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Internal Medicine (Me) > Glomerulonephritis > Flashcards

Glomerulonephritis Flashcards

1
Q

What are the clinical presentations of glomerulonephritis? (5)

A
  1. Isolated haematuria and/or proteinuria
  2. Nephrotic syndrome
  3. Nephritic syndrome
  4. RPGN
  5. CKD
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2
Q

Isolated Haematuria

A

Microscopic vs gross haematuria

RBC 3 or more RBC/hpf or 10x10^6 cells/L

Exclude urological causes
Glomerular haematuria - RBC cast, dysmorphic RBCs

Causes: IgAN, thin membrane disease, Alport’s disease

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3
Q

Isolated Proteinuria

A

Non-nephrotic range vs nephrotic range
- Proteinuria > 0.3g/day to 3.5g/day
- Nephrotic range haematuria >3.5g/day

Non-glomerular causes: overflow or tubular proteinuria
Non-persistent: functional proteinuria, orthostatic
Persistent proteinuria: glomerular causes

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4
Q

Nephrotic Syndrome

A

Proteinuria > 3.5g/day
Hypoalbuminaemia < 25 - urine loss of albumin , inadequate compensatory hepatic synthesis
Oedema - change in Starling forces, reduced oncotic pressure, sodium retention (tubular defect)
Hyperlipidaemia - increased hepatic synthesis, defective lipoprotein lipase activity, increased urine loss of HDL

Mechanism:
Increased glomerular permeability and loss of protein in urine

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5
Q

Complications of Nephrotic syndrome

A
  1. Hypercoagulability
  2. AKI - volume depletion, ATN, interstitial oedema, drugs, renal vein thrombosis
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6
Q

Causes of Nephrotic Syndrome
- Common (5)
- Less common (3)

A

Common
1. Minimal change disease
2. FSGS
3. Membranous nephropthy
4. Diabetic nephropathy
5. Amyloidosis

Less common
6. MPGN type 1
7. Dense drposit disease
8. Cryoglobulinaemic MPGN

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7
Q

Nephritic Syndrome

A

Reduced GFR and oliguria
Haematuria with RBC cast
Variable degree of proteinuria (non-nephrotic range)
Oedema
Hypertension (due to urinary retention)

Mechanism
Inflammatory injury of glomerular capillary wall

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8
Q

Causes of Nephritic Syndrome

A

Common
1. IgAN
2. Lupus
3. Infection

Less common
4. ANCA
5. MPGN

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9
Q

RPGN

A

Rapid loss of renal function (days to weeks) with oliguria or anuria
Features of glomerulonephritis, dysmorphic erythrocyturia, RBC casts, glomerular proteinuria

Crescenteric GN
Pathological term - extracapillary proliferation due to focal rupture of glomerular capillary wall
Presence of crescents in > 50% of glomeruli

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10
Q

Causes of RPGN / CGN

A
  1. Anti-GBM disease - Goodpasture’s syndrome if pulmonary haemorrhage
  2. Pauci-immune GN - systemic vasculitis or renal limited disease
  3. Immune complex GN
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11
Q

How to differentiate between other causes of rapid renal failure vs RPGN/CGN ?

A

Differentials - rapid loss of renal function and oliguria but NO dysmorphic RBCs, RBC casts, substatial proteinuria

  1. Acute thrombotic microangiopathy
  2. Atheroembolic renal disease
  3. ATN
  4. Acute tubulointerstitial nephritis
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12
Q

CKD

A

Chronic glomerulonephritis with slowly progressive renal impairment
No clinical event early in the course of disease to bring to medical attention

Late presentation: hypertension, proteinuria, renal impairment

Biopsy not appropriate (shrunken kidneys)

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13
Q

Initial Investigations for GN

A
  1. Blood - FBC, RP, LFT with albumin
  2. UFEME
  3. Urine ACR/PCR
  4. 24 hour total urine protein
  5. US kidneys +/- RAS Doppler
  6. +/- CT KUB or contrasted CT AP
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14
Q

Further Investigations for Nephrotic Syndrome

A
  1. Myeloma panel (paraproteinaemia, amyoidosis, MM)
  2. Serum anti-PLA2R (idiopathic membranous GN)
  3. Anti-thrombospondin (malignancy immune-mediated membranous GN) (send to Mayo)
  4. C3, C4 (post-infectious, SLE, C3/C4 GN)
  5. ANA, dsDNA (SLE panel)
  6. Virology: Hep B, Hep C, HIV (membranous, cryoglobulinaemia, side effect of medication, screen pre-treatment)
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15
Q

Further Investigations for Nephritic Syndrome

A
  1. C3, C4
  2. Anti-dsDNA
  3. Virology
  4. ANA
  5. ANCA: anti-MPO, anti-proteinase 3
  6. Cryoglobulin
  7. Anti-GBM
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16
Q

Evaluation pre-kidney biopsy

A
  1. FBC - anaemia, thrombocytopenia
  2. RP - uraemia -> platelet dysfunction
  3. Coagulation panel
  4. GXM
  5. Review anti-coagulation/antiplatelet use
17
Q

Can we start RAS blockade immediately upon finding proteinuria?

A

No
Will need to rule out exact causes and renal vein thrombosis

Internal Medicine (Me) (27 decks)

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