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Renal SB > Glomerulonephritis > Flashcards

Glomerulonephritis Flashcards

1
Q

what is the renal parenchyma

A

the kidney itself

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2
Q

what are the two main presentations of GN

A

Chronic GN is 2nd commonest cause of End Stage Renal Failure (after diabetes). More common than acute.

Acute GN is an important treatable cause of Acute Renal Failure

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3
Q

definition of GN

A

Immune-mediated disease of the kidneys affecting the glomeruli

(with secondary tubulointerstitial damage)

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4
Q

how can GN happen

A

Humoral (antibody-mediated)

Cell-mediated (T-cells)

Inflammatory cells, mediators and complements

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5
Q

what is the charges of the glomerular cell membrane

A

negatively charged

allows it to have a size and charge selective barrier

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6
Q

what happens to the barrier in GM

A

disruption of the barrier leading to haematuria and/or proteinuria

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7
Q

what determines how GM presents

A

site and type of injury

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8
Q

what does Damage to endothelial or mesangial cells lead to

A

a proliferative lesion and red cells in urine.

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9
Q

what does damage to podocytes lead to

A

non-proliferative lesion and protein in urine (no RBC)

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10
Q

how is GN diagnosis

A

Clinical presentation
Blood tests
Examination of urine
Kidney biopy

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11
Q

how can urine be analysed

A

Urinalysis - haematuria, proteinuria
Urine microsopy - RBC (dysmorphic), RBC & granular casts, lipiduria
Urine Protein: Creatinine Ratio / 24 hour urine - quantify proteinuria

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12
Q

how can GN present

A 
Haematuria (micro or macroscopic)
Proteinuria 
Impaired renal function (AKI or CKD/ ESRD)
Hypertension
Nephrotic syndrome
Nephritis syndrome
Nephrotic-Nephritic Syndrome
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13
Q

how can proteinuria be defined

A 
Microalbuminuria (30-300mg albuminuria/day)
Asymptomatic proteinuria ( 3 g/day)
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14
Q

what is features of nephritic syndrome

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

Indicative of a proliferative process

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15
Q

what is features of nephrotic syndrome

A

Proteinuria > 3 g/day (mostly albumin, also globulins)

Hypoalbuminaemia (

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16
Q

nephrotic syndrome complications

A

Infections
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

classifications of GN

A

Primary - idiopathic (majority)

Secondary - caused by eg. infections or drugs eg. malignancies part of systemic disease
eg. ANCA - associated systemic vasculitis, lupus, Goodpastures, HSP

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18
Q

how is GN described in terms of histology

A

Proliferative or non-proliferative
Focal/Diffuse
Global/Segmental
Crescentic

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19
Q

what are the aims of GN treatment

A

Reduce degree of proteinuria
Induce remission of nephrotic syndrome
Preserve longterm renal function

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20
Q

what are the two categories of treatment of GN

A

Immunosuppressive

Non-immunosuppressive

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21
Q

Non-immunosuppressive Tx of GN

A

Goal to lower BP:

- Anti-hypertensives (target BP

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22
Q

Immunosuppressive Tx of GN

A

Corticosteroids (Prednisolone po/MethylPred IV)

Azathioprine

23
Q

Tx of nephrotic syndrome

A

Fluid restriction
Salt restriction
Diuretics
ACE Inhibitors/ ARBs

IV Albumin (only if volume deplete)

24
Q

what is needed after initial treatment of nephrotic syndrome

A

immunosuppression to induce remission

- normally steroids

25
Q

what is the definition of complete and partial remission

A

complete remission (proteinuria

26
Q

what are the main primary idiopathic causes of GN

A

Minimal change
FSGS (focal segmental glomerulosclerosis)
Membranous
Membranoproliferative
IgA nephropathy e.g. Henoch-Schönlein purpura (HSP)

27
Q

what is the commonest cause of nephrotic syndrome in children and why is it

A

minimal change nephropathy

Normal renal biopsy on LM & IF with foot process fusion on EM.

28
Q

Tx of minimal change nephropathy

A

Oral steroids - 94% remission

Steroid resistant
Tx with cyclophosphamide/CSA

29
Q

does minimal change nephropathy cause progressive renal failure

30
Q

what is the commonest cause of nephrotic syndrome in adults

A

FSGS - FOCAL SEGMENTAL GLOMERULOSCLEROSIS

31
Q

FSCS can be primary or secondary - what are secondary causes of FSCS

A

HIV/Heroin use/Obesity/ Reflux nephropathy

32
Q

how does FSCS appear on renal biopsy

A

light microscopy with minimal Ig/ Complement deposition on IF

33
Q

Tx of FSCS

A

Prolonged Steroids - remission 60%

2nd line - Cyclophosphamide or Ciclosporin

34
Q

prognosis of FSCS

A

50% progress to end stage renal failure (ESRF) after 10 years

35
Q

what is membranous nephropathy

A

2nd commonest cause of nephrotic syndrome in adults

Can be primary or secondary

36
Q

what are secondary causes of membranous nephropathy

A

infections (hepatitis B/ parasites)
connective tissue diseases (lupus)
malignancies (carcinomas/ lymphoma)
drugs (gold/penicillamine)

37
Q

what is seen on renal biopsy of membranous nephropathy

A

subepithelial immune complex deposition in the basement membrane

38
Q

Tx of membranous nephropathy

A

Steroids + Cyclophosphamide (Alkylating agents)

Consider B cell monoclonal Ab e.g. rituximab

39
Q

prognosis of membranous nephropathy

A

30% progress to end stage renal failure in 10 years

40
Q

what antibody is seen in the majority of MN cases

A

Anti PLA2r antibody

41
Q

what is the commonest GN in the world

A

IgA nephropathy

42
Q

what is IgA nephropathy associated with

A

Henoch-Schonlein Purpura (HSP) (arthritis/colitis/ purpuric skin rash)

43
Q

what is the range of symptoms IgA nephropathy can cause

A

Asymptomatic microhaematuria ± non-nephrotic range proteinuria

Macroscopic haematuria after resp/GI infection

AKI/ CKD

44
Q

what is seen on renal biopsy of IgA nephropathy

A

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

45
Q

Tx of IgA nephropathy

A

BP control/ ACE inhibitors & ARBs/ Fish oil

46
Q

what is RPGN

A

Rapidly progressive glomerulonephritis

  • treatable cause of Acute renal failure
  • causes rapid deterioration in renal function over days/weeks
47
Q

what is RPGN associated with on renal biopsy

A

Glomerular crescents

48
Q

what are the two categories of RPGN

A

ANCA-positive

ANCA-negative

49
Q

what are the ANCA-positive conditions

A

Systemic Vasculitis
Wegener’s granulomatosis
(Granulomatosis with polyangiitis)
Microscopic polyangiitis

50
Q

what are the ANCA-negative conditions

A

Goodpasture’s disease-Anti-GBM
Henoch Scholein Purpura HSP/IgA
SLE

51
Q

how is ANCA detected

A

by indirect immunofluorecence

52
Q

what is antibody in GoodPasture’s syndrome

53
Q

Tx of RPGN

A

Prompt Immunosuppression with supportive care

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

Renal SB (15 decks)

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