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renal > glomerulonephritis > Flashcards

glomerulonephritis Flashcards

1
Q

what is glomerulonephritis?

A

immune mediated disease of the kidneys affecting the glomeruli (with secondary tubulointerstitial damage)

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2
Q

what is the pathogenesis of Glomerulonephritis?

A

humoral (antibody mediated)
cell mediated (T cells)
inflammatory cells, mediators and complements

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3
Q

what is the impact of distruption to the capillary wall in glomerulonephritis?

A

haematuria and/or proteinuria

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4
Q

what happens when endothelial or mesangial cells are damaged in glomerulonephritis?

A

there is a proliferative lesion and red cells in the urine

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5
Q

what happens when podocytes are damaged in glomerulonephritis?

A

a non-proliferative lesion and protein in the urine

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6
Q

how do podocytes respond to injury?

A

atrophies
loss of size/charge specific barrier

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7
Q

what happens when mesangium cells are injured?

A

they proliferate and release angiotensin II
there is a release of chemokines and it attracks inflammatory cells

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8
Q

what happens in endothelial cell injury?

A

vasculitis

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9
Q

how is glomerulonephritis diagnosed?

A

clinical pres
blood tests
urine examination
-urinalysis: haematuria, proteinuria
- microscopy: RBC
- urine protein: creatinine ratio/24hr urine
kidney biopsy

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10
Q

what are the albuminuria indications of glomerulonephritis?

A

Microalbuminuria (30-300mg albuminuria/day)

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11
Q

what are the presenting features of glomerulonephritis?

A

impaired renal function
hypertension

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12
Q

what does nephritic syndrome in glomerulonephritis indicate?

A

a proliferative process affecting endothelial cells

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13
Q

what does nephrotic syndrome in glomerulonephritis indicate?

A

a non proliferative process affecting podocytes

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14
Q

what are the complications of nephrotic syndrome?

A

infections
renal vein thrombosis
pulmonary emboli
volume depletion

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15
Q

what are some causes of glomerulonephritis?

A

majority are primary disease
some are caused by infections/drugs like penicillin or NSAIDs
some are part of systemic disease eg lupus

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16
Q

what are some non-immunosuppressive treatments of glomerulonephritis?

A

anti hypertensives (target BP<130/80 if proteinuria)
ACEi/ARB
SGLT2i
diuretics
statins
anti coagulants in nephrotic syndrome with profound hypoalbuminaemia

17
Q

what are the immunosuppressive treatments of glomerulonephritis?

A

corticosteroids
alkylating agents (cyclophophamide)
calcineurin inhibitors (cyclosporin/tacrolimus)
antiproliferatives (azathioprine)
plasmapheresis
antibodies

18
Q

how are nephrotic patients treated?

A

fluid restriction
salt restriction
diuretics
ACEi/ARB

19
Q

what is the threshold for nephrotic remission?

A

proteinuria < 300mg/day

20
Q

what is the most common cause of nephrotic syndrome in kids?

A

minimal change nephropathy

21
Q

how is minimal change nephropathy treated?

A

oral steroids
cyclophosphamide 2nd line

22
Q

what is the commonest cause of nephrotic syndrome in adults?

A

FSGS- focal segmental glomerulosclerosis

23
Q

what is the 2nd commonest cause of nephrotic syndrome in adults?

A

membranous nephropathy

24
Q

what causes membranous nephropathy?

A

infections
connective tissue disease
malignancies
drugs (gold/penicillamine)

25
Q

how is membranous nephropathy treated?

A

steroids/alkylating agents/ B cell monoclonal antibodies

26
Q

what antibody is present in >70% of primary membranous nephropathy?

A

anti PLA2r antibody

27
Q

what cause membranoproliferative GN?

A

immune complex deposition and complement activation
dysregulation of the alternative complement pathway

28
Q

what is the most common glomerulonephritis worldwide?

A

IgA nephropathy

29
Q

what are some signs of IgA nephropathy?

A

asymptomatic microhaematuria
macroscopic haematuria after resp/GI infection
AKI/CKD
associated with HSP

30
Q

how is IgA nephropathy treated?

A

BP control/ ACEi/fish oil

31
Q

what is rapidly progressing glomerulonephritis?

A

a treatable immune mediated cause of acute kidney injury

32
Q

what are the signs of rapidly progressive glomerulonephritis?

A

rapid deterioration
active urinary sediment
may be part of systemic disease
associated with glomerular crescents on biopsy

33
Q

what conditions are associated with rapidly progressive glomerulonephritis?

A

ANCA assocaited vasculitis

34
Q

how is rapidly progressive glomerulonephritis treated?

A

start treatment ASAP
steroids and cytotoxics (cyclophosphamide) or anti B cell antibody (rituximab) as induction therapy

steroids and azathioprine as maintenance for years to prevent relapse

renal (22 decks)

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