Glomerulonephritis Flashcards
What is glomerulonephritis?
Immune-mediated disease causing damage to the glomerulus, causing a leak of blood +/- protein into the urine
What causes a) proliferative lesions and RBC in urine and b) non-proliferative lesions and protein in urine?
a) damage to the capillary endothelium or mesangial cells b) damage to podocytes
In GN, what may be seen on urine dipstick?
Haematuria and/or proteinuria
What does the image show?
RBC casts
How might GN present, in terms of direct renal disease?
Acute kidney injury- rapidly progressive GN
Hypertension
Nephrotic syndrome
Nephritic syndrome
What is the triad of nephrotic syndrome?
Proteinuria, hypoalbuminaemia, oedema
[hypercholesterolaemia is often seen]
What kind of process is nephrotic syndrome indicative of?
Non-proliferative
What is a presentation of nephritic syndrome usually indicative of?
Nephritic syndrome
What are the main features of nephritic syndrome?
Haematuria with RBC casts and dysmorphic RBCs (urine microscopy)
Progressive oliguria and renal failure
Proteinuria
Why are patients with nephrotic syndrome more prone to infection?
Loss of immunoglobulins in urine (also immunosuppressive treatments)
Other than infection susceptibility, what are the possible complications of nephrotic syndrome?
Thromboembolism (DVT/PE/renal vein thrombosis)
Volume depletion (diuretic use- may lead to pre-renal ARF)
Hyperlipidaemia
How is glomerulonephritis classified?
Primary (idiopathic) or secondary (caused by infections, associated with malignancy, part of systemic disease)
What are the general aims of treatment in glomerulonephritis?
Reduce proteinuria and preserve long-term kidney function
How is glomerulonephritis managed (non-immunosuppresively)?
ACEIs/ARBs
Diuretics
Statins
? Anticoagulation (aspirin/antiplatelets)
What is the target blood pressure in GN a) without proteinuria and b) with proteinuria
a) 130/80 b) 120/75
What kinds of immunosuppressive drugs may be used in GN?
Corticosteroids
AZT
Cyclophosphamide
Mycophenolate
Calcineurin inhibitors
When might plasma exchange (plasmapheresis) be used?
Goodpastures disease (to remove the anti basement membrane antibodies)
How are nephrotic patients managed?
Salt restriction
Diuretics
ACEIs/ARBs
Statins
Treat the underlying cause
What is the commonest cause of nephrotic syndrome in children?
Minimal change glomerulonephritis (75% of GN in children)
What changes are seen in electron microscopy in MCGN?
Fusion of podocytes
How is MCGN treated and what is the prognosis?
Most are steroid responsive (95% go into remission)
Some are steroid-dependent/resistant, or have multiple relapses- second line is cyclophosmamide
Prognosis- about 1% go onto develop ESRF
What is the commonest cause of nephrotic syndrome in adults?
Focal segmental glomerulosclerosis
What is FSGS sometimes secondary to?
vesicouretric reflux, IgA nephropathy, heroin use, HIV, obesity
What is the second most common cause of nephrotic syndrome in adults?
Membranous nephropathy
What is membranous nephropathy associated with?
a) drugs
b) infection
c) systemic disease
a) gold, penicillamine
b) HBV, parasites
c) maligancy, lupus, RA
What changes are seen in renal biopsy of membranous nephropathy, and how does it usually present?
Diffuse thickened basement membrane, sub-epithelial deposits of IgG and C3
Usually nephrotic syndrome
What proportion of membranous nephropathy patients will progress to ESRF?
30% within 10 years
What is the most common GN in the developed world?
IgA nephropathy
How does IgA nephropathy present?
Macro- or micro-haematuria
Typical presentation- young male with episodic macroscopic haematuria occurring a few days after URTI
What is the systemic manifestation of IgA nephropathy? How does this present?
Henoch-Schonlein purpura
Purpuric rash, polyarthritis, abdominal pain
How are IgA nephropathy/HSP treated?
BP control
ACE inhibitors
What is the main classification of rapidly progressive GN?
ANCA -ve: IgA/HSP, SLE, Goodpasture’s Disease
ANCA +ve: systemic vasculitis e.g. Wegeners, microscopic polyangiitis
What is the common biopsy finding in patients with RP-GN?
Glomerular crescents
How is RP-GN treated?
Aggressive immunosuppression (steroids and cyclophosmamide)
+ plasma exchange
