Glomerulonephritis Flashcards
What is it
Immune mediated inflammation of the glomeruli
Types of primary
Minimal change IgA nephropathy (Berger's disease) Focal segmental glomerulosclerosis Membranous Membranoproliferative
Causes of secondary
Malignancy
Infection/drugs
Systemic disease
Which type of nephropathy is most common
IgA nephropathy
IgA nephropathy is preceded by what
Resp or GI infection
IgA nephropathy associated with which systemic condition
HSP
Describe HSP
Purpuric rash on extensor surfaces (particularly buttocks/back of legs), polyarthritis, colitis
Seen on biopsy of IgA nephropathy
Mesangial cell proliferation
IgA deposits
Presentation of IgA nephropathy
Haematuria
Proteinuria
Hypertension
1st line treatment of IgA nephropathy
Ciclosporin
What cells are damaged in minimal change nephropathy
Podocytes
What cells mediate minimal change nephropathy
T cells
What is seen on electron microscopy of minimal change nephropathy
Foot process fusion
Most common cause of nephrotic syndrome in children
Minimal change nephropathy
Signs of nephrotic syndrome
Proteinuria (>3g/24hr) Hypoalbuminaemia (>30g/L)
Odema (Sodium retention)
Hypercholesterolaemia
Hypertriglycerideaemia
1st line treatment of minimal change nephropathy
Prednisolone 60mg orally
2nd line treatment of minimal change nephropathy not responsive to steroids
Cyclophosphamide
Commonest cause of nephrotic syndrome in adults
Focal segmental glomeruloscerolis
What is focal segmental glomerulosclerosis associated with
HIV
Obesity
Heroin
50% of patients progress to ESFR in which type of glomerulonephritis
Focal segmental glomerulosclerosis
Treatment of focal segmental glomerulosclerosis
Prolonged steroids
What is seen on biopsy of membranous nephropathy
Sub-epithelial immune complex deposition in the basement membrane- ‘spike + dome’ appearance
Antibody seen in 70% of patients with membranous nephropathy
anti-PLA2r
What is membranous nephropathy associated with
SLE Hep B Hodgkins lymphoma Gold Penicillamine
Treatment of membranous nephropathy
Steroids
B cell monoclonal antibodies
Alkylating agents
Urinary sediments in rapid progressive glomerulonephritis
RBCs
RBC + granular casts
What is seen in biopsy of rapid progressive glomerulonephritis
Cresents affecting glomeruli
Haemoptysis + rapidly progressive glomerulonephritis suggests which autoimmune disease
Goodpastures disease
Anti-body present in good pastures disease
Anti-GBM
Anti-dsDNA present in blood suggests which disease is causing glomerulonephritis
SLE
ANCA positive immune diseases that cause rapidly progressive GN
GPA (cANCA)
EGPA (pANCA)
1st line treatment of rapidly progressive GN
Immunosuppression with high dose corticosteroids
Cyclophosphamide
Plasmapheresis
Which types of glomerulonephritis present with nephrotic syndrome
Minimal Change
Focal segmental
Membranous
Treatment of nephrotic syndrome
Fluid+ Salt restriction Thiazide diuretic followed by furosemide if unresponsive ACEi/ARB Anti-coagulation Statin for hypercholesterolaemia IV albumin if volume deplete
