Glomerulonephritis Flashcards
What is glomerulonephritis?
An immune mediated disease affecting the glomerulus with secondary tubulointerstitial damage.
What is the most common process underpinning glomerulonephritis?
Autoimmune
What do you get in the urine of there is damage to endothelial or mesanglial cells?
Proliferative lesion and red cells in urine.
If there is endothelial damage then what sorts of lesions do you get in the kidney?
Proliferative
If the podocytes are damaged what sort of lesions are there?
Non proliferative
What substance appears in the urine if there is damage to podocytes?
Protein
Is microscopic haematuria more likely to be a problem in the kidney or lower urinary tract?
Kidney
Is macroscopic haematuria more likely to be a problem in the kidney or lower urinary tract?
Lower urinary tract
What condition do you get if the podocytes are damaged causing massive protein leakage but no decline in renal function?
Nephrotic syndrome
What level of protein in the urine counts as nephrotic syndrome?
More than 3g per day
On urine microscopy you see non dysmorphic red blood cells. Where is the blood coming from?
Lower urinary tract
On urine microscopy you see dysmorphic red blood cells. Where is the blood coming from?
Kidney. They are squashed to go through the glomerulus.
What causes frothy urine?
Protein
In nephritic syndrome a proliferative or non proliferative process?
Proliferative
A patient has oliguria, hypertension and her urine shows RBCs and granular casts
Nephritic syndrome
A patient presents with proteinuria, massive pitting oedema and normal renal function
Nephrotic syndrome
In nephrotic syndrome a proliferative or non proliferative condition?
Non proliferative
What could cause acute kidney injury in a patient with nephrotic sydrome?
Renal vein thrombosis
List some complications of nephrotic sydnrome?
Infections Renal vein thrombosis PE Volume depletion Vitamin D deficiency Subclinical hypothyroidism
What does proliferative /non proliferative actually mean in glomerulonephritis?
Presence or absence of proliferation of mesangial cells.
How would you treat glomerulonephritis? (non immunosuppressive)
Anti hypertensives ACE inhibitors/ARB Diuretics Statins Anticoagulants if nephrotic syndrome
What is the target blood pressure for a patient with glomerulonephritis?
130/80
What is the first line immunosuppressive in glomerulonephritis?
Corticosteroids
How do you treat patients with nephrotic syndrome?
Fluid restrict Salt restrict Diuretics ACE inhibitors/ARBs Anticoagulation
When would you give a patient with nephrotic syndrome IV albumin?
If the become volume depleted ie the water is in the wrong place!
What is the most common type of renal disease seen in patients with SLE?
Diffuse proliferative glomerulonephritis
Which antibody shows a ribbon like pattern on immunofluresence?
Anti glomerular basement antibodies
What immunosuppressive treatments would you use for treatment of glomerulonephritis?
Steroids Azathioprine Cyclophosphamide Cyclosporin Mycophenolate IV immunoglobulin Monoclonal antibodies
What non drug treatment can you use in the treatment of glomerulonephritis?
Plasmapharesis
List the five main types of glomerulonephritis
Minimal change disease FSGS Membranous Membranoproliferative IgA nephropathy
What is the commonest cause of nephrotic syndrome in children?
Minimal change nephropathy
A 9 year old girl presents with proteinuria. Her renal biopsy in normal.
Minimal change nephropathy
What is the first line treatment for minimal change nephropathy?
Oral steroids
When would you use cyclophosphamide in the treatment of minimal change nephropathy?
If it was unresponsive to steroids/dependant on high doses
Does minimal change nephropathy cause progressive renal failure?
No
What are 4 causes of secondary membranous nephropathy?
Infections (parasites/hep B)
Lupus
Malignancy
Drus (Gold)
What do you see in the renal biopsy of membranous nephropathy?
Subepithelial immune complex deposition in the basement membrane
What kidney problem is associated with henoch schonlein purpura?
IgA nephropathy
You see glomerular crescents on a kidney biopsy. What is the most likely diagnosis?
Rapidly progressive glomerulonephritis
List three ANCA +ve diseases that cause glomerulonephritis
Systemic vasculitis
Wegners granulomatosis
Microscopic polyangiitis
List three ANCA negative causes of glomerulonephritis
Goodpastures
Henoch Scholein
SLE
