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Renal > Glomerulonephritis > Flashcards

Glomerulonephritis Flashcards

1
Q

What is GN?

A

Immune mediated disease of the kidneys affecting the glomeruli (with secondary tubulointerstitial damage)

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2
Q

Damage to endothelial or mesangial cells leads to which type of lesion?

A

Proliferative lesion and red cells in urine

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3
Q

Damage to podocytes leads to which kind of lesion?

A

Damage to podocytes leads to a non-proliferative lesion and protein in the urine

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4
Q

Urinalysis findings of glomerulonephritis?

A

Haematuria, proteinuria

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5
Q

Urine microscopy would show what in glomerulonephritis?

A

RBC (dysmorphic), RBC and granular casts, lipiduria

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6
Q

Haematuria in GN presentation

A

Episodes of painless macroscopic haematuria

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7
Q

Nephrotic syndrome

A

> 3g protein per day

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8
Q

Heavy proteinuria

A

1-3g/day

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9
Q

Asymptomatic proteinuria

A

<1g per day

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10
Q

Microalbuminuria

A

30-300mg albuminuria/day

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11
Q

Red cell casts are pathogonomic of what?

A

GN

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12
Q

Red blood cells in GN?

A

Dysmorphic

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13
Q 
Acute Renal Failure
Oliguria
Oedema/ Fluid retention
Hypertension
Active urinary sediment
RBC’s, RBC & Granular Casts

Indicative of a proliferative process

A

Nephritic syndrome

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14
Q 
Proteinuria  3 g/day (mostly albumin, also globulins)
Hypoalbuminaemia (<30)
Oedema 
Hypercholesterolaemia
Usually normal renal function

Indicative of a non proliferative process

A

Nephrotic syndrome

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15
Q

Hypercholesterolaemia in nephritic or nephrotic syndrome?

A

Nephrotic

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16
Q

Nephrotic syndrome complications?

A

Infections - loss of opsonising antibodies
Renal vein thrombosis
Pulmonary emboli
Volume depletion (overaggressive use of diuretics) - may lead to ARF (pre-renal)

Vit D deficiency
Subclinical hypothyroidism

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17
Q

Most common cause of glomerulonephritis?

A

Idiopathic

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18
Q

Systemic diseases associated with glomerulonephritis?

A

ANCA associated systemic vasculitis
Lupus
Goodpastures
HSP

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19
Q

Proliferative or non-proliferative

A

usually refers to presence or absence of proliferation of mesangial cells

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20
Q

Focal/diffuse

A

< or > 50% of glomeruli affected

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21
Q

Global/segmental

A

All or part of glomerulus affected

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22
Q

Crescenteric

A

Presence of crescents - epithelial cell extracapillay proliferation e.g. RPGN in vasculitis

(RPGN = rapidly progressing glomerulonephritis)

23
Q

Easier explanation of crescenteric glomerulonephritis?

A

Crescenteric more often seen in conditions like Goodpastures and systemic vasculitis
(crescenteric GN = when there is an accumulation of cells outside the capillary loops, but within the Bowman’s capsule)
-Presents as RPGN

24
Q

Treatment of GN
(non-immunosuppression)
DASH

A 
DASH
Diuretics
ACEi/ARB
Steroids
anti-Hypertensives
25
Q

Treatment of GN (immunosuppression)

A

Drugs
Corticosteroids (Prednisolone po/MethylPred IV)
Azathioprine
Alkylating agents (Cyclophosphamide/ Chlorambucil)
Calcineurin inhibitors (Cyclosporin/Tacrolimus)
Mycophenolate Mofetil (MMF)

Plasmaphoresis: TPE (therapeutic plasma exchange)

Antibodies: IV immunoglobulin
Monoclonal T or B cell antibodies

26
Q

General treatment of nephrotic patients

A

Fluid restriction
Salt restriction
Diuretics
ACE inhibitors/ARBs

?anticoagulation
IV albumin (only if volume deplete)
27
Q

What is complete remission?

A

Proteinuria <300mg/day

28
Q

What is partial remission?

A

Proteinuria <3g/day

29
Q

What is partial remission?

