Glomerulonephritis Flashcards
What are the 5 primary characteristics of nephritic syndrome?
- Reduction in GFR as indicated by an elevated serum creatinine
- Active urine sediment in the form of RBCs, WBCs, and RBC casts
- Proteinuria (usually sub-nephrotic)
- Edema
- Hypertension
What glomerulonephritis is associated with ANA, Anti-DS DNA?
Lupus
What glomerulonephritis is associated with positive blood cultures?
Bacterial endocarditis
What glomerulonephritis is associated with ASO?
A post-infections glomerulonephritis, usually strep.
What glomerulonephritis is associated with Hepatitis C?
Cryoglobulinemia
HepC and Cryo… both start with C.
What glomerulonephritis is associated with Hepatitis B?
Membranoproliferative glomerulonephritis
What glomerulonephritis is associated with ANCA
Pauci-immune vasculitis
What glomerulonephritis is associated with anti-GBM antibodies?
Anto-GBM disease, Goodpasture’s Syndrome
What is the role of immune complexes in the pathophysiology of nephritic syndrome?
Immune complexes get lodged in the mesangium or subendothelial space and generate an inflammatory response.
What is the role of autoantibodies in (some) glomerulonephritis pathophysiologies?
Autoantibodies attach to self-cells and elicit a destructive immune response.
What is the level of proteinuria in glomerulonephritis?
Usually less than 3gm/day
Why is the proteinuria in glomerulonephritis less than that of nephrotic syndrome?
Because the inflammatory insults in GN are generally focal in nature.
What is the process by which reduction in GFR arises in GN?
An acute inflammatory process results in glomerular vasoconstriction and/or occlusion or thrombosis of SOME capillary loops.
Test Presentation: Child with edema and sudden extreme weight gain, recent history of GAS. Decreased C3 with normal C4. IF shows granular deposits, and EM shows “subepithelial humps.”
Post-infectious glomerulonephritis
I say subepithelial humps and you say _____
Post-infectious glomerulonephritis
T/F: Renal biopsy is typically performed to verify a diagnosis of post-infectious glomerulonephritis.
F. It’s usually self-limited and not a huge deal. We don’t go around stabbing children for such things.
Test Presentation: 22yo male presents with asymptomatic microhematuria. IgA deposits in the skin, an din the mesangium upon IF.
IgA Nephropathy
What is the most common type of acute glomerulonephritis?
IgA nephropathy
What is the treatment for IgA nephropathy?
Studies show that there is a potential benefit with ACEi and steroids.
Test Presentation: A patient presents with hypertension and early nephritic syndrome. Perhaps a history of chronic HCV. Cryoglobulins, rheumatoid factor, low complement. C3 and IgG deposits.
MPGN
What is the treatment for MPGN?
Not tons. Can do alternate day steroids, and treat the HCV. But it’s a pretty shit prognosis.
Test presentation: Patient presents with hemoptysis, fatigue. Anti-GBM antibodies are found. Linear deposits on IF
Anti-GBM or Goodpasture’s syndrome.
Goodpasture’s MUST involve the lungs as well.
What is the treatment for anti-GMB?
EARLY steroids, immunosuppresents, and plasma exchange.
T/F: A patient will benefit from IMMEDIATE kidney transplant in the case of anti-GBM
F. If the antibodies are still circulating, it’s likely the problem will manifest in the new kidney.
Test Presentation: Patient presents with GI problems, a strange rash, pulmonary problems, and GN. No immune complexes on IF, but there is detectable ANCA.
Pauci-immune Renal Vasculitis.
Treatment for pauci-immune renal vasculitis
Immunosuppression
Test Presentation: Patient with detectible ANA presents with hematuria, proteinuria, and various other problems.
Lupus nephritis
Treatment for lupus nephritis
High-dose corticosteroids with mycophenolate mofetil or cyclophosphamide
Test presentation: Patent presents with palpable purpura, arthralgia, and generalized weakness. Proteinuria and hematuria are detected with a low level of C4 and possible RF activity.
Cryoglobulinemia
What disease is associated with cryoglobulinemia?
HepC
Treatment for cryoglobulinemia
Antivirals for HepC, B-cell depleting therapy for lymphoproliferative disease or rapidly progressing/resistant. Plasmapheresis.
Test presentation: Child presents with skin lesions, arthritis, GI colic and bleeding, and GN. Crescent formation with mesangial and capillary wall deposits of IgA.
Henoch-Schonlein Purpura. (HSP)
