Glomerulonephritis Flashcards
What is glomerulonephritis?
Immune-mediated disease of the kidneys affecting the glomeruli (with secondary tubulointerstitial changes)
What is glomerulonephritis?
Immune-mediated disease of the kidneys affecting the glomeruli (with secondary tubulointerstitial changes)
Pathogenesis of GN
antibody mediated depostition of circulating immune complexes in the glomerulus
What is the function of Bowman’s space?
Where the filtrate accumulates before entering the proximal tubule
Which cells bind the capillaries together in the glomerulus?
Mesangial cells
How is assymptomatic proteinuria defined?
How is heavy proteinuria defined?
1-3 g/day
How much protein is present in the urine in nephrotic syndrome?
> 3g/day
Signs of GN on urine microscopu
Squashed dysmorphic red cells
Red cell casts
Features of nephrotic syndrome
Proteinuria
Hypoalbuminaemia (
What does nephrotic syndome indicate about the site of injury?
Non-roliferativew process at the podocytes
Complications of nephrotic syndrome
Infections Renal vein thrombosis Pulmonary emboli Volume depletion Vit D deficiency Subclinical hypothyroidism
Features of nephritic syndrome
Acute renal failure Oliguri Oedema Hypertension Active urinary sediment
What does nephritic syndrome indicate about the sit of injury?
Proliferative process on the endothelial side of GBM
What does proliferative and non-proliferative descrbe about GN?
Presence or abscence of proliferation of mesangial cells
What does focal or diffuse indicate about GN?
50% of glomeruli affected
What des global or segmental indicate about GN?
All or part of glomerulus affected?
What is the target BP for patients with GN?
What is the role of diuretics in GN?
Offload salt & water retention that patients get as a result ofprotein loss
What is the role of statins in GN?
To reduce hyperlipidaemia
What immunosupressive agents can be used in the treatment of GN
Corticosteroids Azathioprine Alkylating agents (cyclophosphamide) Caclneurin inhibitors (cyclosprorin, tacrolimus) Mycophenylate
Whatimmunosupressive agents can be used in the treatment of GN
Corticosteroids Azathioprine Alkylating agents (cyclophosphamide) Caclneurin inhibitors (cyclosprorin, tacrolimus) Mycophenylate
Pathogenesis of GN
antibody mediated depostition of circulating immune complexes in the glomerulus
What is the function of Bowman’s space?
Where the filtrate accumulates before entering the proximal tubule
Which cells bind the capillaries together in the glomerulus?
Mesangial cells
How is assymptomatic proteinuria defined?
How is heavy proteinuria defined?
1-3 g/day
How much protein is present in the urine in nephrotic syndrome?
> 3g/day
Signs of GN on urine microscopu
Squashed dysmorphic red cells
Red cell casts
Features of nephrotic syndrome
Proteinuria
Hypoalbuminaemia (
What does nephrotic syndome indicate about the site of injury?
Non-roliferativew process at the podocytes
Complications of nephrotic syndrome
Infections Renal vein thrombosis Pulmonary emboli Volume depletion Vit D deficiency Subclinical hypothyroidism
Features of nephritic syndrome
Acute renal failure Oliguri Oedema Hypertension Active urinary sediment
What does nephritic syndrome indicate about the sit of injury?
Proliferative process on the endothelial side of GBM
What does proliferative and non-proliferative descrbe about GN?
Presence or abscence of proliferation of mesangial cells
What does focal or diffuse indicate about GN?
50% of glomeruli affected
What des global or segmental indicate about GN?
All or part of glomerulus affected?
What is the target BP for patients with GN?
What is the role of diuretics in GN?
Offload salt & water retention that patients get as a result ofprotein loss
What is the role of statins in GN?
To reduce hyperlipidaemia
When should anti-coagulants be given to GN patients?
When profoundly ablunminaemic (
Whatimmunosupressive agents can be used in the treatment of GN
Corticosteroids Azathioprine Alkylating agents (cyclophosphamide) Caclneurin inhibitors (cyclosprorin, tacrolimus) Mycophenylate
What would indicate complete remission from nephrotic syndrome?
Proteinuria
What is the commonest form of nephrotic syndrome in childern & young adults?
Minimal change
Findings of minimal change on biosy
Normal on LM & IF with foot process fusion on EM
What percentage of minimal change achieves complete remission with oral steroids?
94%
What is the second line drug for rsistant minimal change?
Cyclophosphamide/CSA
Dos minimal change cause progressive renal failure?
No
What is the commonest cause of glomerulonephritis in adults?
FSGS
What can FSGS be secondary to?
HIV
Heroin use
Obesity
Reflux nephropathy
Findings of FSGS on renal biopsy
LM - minimal Ig/Complement deposition on IF
What percentage of patients with FSGS progress to end stage renal failure after 10 years?
50%
What is he second most common cause of nephrotic syndrome in adults?
Membranous GN
Secondary causes of membranous GN
Infection (Hep B/parasites)
Connective tissue disease (lupus)
Malignancies (carcinoma/lymphoma)
Drugs (gold/penicillamine)
Finsings of membranous GN on biopsy
Subepithelial immune complex deposition in the basement membrane
What percentage of membranious GN progress to end stage renal failure
30%
Which antibody is present in >70% of primary membranous nephopathy?
Anti-PLA2r antibody
What is the commonest GN in the wrold?
IgA nephropathy
Common presentation of IgA nephropathy
Macrscopic haematuria after resp/GI infection
What is IgA nephropathy associated with?
HSP
Findings of IgA nephropathy on renal biopsy
Mesangial cell proliferation and exapnsion on light microscopy with IgA deposits in mesangium on IF (increased number of cells)
What is RPGN associated with on biopsy?
Crescents
ANCA positive causes of RPGN
Wegners (GPA)
MPA
ANCA negative causes of RPGN
Goodpastures (antiGBM)
Henoch-Scholein Purpura (HSP/IgA)
SLE
Treatment of RPGN
Prompt strong immunosupression with supportive care
