘spike and dome’ // immune complex in basement
mx membranous glomerulonephritis
all on ACEi or ARB // immunosuppression eg steroid + cyclophosphamide // maybe anti-coag
prognosis membranous glomerulonephritis
3rd commonest cause ESRF
good prognostic factors membranous glomerulonephritis
female, young, asymptomatic proteinuria
complications of nephrotic syndrome(5)
thromboembolism (lost antithrombin III) eg PE or renal // hyperlipidaemia –> stroke // CKD // infection (Ig loss) // hypocalcaemia
symptoms nephritic syndrome
haematuria, + hypertension!!! // protein, oliguria
conditions nephritic syndrome
IgA, rapidly progressing, anti-GBM, ANCA vasculitis, HSP, alport’s
most common cause glomerulonephritis worldwilde
IgA nephropathy (nephritic) aka bergers
symptoms IgA nephropathy
macrosopic haematuria in young people 1-2 days after URTI // males // proteinuria or renal failure rare
assoc conditions IgA nephropathy
alcoholic cirrhosis, coeliac, HSP
pathology IgA nephropathy
deposit IgA immune complex in mesangial // overlap with HSP
biopsy IgA nephropathy
immunofluorescence IgA + C3
good prognsis IgA nephropathy
frank haematuria
bad prognosis IgA nephropathy
male, proteinurea, hypertension, smoking, hyperlipidaemia
prognosis IgA nephropathy
25% –> ESRF
what is rapidly progressive glomerulonephritis
rapid loss of renal function + epithelial crescents
what can cause rapidly progressive glomerulonephritis
Goodpastures // ANCA+ eg MPA and GPA // SLE //
symptoms rapidly progressive glomerulonephritis
nephritic: haematuria + red cell casts, hypertension, oliguria, proteins
mx rapidly progressive glomerulonephritis
steroids + immunosuppression eg Cyclophosphamide, azathioprine
what is anti-glomerular basement membrane (anti-GBM) disease aka Goodpastures
small vessel vasculitis –> pulm haemorrhage + rapid glomerulonephritis
what type of hypersensitivity is ant-GBM and what immune cells are involed
type II // antibodies to collagen IV
RF anti-GBM
young males, 20-30 or 60-70 // HLA DR2 (SLE, narcolepsy)
symptoms anti-GBM
pulm haemorrhage // AKI + nephritis –> haematuria + proteinurea
biopsy + bloods anti-GBM
biopsy = IgG in basement membrane // bloods = raised transfer factor
mx anti-GBM
plasma exchange // steroids // cyclophospamide
RF pulm haemorrhage in anti-GBM
smoking // LRTI // pulmonary oedema // inhaled hydrocarbons // young males
symptoms Membranoproliferative glomerulonephritis
proteinurea, haematuria, mixed picture
most common type Membranoproliferative glomerulonephritis
type 1
causes Membranoproliferative glomerulonephritis
cryoglobulinaemia, hep C
biopsy type 1 Membranoproliferative glomerulonephritis
electron = subendothelial + mesangial immune deposits –> tram track
biopsy Membranoproliferative glomerulonephritis type 2
low C3, C3b nephritic factor // intramembranous immune complexes
symptoms Membranoproliferative glomerulonephritis type 2
no subcut fat on their face
cause type 3 Membranoproliferative glomerulonephritis
hep B + C
mx Membranoproliferative glomerulonephritis
steroids
what causes Post-streptococcal glomerulonephritis
srep pyogenes –> 1-2 weeks –> immune complex deposits in glomeruli
symptoms Post-streptococcal glomerulonephritis
malaise // visiable haematuria // proteinuria // hypertension // oligouria
bloods Post-streptococcal glomerulonephritis
low C3 // raised anti-strep O