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
what is the definition of complete and partial remission
complete remission (proteinuria
26
what are the main primary idiopathic causes of GN
Minimal change FSGS (focal segmental glomerulosclerosis) Membranous Membranoproliferative IgA nephropathy e.g. Henoch-Schönlein purpura (HSP)
27
what is the commonest cause of nephrotic syndrome in children and why is it
minimal change nephropathy Normal renal biopsy on LM & IF with foot process fusion on EM.
28
Tx of minimal change nephropathy
Oral steroids - 94% remission Steroid resistant Tx with cyclophosphamide/CSA
29
does minimal change nephropathy cause progressive renal failure
NO
30
what is the commonest cause of nephrotic syndrome in adults
FSGS - FOCAL SEGMENTAL GLOMERULOSCLEROSIS
31
FSCS can be primary or secondary - what are secondary causes of FSCS
HIV/Heroin use/Obesity/ Reflux nephropathy
32
how does FSCS appear on renal biopsy
light microscopy with minimal Ig/ Complement deposition on IF
33
Tx of FSCS
Prolonged Steroids - remission 60% 2nd line - Cyclophosphamide or Ciclosporin
34
prognosis of FSCS
50% progress to end stage renal failure (ESRF) after 10 years
35
what is membranous nephropathy
2nd commonest cause of nephrotic syndrome in adults | Can be primary or secondary
36
what are secondary causes of membranous nephropathy
infections (hepatitis B/ parasites) connective tissue diseases (lupus) malignancies (carcinomas/ lymphoma) drugs (gold/penicillamine)
37
what is seen on renal biopsy of membranous nephropathy
subepithelial immune complex deposition in the basement membrane
38
Tx of membranous nephropathy
Steroids + Cyclophosphamide (Alkylating agents) Consider B cell monoclonal Ab e.g. rituximab
39
prognosis of membranous nephropathy
30% progress to end stage renal failure in 10 years
40
what antibody is seen in the majority of MN cases
Anti PLA2r antibody
41
what is the commonest GN in the world
IgA nephropathy
42
what is IgA nephropathy associated with
Henoch-Schonlein Purpura (HSP) (arthritis/colitis/ purpuric skin rash)
43
what is the range of symptoms IgA nephropathy can cause
Asymptomatic microhaematuria ± non-nephrotic range proteinuria Macroscopic haematuria after resp/GI infection AKI/ CKD
44
what is seen on renal biopsy of IgA nephropathy
Mesangial cell proliferation and expansion on light microscopy with IgA deposits in mesangium on IF
45
Tx of IgA nephropathy
BP control/ ACE inhibitors & ARBs/ Fish oil
46
what is RPGN
Rapidly progressive glomerulonephritis - treatable cause of Acute renal failure - causes rapid deterioration in renal function over days/weeks
47
what is RPGN associated with on renal biopsy
Glomerular crescents
48
what are the two categories of RPGN
ANCA-positive ANCA-negative
49
what are the ANCA-positive conditions
Systemic Vasculitis Wegener’s granulomatosis (Granulomatosis with polyangiitis) Microscopic polyangiitis
50
what are the ANCA-negative conditions
Goodpasture’s disease-Anti-GBM Henoch Scholein Purpura HSP/IgA SLE
51
how is ANCA detected
by indirect immunofluorecence
52
what is antibody in GoodPasture's syndrome
Anti-GBM
53
Tx of RPGN
Prompt Immunosuppression with supportive care - Steroids (IV Methylprednisolone / Oral Prednisolone) - Cytotoxics (Cyclophosphamide/ Mycophenolate/ Azathioprine - Rituximab