Glomerulonephritis Flashcards
nephrotic syndrome criteria
peripheral oedema
massive proteinuria > 3g/24hrs
serum albumin < 25g/L hypoalbuminaemia
Hypercholesterolaemia
nephritic syndrome criteria
haematuria. cola coloured urine
oliguria
proteinuria <3g/24hr
normal albumin or slightly raised
fluid retention
hypertension
abrupt onset
frothy urine is a sign of what
proteinuria, nephrotic syndrome
frothy urine is a sign of what
proteinuria, nephrotic syndrome
minimal change disease signs
common in children
sudden oedema
proteinuria
tests for minimal change disease
creatinine
eGFR
cholesterol
albumin
haemoglobin
treatment minimal change
prednisolone high dose
slow taper over 6 months
2/3 relapse, steroids
diuretics and thromboprophylaxis if necessary
focal and segmental glomerulonephritis
syndrome with multiple causes
steroid resistant
nephrotic
tests- urine PCR, albumin, creatinine, GFR
treat with steroid trial (resistant)
cyclosporin, cyclophosphamide, ritixumab
diuretics, renal transplant or plasma exchange
commonest cause of nephrotic syndrome in adults and commonest type of glomerulonephritis overall
membranous nephropathy
cause of membranous nephropathy
secondary : malignancy, SLE, rheumatoid arthritis, NSAIDs, penicillamine
membranous nephropathy signs
histology shows IgG and complement deposits on the basement membrane
PLA2R positive in 70% of cases
THSD7A in around 2%
membranous nephropathy treatment
immunesuppression if symptomatic, rising proteinuria or decrease renal function
cyclophosphamide and steroids (alternate months)
ritixumab
or just cyclophosphamide if severe
Crescenteric glomerulonephritis types
ANCA associated- microscopic polyangiitis, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis
Anti GBM- anti GBM nephritis or goodpastures sydnrome
IgA vasculitis
post infection glomerulonephritis
SLE
what is anti GBM disease/ good pastures syndrome
anti GBM antibodies attack glomerulus and pulmonary basement membranes. cause glomerulonephritis and pulmonary haemorrhage. shows anti GBM antibodies in serum and biopsy, 10-20% of crescenteric glomerulonephritis. can lead to rapidly progressive glomerulonephritis
treating good pastures syndrome
aggressive immunesupression
steroids
plasma exchange
cyclophosphamide
presentation good pasture syndrome
nephritis or nephritis and lung haemorrhage, haemoptysis
IgA nephropathy (bergers disease)
most common cause of primary glomerulonephritis Histology shows “IgA deposits and glomerular mesangial proliferation”.
signs for IgA nephropathy
microscopic haematuria
proetinuria
nephrotic syndrome
hypertension
managament for IgA nephropathy
usually self limiting
ACE i
kidney disease progresses then transplant
post infectious glomerulonephritis signs
10-12 days post streptococcal infection
so throat or skin infection signs
haematuria
high BP
low complement
creatinine
post strep glomerulonephritis treatment
antibiotics if necessary
loop diuretics- furosemide for oedema
anti hypertensives
granulomatosis with polyangiitis (wegener’s)
form of vasculitis which affects kidneys, nose and lungs
shows ANCA antineutrophil cytoplasmic antibodies
fatal if left untreated
what causes nephritic state
attack on endothelium causes a spillage of RBCs so haematuria
what causes nephrotic state
ill and shrunk podocytes cause spillage of protein so proteinuria
usual treatment of glomerulonephritis in general is
immunosuppression eg steroids and blood pressure control by RAAS eg ACEi
causes of nephritic syndrome
SHARP AIM
SLE
henoch schonlein purpura
anti GBM
rapidly progressive GN
post strep GN
alports syndrome
IgA nephropathy
membranoproliferative GN
what requires a renal biopsy
proteinuria of more than 1g in 24 hrs
combo of proteinuria and haematuria
nephrotic syndrome in adults
when should you avoid a renal biopsy
PKD due to fear of infection or haemorrhage
uncontrolled hypertension
what is the most common viral cause of FSGS
HIV
also bergers, sickle cell
what is the most common viral cause of membranous GN
Hep B
