Glomerulonephritis Flashcards
Does focal segmental glomerulonephritis (FSGS) cause nephrotic or nephritic syndrome?
Nephrotic
What age does focal segmental glomerulosclerosis most commonly present?
Young adults (20-30)
What are the causes of focal segmental glomerulosclerosis?
Idiopathic
Secondary to other renal pathology e.g. IgA Nephropathy, reflux nephropathy
HIV
Heroin
Alport’s syndrome
Sickle-cell
What happens in renal transplants in patients with FSGS?
Commonly recurrs
What is seen on light microscopy in FSGS?
Focal and segmental sclerosis and hyalinosis on light microscopy
What is seen on electron microscopy in FSGS?
Effacement of foot processes
What is the management for FSGS?
Steroids and immunosuppressants
What is the commonest form of nephrotic syndrome in adults?
FSGS (unsure might be membranous)
How can you tell the difference between IgA nephropathy and post-streptococcal glomerulonephritis (AKA diffuse proliferative glomerulonephritis)?
IgA starts a day or two after URTI, whereas post-streptococcal is weeks after infection
What are the 4 main features of nephritic syndrome?
Haematuria (microscopic or macroscopic)
Oliguria
Proteinuria (less than 3g/day)
Fluid retention
What are the 4 main features of nephrotic syndrome?
Peripheral oedema
Proteinuria >3g/day
Serum albumin <25g/l
Hypercholesterolaemia (due to increased production and decreased metabolism)
What is the commonest form of glomerulonephritis in children?
Minimal change disease
What is the cause of minimal change disease?
Idiopathic
What is the management and prognosis of minimal change disease?
Steroids
Good prognosis
What syndromes do post-streptococcal and IgA nephropathy cause?
Nephritic
What is the commonest overall glomerulonephritis in adults?
Membranous glomerulonephritis
Is membranous glomerulonephritis nephrotic or nephritic?
Nephrotic most common
What is the peak incidence of membranous glomerulonephritis?
50-60 years
What are the causes of membranous glomerulonephritis?
idiopathic
infections: hepatitis B, malaria, syphilis
malignancy: lung cancer, lymphoma, leukaemia
drugs: gold, penicillamine, NSAIDs
autoimmune diseases: systemic lupus erythematosus (class V disease), thyroiditis, rheumatoid
What antibodies are involved in idiopathic membranous glomerulonephritis?
anti-phospholipase A2 antibodies
What does membranous glomerulonephritis look like on electron microscopy?
the basement membrane is thickened with subepithelial electron dense deposits. This creates a ‘spike and dome’ appearance
What is the management of membranous glomerulonephritis?
ACEI or ARB (reduced proteinuria and improves prognosis)
Combination of steroid and cyclophosphamide in severe or progressive disease (many patients spontaneously improve)
Anticoagulation for high risk patients
What is the prognosis for membranous glomerulonephritis?
Prognosis - rule of thirds
one-third: spontaneous remission
one-third: remain proteinuric
one-third: develop ESRF
