glomerulonephritis Flashcards
• terms used to describe histologically the number of glomeruli affected in a given condition:
diffuse: majority of glomeruli abnormal (>50%)
focal: some glomeruli affected
terms used to describe histologically the extent to which individual glomeruli are affected in a given condition:
global: entire glomerulus abnormal
segmental: only part of the glomerulus abnormal
proliferation
hyperplasia of one of the glomerular cell types (mesangial, endothelial, parietal epithelial), +/- inflammatory cell infiltration
membranous changes
capillary wall thickening due to immune deposits or alterations in basement membrane
crescent formation
parietal epithelial cell proliferation and mononuclear cell infiltration form crescent-shape in Bowman’s space
gold standard to assess degree of proteinuria
24-h urine protein
microalbuminuria defn
ACR ≥2.8 mg/mmol (female) or ≥2.0 mg/mmol (male)
screen for diabetic nephropathy
urine ACR
normal daily excretion of protein
<30g albumin
microalbuminuria, proteinuria, nephrotic syndrome
30-300mg albumin, 300mg-3g protein, >3.5g protein with hypoalbuminaemia (<35g/L)
ix for nephrotic syndrome or nephritic syndrome
Nephrotic: Urinalysis FBE, UEC, LFT, CRP/ESR Glucose Serology: ANA, RF, p-ANCA, c-ANCA, HBV, HCV, HIV, ASOT Immunoglobulins Urine MCS, 24h urinary protein and creatinine Renal ultrasound
Nephritic is same, but add 24h urine stone workup if there is a history of stone formation
indications for nephrology referral
heavy proteinuria (ACR >30mg/mmol) or nephrotic syndrome
broad categories of proteinuria
tubulointerstitial, glomerular, overflow
tubulointerstitial proteinuria
impaired resorption
s syndrome
glomerular proteinuria categories
primary, secondary
primary glomerular proteinuria
minimal change, membranous, FSGS, membrano-proliferative, post-strep, IgA
secondary glomerular proteinuria categories
systemic disease hereditary/metabolic infectious medications cancer others
secondary glomerular proteinuria systemic disease
diabetes, SLE, vasculitis
hereditary/metabolic
Alford’s, PCKD, Fabry’s, SCD
infectious
HBV, HCV, HIV, bacterial endocarditis
medications
NSAIDs, gold, heavy metals
cancer
lymphoma, RCC
others
cryoglobulinaemia, hypertensive nephrosclerosis
overflow proteinuria
overflow of low molecular weight proteins e.g. multiple myeloma, amyloidosis, Waldenstrom’s macroglobulinaemia
