Glomerulonephritis Flashcards
Presentation of nephrotic syndrome
- Oedema
- Albumin less than 30g/L
- Urine more than 3g protein in 24hrs
- Hypercholesterolaemia
Complications of nephrotic syndrome
- Higher risk of infection
- VTE
- Progression of CKD
- HTN
- Hyperlipidaemia
Causes of nephrotic syndrome
- Minimal change disease - most common GN in children
- Focal segmental glomerulosclerosis - idiopathic or secondary to infection, malignancy, drugs etc
- Membranous nephropathy - same as above, most common adult cause
- Membranoproliferative glomerulonephritis (but more commonly presents as nephritic)
- Amyloidosis/myeloma/diabetes - proteinuria but no other nephrotic features
Presentation of nephritic syndrome
- AKI - sometimes GFR can drop drastically
- Blood +/- protein +/- on urine dip
- Sometimes mild/moderate oedema
- Proteinuria less than 3/5g in 24hrs though
- HTN
- Haematuria visible?
Causes of nephritic syndrome
- Post streptococcal
- IgA nephropathy
- Small vessel vasculitis (ANCA)
- Anti GBM disease (Goodpastures)
- Thin basement membrane disease
- Alport syndrome
- Lupus nephritis
Associations of post streptococcal GN
- Weeks after Group A beta haemolytic streptoccal infections
- 1-2 weeks post tonsillitis/pharyngitis
- 3-4 weeks after impetigo/cellulitis
- Children ages 3-12
- Can lead to rapid progressive GN
Investigation features of post strep GN
- Positive anti-streptococcal antibodies - anti-streptolysin O titre
- Low serum C3
- Biopsy shows immune complex deposition IgG, IgM, C3
Treatment for post strep GN
- Usually self limiting
- Supportive therapy of ACEi/ARB for proteinuria and HTN
- Low sodium diet
- If proceeds to ESRF –> RRT
Associations of IgA nephropathy
- Most common idiopathic GN worldwide
- Episodic gross haematuria during/directly after URTI, GI infections or strenous exercise
- Affects males more than females
- Peak incidence 20-30s
- 25-30% progress to ESRF within 20-25yrs
Investigation findigns for IgA nephropathy
- Asymptomatic microhaematuria
- Intermittent visible haematuria
- Increase serum IgA
- Normal C3 and C4
Biopsy findings IgA nephropathy
- Biopsy shows mesangial immune complex deposits in glomeruli
Treatment for IgA nephrotpathy
Supportive:
* ACEi/ARB for proteinuria and HTN
3 types of small vessel vasculitis (ANCA associated)
- Granulomatosis with polyangitis (GPA)
- Microscopic polyangitis (MPA)
- Eosinophilic granulomatosis (Churg-Strauss syndrome)
Associations of GPA vasculitis
Pulmonary and nasopharyngeal involvement - haemoptysis and nasal ulcers/polyps
Saddle nose
Nasal crusting
Investigation findings for GPA vasculitis
- c-ANCA (PR3)
- Biopsy shows segmental necrotizing GN
Treatment for all small vessel vasculitis (ANCA associated)
Immunosupression
Associations of MPA vasculitis
Mild respiratory symptoms
Investigation findigns for MPA vasculitis
- p-ANCA (MPO)
- Biopsy shows segmental necrotizing GN (same as GPA)
Associations of Churg-strauss syndrome
- Asthma
- Allergic rhinitis
- Purpura
- Peripheral neuropathy
Inv findings for Churg-Strauss syndrome
- p-ANCA
- Bloods show eosinophilia
- Biopsy shows focal segmental necrotizing GN
Associations with Goodpastures syndrome
Two peaks:
* 30s - affecting male more than females
* 60s - affecting females more than males
* Antibodies against type IV collagen - react with pulmonary BM causing pulmonary haemorrhage
* Can lead to rapdly progressive GN
Inv findings for Goodpastures
- Anti GBM antibodies
- Pulmonary infiltrates on CXR
- Biopsy shows linear deposition of IgG along BM
Treatment for Goodpastures
Plasma exchange
Immunosupression
Associations with thin basement membrane disease
- Hereditary
- Abnormalities with Type IV collagen
- Good prognosis
Inv findigns for thin basement membrane disease
- Peristent microscopic haematuria - possible intermittent visible
- Biopsy shows diffuse thinning of GBM
Treatment for thin basement membrane disease
- Monitor renal function
- Supportive treatment
Associations with alport syndrome
- X linked - affects males mostly
- Mutation in gene coding for Type IV collagen
- Associated with hearing loss and abnormalities of eyes
- Often leads to ESRF
Inv findings for Alport syndrome
- Persistent microscopic haematuria with intermittent visible
- Sensorineural hearing loss
- Biopsy - splitting of GBM and alternating thickening and thinning
- Genetic studies show FH
Treatment for alport syndrome
- Supportive
- RRT
- Renal transplant - BUT can lead to development of Goodpasture syndrome
Associations of lupus nephritis
- Complication of SLE
- Nephritic or nephrotic
Inv findings for lupus nephritis
- ANA and anti-dsDNA +ve
- Biopsy shows 6 different classes with different presentations and varied treatment options
Treatment for lupus nephritis
Supportive therapy
Immunosupressive based on classification/presentation
Supportive general therapy of glomerulonephritis
- If suspect GN - discuss with renal team
- MDT approach
- ACEi/ARB control proteinuria
- Control BP
- Salt and water restriction if fluid overload/diuretics
- If hypoalbuminaemic less than 20g/dL then higher risk of VTE - consider LMWH
- Statins for hypercholesterolaemia
Examples of immunosupressive therapy
- Oral corticosteroids
- IV pulsed methylprednisolone
- Cyclophosphamide
- Tacrolimus
- Ciclosporin
- Rituximab
- Mycophenolate Mofetil
- Azathioprine
Invasive therapy for GN
- RRT/haemodialysis if severe AKI or ESRF
- Plasma exchange for ANCA associated vasculitis and anti GBM (goodpastures)
