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Renal > Glomerulonephritis > Flashcards

Glomerulonephritis Flashcards

1
Q

What is glomerulonephritis?

A
  • Glomerulonephritis: A group of diseases associated with inflammatory injury of the glomeruli
  • Sources of Inflammation
    • Infiltration of leukocytes
    • Deposition of immune proteins
    • Disturbed function of the affected tissue
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2
Q

Is glomerulonephritis nephritic or nephrotic?

A
  • Nephritic
    • Can be rapidly progressive and include pulmonary renal syndrome
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3
Q

What 4 cell types may be affected in glomerulonephritis?

A
  1. Mesangium
  2. Podocytes
  3. Capillaries
  4. Parietal epithelial cells
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4
Q

T/F: Anti-GBM disease leads to a nephrotic disease process

A
  • False, Anti-GBM leads to Glomerulonephritis which is nephritic
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5
Q

What are the two most common causes of glomerulonephritis with a renal etiology?

A

Most common renal etiology of glomerulonephritis

  1. IgA nephropathy
    • Mesangial immune complexes containing IgA
  2. Anti-GBM disease
    • Antibody to glomerular antigen

Note: there are many other etiologies but these were in red as the most common

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6
Q

What are the two most common systemic etiologies of glomerulonephritis?

A

Most common systemic etiologies of glomerulonephritis

  • Lupus nephritis
    • Immune complex deposition
  • ANCA asscoiated vasculitis
    • “Pauci-Immune”
    • Small vessel vasculitis

Note: there are many other etiologies but these were in red as the most common

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7
Q

What are the clinical findings c/w (consistent with) nephritic syndrome

A

Nephritic Syndrome Clinical Findings

  • Hematuria
    • Dysmorphic RBC’s
    • RBC casts
  • Proteinuria
    • 200mg - 10gm
  • Elevated Cr
  • Elevated BP
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8
Q

What 3 diseases can cause pulmonary renal syndrome?

A
  1. Anti-GBM Disease
  2. ANCA associated vasculitis
  3. Lupus

pulmonary-renal syndrome requires aggressive therapy like cytotoxic drugs and plasma exchange

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9
Q

What are the criteria for calling a glomerulonephritis “rapidly progressive?”

A
  • Serum Cr doubles or GFR falls by 50% within a few days to 3 months
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10
Q

What 3 diseases are usually associated with Rapidly Progressive Glomerular Nephritis?

A
  1. Anti-GBM disease
  2. ANCA associated Vasculitis
  3. Lupus

Note: these are the same 3 diseases that are associated with pulmomary renal syndrome

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11
Q

What is pulmomnary renal syndrome?

A

Pulmomonary renal syndrome: Glomerulonephritis w/ pulmonary capillaritis

  • Presents with nephritic syndrome and hemoptysis
  • Capillaries of the kidney are involved and capillaries of the lung are invovled
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12
Q

For the following labs name what diseases they test for:

  1. ANA, Anti-DS DNA
  2. C3,C4 - if they come back low
  3. Blood cultures
  4. ASO
  5. Hepatitis C
  6. Hepatitis B
  7. Anti-neutrophil cytoplasmic antibodies (ANCA)
  8. Anti-GBM antibodies
A
  1. Lupus
  2. Several diseases including glomerulonephritis, vasculitis, autoimmune, infection
  3. Infection: Bacterial endocarditis specifically listed
  4. Streptococcus
  5. Cryoglobulinemia
  6. Membranoproliferative glomerulonephritis
  7. Pauci-immune vasculitis
  8. Anti-GBM disease, good pasture’s syndrome
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13
Q

Alex’s Made Up Vignette: 56 y/o female presents to the ED coughing up blood snd complaining of dark colored urine. A urine analysis reveals proteinuria and hematuria with RBC casts.

Question:

  1. What tests should you order
  2. Why?
A
  1. ANA, ANCA, Anti-GBM
  2. This is pulmonary renal syndrome:
    • The 3 main causes are Lupus, ANCA assoc Vasculitis, and Anti-GBM disease
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14
Q

T/F: You do not need a kidney biopsy to definitively diagnose glomerulonephritis.

