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nephrology > glomerulonephritis > Flashcards

glomerulonephritis Flashcards

1
Q

• terms used to describe histologically the number of glomeruli affected in a given condition:

A

diffuse: majority of glomeruli abnormal (>50%)
focal: some glomeruli affected

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2
Q

terms used to describe histologically the extent to which individual glomeruli are affected in a given condition:

A

ƒ global: entire glomerulus abnormal

ƒ segmental: only part of the glomerulus abnormal

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3
Q

proliferation

A

hyperplasia of one of the glomerular cell types (mesangial, endothelial, parietal epithelial), +/- inflammatory cell infiltration

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4
Q

membranous changes

A

capillary wall thickening due to immune deposits or alterations in basement membrane

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5
Q

crescent formation

A

parietal epithelial cell proliferation and mononuclear cell infiltration form crescent-shape in Bowman’s space

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6
Q

gold standard to assess degree of proteinuria

A

24-h urine protein

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7
Q

microalbuminuria defn

A

ACR ≥2.8 mg/mmol (female) or ≥2.0 mg/mmol (male)

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8
Q

screen for diabetic nephropathy

A

urine ACR

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9
Q

normal daily excretion of protein

A

<30g albumin

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10
Q

microalbuminuria, proteinuria, nephrotic syndrome

A

30-300mg albumin, 300mg-3g protein, >3.5g protein with hypoalbuminaemia (<35g/L)

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11
Q

ix for nephrotic syndrome or nephritic syndrome

A 
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

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12
Q

indications for nephrology referral

A

heavy proteinuria (ACR >30mg/mmol) or nephrotic syndrome

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13
Q

broad categories of proteinuria

A

tubulointerstitial, glomerular, overflow

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14
Q

tubulointerstitial proteinuria

A

impaired resorption

s syndrome

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15
Q

glomerular proteinuria categories

A

primary, secondary

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16
Q

primary glomerular proteinuria

A

minimal change, membranous, FSGS, membrano-proliferative, post-strep, IgA

17
Q

secondary glomerular proteinuria categories

A 
systemic disease
hereditary/metabolic
infectious
medications
cancer
others
18
Q

secondary glomerular proteinuria systemic disease

A

diabetes, SLE, vasculitis

19
Q

hereditary/metabolic

A

Alford’s, PCKD, Fabry’s, SCD

20
Q

infectious

A

HBV, HCV, HIV, bacterial endocarditis

21
Q

medications

A

NSAIDs, gold, heavy metals

22
Q

cancer

A

lymphoma, RCC

23
Q

others

A

cryoglobulinaemia, hypertensive nephrosclerosis

24
Q

overflow proteinuria

A

overflow of low molecular weight proteins e.g. multiple myeloma, amyloidosis, Waldenstrom’s macroglobulinaemia

25
Q

urine workup for gross haematuria

A

Centrifuge.
If sediment red - true haematuria (RBC+, dipstick+)
If supernatant red (RBC-) - dipstick for haeme
If dipstick+, myoglobinuria or haemoglobinuria
If dipstick-, pseudohaematuria (beetroot, rifampicin, porphyria)

26
Q

primary nephritic syndrome causes

A 
post-strep
IgA
rapidly progressive
membrano-proliferative
interstitial nephritis
papillary necrosis
27
Q

features of nephritic syndrome

A 
PHAROH
proteinuria
haematuria
azotemia
RBC casts
oliguria
hypertension
28
Q

acute nephritic syndrome defn

A

a subset of nephritic syndrome in which the clinical course proceeds over days

29
Q

nephritic syndrome pathology types

A
  1. Anti-GBM mediated (15%)
  2. Immune complex mediated (24%)
  3. Non-immune mediated (60%)
  4. Double antibody positive
30
Q

anti-GBM mediated pathology

A

anti-GBM positive. linear inflammatory pattern due to IgG and C3 deposition along the capillary loops.

31
Q

anti-GBM ddx

A

with lung haemorrhage: goodpasture’s

without lung haemorrhage: anti-GBM

32
Q

type II pathology

A

granular pattern due to sub endothelial or subepithelial deposits of IgG and C3

33
Q

type II ddx

A

C3 normal - IgA nephropathy, HSP

C3 decreased - post-strep, membrano-proliferative, SLE, IE, cryoglobulinaemia

34
Q

type III pathology

A

pauci-immune. no immune staining. ANCA +ve

35
Q

type III ddx

A

c-ANCA +: granulomatosis with polyangitis

p-ANCA +: microscopic polyangitis, churg-strauss

36
Q

type IV pathology

A

features of type I and type III. double anti-body positive

37
Q

lab features of RPGN

A

fibrous crescents on histopathology

RBC casts and/or dysmorphic RBCs in urine

nephrology (7 decks)

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