glomerulonephritis Flashcards
what is glomerulonephritis?
immune mediated disease of the kidneys affecting the glomeruli (with secondary tubulointerstitial damage)
what is the pathogenesis of Glomerulonephritis?
humoral (antibody mediated)
cell mediated (T cells)
inflammatory cells, mediators and complements
what is the impact of distruption to the capillary wall in glomerulonephritis?
haematuria and/or proteinuria
what happens when endothelial or mesangial cells are damaged in glomerulonephritis?
there is a proliferative lesion and red cells in the urine
what happens when podocytes are damaged in glomerulonephritis?
a non-proliferative lesion and protein in the urine
how do podocytes respond to injury?
atrophies
loss of size/charge specific barrier
what happens when mesangium cells are injured?
they proliferate and release angiotensin II
there is a release of chemokines and it attracks inflammatory cells
what happens in endothelial cell injury?
vasculitis
how is glomerulonephritis diagnosed?
clinical pres
blood tests
urine examination
-urinalysis: haematuria, proteinuria
- microscopy: RBC
- urine protein: creatinine ratio/24hr urine
kidney biopsy
what are the albuminuria indications of glomerulonephritis?
Microalbuminuria (30-300mg albuminuria/day)
what are the presenting features of glomerulonephritis?
impaired renal function
hypertension
what does nephritic syndrome in glomerulonephritis indicate?
a proliferative process affecting endothelial cells
what does nephrotic syndrome in glomerulonephritis indicate?
a non proliferative process affecting podocytes
what are the complications of nephrotic syndrome?
infections
renal vein thrombosis
pulmonary emboli
volume depletion
what are some causes of glomerulonephritis?
majority are primary disease
some are caused by infections/drugs like penicillin or NSAIDs
some are part of systemic disease eg lupus
what are some non-immunosuppressive treatments of glomerulonephritis?
anti hypertensives (target BP<130/80 if proteinuria)
ACEi/ARB
SGLT2i
diuretics
statins
anti coagulants in nephrotic syndrome with profound hypoalbuminaemia
what are the immunosuppressive treatments of glomerulonephritis?
corticosteroids
alkylating agents (cyclophophamide)
calcineurin inhibitors (cyclosporin/tacrolimus)
antiproliferatives (azathioprine)
plasmapheresis
antibodies
how are nephrotic patients treated?
fluid restriction
salt restriction
diuretics
ACEi/ARB
what is the threshold for nephrotic remission?
proteinuria < 300mg/day
what is the most common cause of nephrotic syndrome in kids?
minimal change nephropathy
how is minimal change nephropathy treated?
oral steroids
cyclophosphamide 2nd line
what is the commonest cause of nephrotic syndrome in adults?
FSGS- focal segmental glomerulosclerosis
what is the 2nd commonest cause of nephrotic syndrome in adults?
membranous nephropathy
what causes membranous nephropathy?
infections
connective tissue disease
malignancies
drugs (gold/penicillamine)
how is membranous nephropathy treated?
steroids/alkylating agents/ B cell monoclonal antibodies
what antibody is present in >70% of primary membranous nephropathy?
anti PLA2r antibody
what cause membranoproliferative GN?
immune complex deposition and complement activation
dysregulation of the alternative complement pathway
what is the most common glomerulonephritis worldwide?
IgA nephropathy
what are some signs of IgA nephropathy?
asymptomatic microhaematuria
macroscopic haematuria after resp/GI infection
AKI/CKD
associated with HSP
how is IgA nephropathy treated?
BP control/ ACEi/fish oil
what is rapidly progressing glomerulonephritis?
a treatable immune mediated cause of acute kidney injury
what are the signs of rapidly progressive glomerulonephritis?
rapid deterioration
active urinary sediment
may be part of systemic disease
associated with glomerular crescents on biopsy
what conditions are associated with rapidly progressive glomerulonephritis?
ANCA assocaited vasculitis
how is rapidly progressive glomerulonephritis treated?
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