A
  • False: Kidney biopsy is required for definitive diagnosis of glomerulonephritis
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15
Q
  1. A kidney biopsy is performed and cresencents are seen, what disease is this c/w?
  2. What other diseases are usually associated with this disease?
  3. What kind of treatment does this disease require?
A
  1. “Crescentic” glomerulonephritis
    • associated with severe disease, caused by rupture of the capillary wall
  2. The trifecta as I call them
    • Anti-GBM
    • ANCA associated vasculitis
    • Lupus
  3. Aggressive therapy
    • Cytotoxic drugs
    • Plasma exchange (plasmaphoresis)
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16
Q
  • What disease is associated with subepithelial immune complex deposition?
A
  • Membrounous disease
17
Q

What are the 8 main drugs used to treat glomerulonephritis?

A
  1. Prednisone
  2. Cyclophophamide
  3. Mycophenolate mofetil (MMF)
  4. Azathioprine
  5. Chlorambucil
  6. Rituximab
  7. Eculizumab
  8. Intravenous Immunoglobulin (IVIg)
18
Q

What is the most common cause of glomerulonephritis world wide?

A
  • IgA nephropathy
    • Usually presents with hematurea +/- subnephrotic proteinuria
19
Q

What disease is c/w this IF slide?

A
  • IgA nephropathy
20
Q

What are treatments availablefor IgA nephropathy?

A
  • Symptom management: Blood pressure, ACE inhibitors)
  • Prednisone (new studies show uncertain benefit though)
21
Q

Lupis nephritis can cause hematuria, nephritic disease, or nephrotic disease depending on where the immune complexes end up getting deposited.

Question: Immune complex depositions in what cell layers cause

  1. Hematuria
  2. Nephritic syndrome
  3. Nephrotic syndrome
A
  1. Hematuria - IC deposits in Mesangium
  2. Nephritic - IC deposits in Subendothelial
  3. Nephrotic - IC depotis in Subepithelial
22
Q

What disease is this based only on these IHC (immunohistochemistry) slides

A
  • Anti-GBM
    • Notice in the slide on the left, how the capillaries have formed a “crescent” around the glomerulus
      • This should at least tell you its severe disease
    • Notice on the right slide the linear deposition of antibodies
      • This is deposition into the basement membrane structure
    • If untreated can lead to ESRD (end stage renal disease) quickly
23
Q

ANCA associated vasculitis is actually a group of diseases.

Question: What 4 vasculitis diseases make up ANCA associated vasculitis?

A
  1. Granulomatosis with Polyangiitis (Wegener’s disease)
  2. Microscropic polyangiitis
  3. Eosinophilic granulomatosis with polyangiitis
  4. Renal limited vasculitis
24
Q
  • Is Granulomatosis with polyangiitis associated with C-ANCAor P-ANCA?
    • What are the clinical findings?
A
  • Granulomatosis with polyangiitis:
    • C-ANCA (PR3)
      • Clinical findings: Nephritic syndrome often with extra-renal involvement (airways)
25
Q
  • Is Microscopic polyangiitis associated with C-ANCA or P-ANCA?
    • What are the clinical findings?
A
  • Microscopic polyangiitis
    • P-ANCA (MPO)
      • Clinical findings: Nephritic syndrome, often with extra-renal involvement (airways)
26
Q
  • Is Eosinophilic granulomatosis with polyangiitis (Churg-Strauss) associated with associated with C-ANCA or P-ANCA?
    • What are the clinical findings?
A
  • Eosinophilic granulomatosis with polyangiitis
    • P-ANCA (MPO) > C-ANCA (PR3)
      • Clinical findings: Lung and skin vasculitis, asthma, eosinophilia
27
Q

T/F: Renal limited vasculitis is usually associated with C-ANCA (PR3)

A
  • False, its usually associated with P-ANCA (MPO)
28
Q

What are the treatment guidelines for ANCA associated vasculitis?

A
  • Cytotoxic drugs
    • Cyclophosphamide
  • Corticosteroids
  • B-cell targeted therapies
    • Rituximab
  • Plasma exchange (plasmaphoresis)
    • Removes pathogenic autoantibodies

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