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Renal + Urology > Glomerulonephritis > Flashcards

Glomerulonephritis Flashcards

1
Q

What does focal mean with regards to glomerulonephritis?

A

affecting only some glomeruli

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2
Q

What does diffuse mean with regards to glomerulonephritis?

A

affecting all glomeruli

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3
Q

What does segmental mean with regards to glomerulonephritis?

A

affecting only part of glomerulus

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4
Q

What does global mean with regards to glomerulonephritis?

A

affecting whole glomerulus

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5
Q

What does proliferation mean with regards to glomerulonephritis?

A

increase in number of cells

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6
Q

What does expansion mean with regards to glomerulonephritis?

A

increase in intercellular matrix

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7
Q

What does crescent mean with regards to glomerulonephritis?

A

proliferation of cells within Bowman’s space

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8
Q

Describe some mechanisms underlying glomerulonephritis

A

Immunological:
- antibody binding to intrinsic glomerular antigens eg. Goodpasture’s disease

  • antibody binding to ‘planted’ glomerular antigens eg. post-strep glomerulonephritis
  • deposition of circulating antigen-antibody complexes eg. lupus nephritis
  • non-specific deposition of circulating antibody eg. IgA nephropathy

Vascular:
- ‘pauci-immune’ capillary inflammation (eg. systemic vasculitis)

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9
Q

Indications for renal biopsy

A

nephrotic syndrome (adults)
renal dysfunction of unknown cause (particularly acute)
to guide treatment or assess prognosis when diagnosis known
dysfunction of transplant kidney
(haematuria)
(proteinuria)

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10
Q

Complications of renal biopsy

A

pain
bleeding

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11
Q

Absolute/relative contraindications to renal biopsy

A

abnormal clotting/thrombocytopenia
drugs (aspirin, clopidogrel, warfarin, DOACs etc)
uncontrolled hypertension (>170/100)
single kidney
hydronephrosis
UTI (pyelonephritis)

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12
Q

How are renal biopsies interpreted?

A

light microscopy
immunostaining (looks for immunoglobulin or complement components)
electron microscopy (ultrastructural detail including immune deposits)

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13
Q

Modes of presentation of renal disease

A

haematuria
proteinuria
hypertension
nephrotic syndrome
nephritic syndrome
AKI
CKD

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14
Q

Nephrotic syndrome signs/symptoms

A

proteinuria
hypoalbuminaemia
oedema

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15
Q

Describe minimal change disease

A

commonest cause of nephrotic syndrome in children
electron microscopy = fusion of podocyte foot processes
steroid-responsive
usually idiopathic

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16
Q

What is the commonest cause of nephrotic syndrome in children?

A

minimal change disease

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17
Q

Minimal change disease causes

A

usually idiopathic
drugs (eg. NSAIDs)
lymphoma

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18
Q

How does focal segmental glomerulosclerosis (FSGS) present?

A

nephrotic syndrome +/- renal impairment
focal involvement of kidney - may be missed on biopsy

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19
Q

Causes of focal segmental glomerulosclerosis

A

obesity
IV heroin use
HIV
drugs (eg. pamidronate)

20
Q

What is the commonest cause of nephrotic syndrome in adults?

A

membranous nephropathy

21
Q

What does histology show in membranous nephropathy?

A

spikes on basement membranes
IgG deposition

22
Q

What conditions/causes is membranous nephropathy associated with?

A

malignancy (solid organ -> lung, colon, breast)
drugs (eg. gold, penicillamine, captopril)
infections (eg. hepatitis, malaria)

23
Q

How can mesangiocapillary glomerulonephritis present?

A

several ways –> including nephrotic and nephritic syndromes
can recur following transplantation

24
Q

Biopsy findings in mesangiocapillary glomerulonephritis

A

mesangial proliferation
thickened capillary walls
‘double contouring’ of basement membrane
positive immunofluorescence (eg. C3)

25
Q

What conditions is mesangiocapillary glomerulonephritis associated with?

A

infections (hepatitis, malaria, endocarditis, shunt nephritis)
cryoglobulinaemia
malignancy

26
Q

How does diabetic nephropathy present?

A

patients usually have other microvascular complications eg. retinopathy, peripheral neuropathy

earliest feature = low level proteinuria (‘microalbuminuria’)
proteinuria then becomes heavier

27
Q

What does histology show in diabetic nephropathy?

A

Kimmelstiel-Wilson lesions (nodular glomerulosclerosis)

28
Q

How can amyloidosis affecting the kidneys present?

A

heavy proteinuria +/- nephrotic syndrome +/- renal failure

29
Q

What stain is used for amyloidosis?

A

congo red - apple green birefringence under polarised light

30
Q

What are the 2 subtypes of amyloidosis?

A

AL - light chain deposition (eg. myeloma)
AA - chronic inflammation (eg. infection, connective tissue disorders)

31
Q

What is the commonest form of glomerulonephritis?

A

IgA nephropathy (Berger’s disease)

32
Q

What occurs in IgA nephropathy?

A

deposition of circulating IgA within mesangium leading to expansion of mesangial matrix and mesangial cell proliferation

33
Q

IgA nephropathy presentations

A

asymptomatic microscopic haematuria
episodic macroscopic haematuria (eg. exercise, respiratory tract infection)
progressive renal impairment, end stage renal failure

34
Q

What is a nephritic pattern?

A

hypertension
haematuria
renal impairment
(oedema)

35
Q

When does post-streptococcal glomerulonephritis occur?

A

2-3 weeks after group A streptococcal infection (throat, skin)
usually presents as nephritic illness

36
Q

How is post-infectious glomerulonephritis treated?

A

supportive treatment

37
Q

Which vasculitides are more likely to affect the kidneys?

A

small vessel

38
Q

Systemic vasculitis affecting kidneys signs on biopsy

A

focal necrotising glomerulonephritis +/- crescents
pauci-immune

39
Q

Antibody present in Goodpasture’s disease

A

anti-GBM (glomerular basement membrane)

40
Q

How does Goodpasture’s disease present?

A

AKI and/or pulmonary haemorrhage

41
Q

Goodpasture’s disease biopsy findings

A

focal necrotising glomerulonephritis +/- crescents
linear antibody deposition

42
Q

Goodpasture’s disease treatment

A

may respond if treated early - immunosuppression +/- plasma exchange

43
Q

How does rapidly progressing glomerulonephritis (crescentic nephritis) present?

A

nephritic illness with rapidly deteriorating renal function
(can be caused by systemic vasculitis and Goodpasture’s disease)

44
Q

Rapidly progressing glomerulonephritis renal biopsy findings

A

acute inflammatory process with crescent formation - cellular proliferation in Bowman’s space

45
Q

Investigations to consider in patients with glomerular disease

A

Urine:
- dipstick
- microscopy
- culture
- protein quantification

blood:
- FBC, ESR, coag, blood film, U&E, LFT, Ca, PO4, CRP
- autoantibodies (ANA, ANCA, anti-GBM)
- serum immunoglobulins and electrophoresis
- serum free light chains
- cryoglobulins
- complement levels
- blood cultures
- serology (hepatitis B/C, HIV, ASO titre)

renal biopsy

Renal + Urology (37 decks)

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