Glomerulonephritis Flashcards
What two main groups can glomerulonephritis be divided into?
Proliferative
Non - proliferative
What is non - proliferative glomerulonephritis?
Damage to the podocytes
What is proliferative glomerulonephritis?
Damage to endothelial/mesangial cells
Examples of non proliferative Gn
Minimal change disease
Focal segmental glomerulosclerosis
Membranous Gn
Examples of proliferative Gn
Membranoproliferative Gn
IgA nephropathy
Post-streptococcal Gn
Rapidly progressive Gn (crescentic) — either ANCA +ve or ANCA -ve
What are ANCA +ve vasculitic disorders?
Microscopic polyangiitis –
p-ANCA
Wegener’s granulomatosis (GPA) –
c-ANCA
Goodpasture’s disease is ANCA +ve. True/false
False. ANCA - ve
Often detected by renal biopsy or blood test for anti-GBM antibodies
Most common cause of Gn (aka nephritic disease) in adults
IgA nephropathy
Most common cause of nephrotic disease in adults
Focal segmental glomerulosclerosis
What skin condition is IgA nephropathy associated with?
HSP (henoch - schonlein purpura)
Most common nephrotic syndrome in children
Minimal change disease
What are some associated causes of focal segmental glomerulosclerosis?
HIV, heroin use and obesity
What is the main difference between post - streptococcal Gn and IgA nephropathy?
IgA nephropathy usually occurs 24-48 hrs after URTI
Post streptococcal Gn usually occurs a few weeks after URTI
How is proteinuria quantified?
By calculating the urine protein:creatinine ratio. Measured over 24 hours.
Chronic GN is the 2nd most common cause of end-stage renal failure (CKD). What is the most common cause?
Diabetic nephropathy, a microvascular complication of diabetes mellitus.
Glomerulonephritis is caused by infection. True/false.
False. It is immune-mediated (autoimmune).
2nd most common cause of nephrotic syndrome in adults?
Membranous Glomerulonephritis
How is minimal change disease shown on microscopy and how is it treated?
Abnormal Podocytes are seen on electron microscopy. Usually treated with supportive care and prednisolone.
Focal segmental glomerulosclerosis presents with nephritic syndrome and is treated with steroid. True/false.
False. Focal segmental glomerulosclerosis presents with nephrotic syndrome and steroids are often ineffective.
What is membranous GN characterised by and what is it caused by?
Thickened glomerular basement membrane due to immune complex deposition at the basement membrane and is idiopathic.
What antibody is membranous GN associated with?
Anti-PLA2R (present in 70% of cases).
What characteristic does rapidly progressive Glomerulonephritis have?
Crescentic - presence of crescents (epithelial cell extracapillary proliferation).
List primary and secondary causes of membranoproliferative GN
Primary: immune-mediated
Secondary: SLE and Hep
Membranoproliferative GN usually progresses to end stage renal failure. True/false
True
Wegeners granulomatosis (GPA) is c-ANCA positive and microscopic polyangiitis is p-ANCA positive. True/false.
True
GPA presentation?
Vasculitis
Affects lungs, kidneys and other organs.
C-ANCA +ve
Treat with steroids + cyclophosphamide
Microscopic polyangiitis presentation?
Small vessel vasculitis
P-ANCA +ve
Treat with long term steroids +/- cytotoxic agents
Another name for Anti-GBM disease
Goodpasture’s disease
Goodpasture’s disease presentation?
Presence of autoimmune Anti-GBM antibody in the blood
Glomerulus and lungs are affected
Haematuria (blood in urine) and haemoptysis (coughing up blood)
Treat with steroids +/- steroid sparing agents
What bacteria is involved in post - infectious (post -streptococcal) GN?
Strep pyogenes
What is treatment for post -strep GN?
Supportive treatment (diet changes etc)
Resolves over 2-4 weeks
Main differences between nephrotic and nephritic syndrome.
Nephrotic:
Urinary albumin > 3g/day
Hypoalbuminaemia
Periorbital oedema
Appearance of “frothy urine” due to high protein lost in urine.
Lipiduria
Nephritic syndrome:
Haematuria/RBC casts
Oliguria (low urinary output of less than 400ml per day)
Decreased GFR
Proteinuria (nowhere near as much as nephrotic syndrome)
Appearance of brownish -red (“coca cola”) urine due to presence of haematuria +RBC casts
Types of nephrotic syndrome
Focal segmental glomerulosclerosis
Membranous nephropathy
Amyloidosis
Minimal change disease
Diabetic nephropathy
Types of nephritic syndrome
Post-streptococcal GN (acute)
Alport syndrome
IgA Nephropathy
Rapidly progressive Glomerulonephritis
Types of mixed nephrotic/nephritic syndrome
Membranoproliferative GN
Diffuse proliferative GN
Nephritic syndrome can also present with oedema. True/false
True, nephritic syndrome can also present with mild oedema. Whereas nephrotic syndrome will result in more apparent oedema. This is due to hypoalbuminaemia and large loss of the albumin protein in the urine.
Another name for IgA nephropathy?
Berger disease