A

Proteinuria <3g/day

30
Q

Commonest cause of nephrotic syndrome in children

A

Minimal change nephropathy

31
Q

Biopsy, ML & IF and EM findings of minimal change nephropathy

A

Normal biopsy
Normal LM & IF
Foot process fusion on EM

32
Q

How to treat minimal change nephropathy

A

94% remission with oral steroids

Second-line drugs: cyclophosphamide/CSA

(some are steroid resistant/dependent or have multiple relapses

33
Q

Does not cause progressive renal failure

Possibly caused by IL-13

A

Minimal change nephropathy

34
Q

Commonest cause of nephrotic syndrome in adults (35%)
10 or 20 (HIV/Heroin use/Obesity/ Reflux nephropathy)
Renal biopsy: As its name describes on light microscopy with minimal Ig/ Complement deposition on IF
Remission with prolonged steroids in 60 %
50 % progress to end stage renal failure after 10 years

A

Focal Segmental Glomerulosclerosis

35
Q

Risk factors for FSGS

A

HIV/heroin use/obesity/reflux nephropathy

36
Q

Renal biopsy findings of FSGS

A

Focal segmental glomerulosclerosis (as the name tells you lol)

Minimal Ig/complement deposition on IF

37
Q

Treatment of FSGS

A

Remission with prolonged steroids in 60%

50% progress to end stage renal failure after ten years

38
Q

New data implicating soluble urokinase plasminogen activator receptor (suPAR).
Upregulate integrins (cell signalling molecules).
Podocyte effacement.
67% of patients have increased suPAR levels.

A

FSGS

39
Q

2nd commonest cause of nephrotic syndrome in adults (15-30%)
10 or 20
Important 20 causes include:
infections (hepatitis B/ parasites)
connective tissue diseases (lupus)
malignancies (carcinomas/ lymphoma)
drugs (gold/penicillamine)
Renal biopsy: subepithelial immune complex deposition in the basement membrane
Steroids/ Alkylating agents/B cell monoclonal Ab
30% progress to end stage renal failure in 10 years

A

Membranous nephropathy

40
Q

Causes of nephropathy

A

Infections (hep B/parasites)

Connective tissue diseases (lupus)

Malignancies (carcinomas/lymphoma)

Drugs (gold/penicillamine)

41
Q

Renal biopsy findings in membranous nephropathy

A

Subepithelial immune complex deposition in the basement membrane

42
Q

Treatment for membranous nephropathy?

A

Steroids
Alkylating agents
B cell monoclonal antibodies

-30% progress to end stage renal failure in 10 years

43
Q

Anti PLA2r antibody

A

Present in >70% cases of primary membranous nephropathy

44
Q

Thickened basement membrane on silver stain?

A

Membranous nephropathy

45
Q

What does the basement membrane look like in membranous nephropathy? and what stain would you use?

A

Thickened basement basement membrane using silver stain

46
Q

Commonest GN in the world?

A

IgA nephropathy

47
Q

Associated with HSP

A

IgA nephropathy

remember HSP is IgA complex mediated anyway

48
Q

Renal biopsy findings of IgA nephropathy?

A

Mesangial cell proliferation and expansion on light microscopy with IgA deposits in mesangium on IF

49
Q

Drugs used in IgA nephropathy?

A

BP control
ACEi & ARB
Fish oil

50
Q

Which stain would show mesangial cell proliferation and expansion?

A

H&E stain

51
Q

A treatable cause of acute renal failure
Rapid deterioration in renal function over days/weeks
Active urinary sediment (RBC’s, RBC & Granular Casts)
May be part of systemic disease.
Associated with glomerular crescents on biopsy.

A

Rapidly progressing glomerulonephritis

RPGN

52
Q

How do you detect ANCA? (anti-neutrophil cytoplasmic antibodies)

A

Immunofluorecence

53
Q

Treatment for RPGN

A

Treatment must be prompt!

Strong immunosuppression with supportive care including dialysis if needed

54
Q

Treatment for RPGN

A

Immunosuppression
Steroids (IV Methylprednisolone / Oral Prednisolone)
Cytotoxics (Cyclophosphamide/ Mycophenolate/ Azathioprine

Plasmapheresis

Renal (44 decks)

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