Glomerulonephritis Flashcards
Classification of glomerulonephritis
Proliferative
Non-proliferative
Appearance of glomerulus, tubules and interstitium in Non-proliferative glomerulonephritis
Glomeruli look normal or have areas of scarring. They have normal numbers of cells
Tubules and interstitium may be damaged
Appearance of glomerulus in proliferative glomerulonephritis
Excessive number of cells in glomeruli.
What extra cells are also present in proliferative glomerulonephritis
Leucocytes
4 types of Proliferative glomerulonephritis
Diffuse proliferative - post-infective nephritis
Focal proliferative - mesangial IgA disease
Focal necrotizing (crescentic) nephritis
Membrano-proliferative nephritis
Common presentation of diffuse proliferative glomerulonephritis
10-21 days after throat or skin infection
4 presentations of acute nephritis
Fluid retention with oedema Normal serum albumin Little proteinuria Hypertension Renal impairment (typical of post infection glomerulonephritis)
Seven year old boy brought to GP generally unwell, dark urine
Puffy face, no rashes no oedema, BP 125/80mm
Had had a sore throat 2 weeks previously
Possible diagnosis and what investigations?
Post infective glomerulonephritis
FBC, U&E (and creatinine), MSSU Microscopy and Urinalysis (dipstick)
Treatment of post-infective glomerulonephritis
Antibiotics for infection
Loop diuretics eg frusemide for oedema
Vasodilator drugs for hypertension
Consider immunosupression for severe disease
Most common cause glomerulonephritis
IgA Nephropathy
Presentation of IgA nephropathy
Typically occurs in the young Presents with MACROSCOPIC haematuria Provoked by intercurrent infection Usually not hypertensive No characteristic serology
How is IgA nephropathy diagnosed
Renal biopsy
14 year old boy presents to GP with bright red urine
No other urinary symptoms but concurrent URT infection
Physical examination including blood pressure normal
Urine dipstix showed blood++++, protein trace
Diagnosis and investigations?
IgA Nephropathy
FBC, U&E (and creatinine), MSSU Microscopy, renal Ultrasound, Urinalysis (dipstick) and RENAL BIOPSY (for diagnosis)
Prognosis of IgA nephropathy
Children - good
Adults- 1/4 develop renal failure (treated with ACE-I)
Clinical features of crescentic glomerulonephritis
Presents with rapidly progressive glomerulonephritis
May occur in isolation or complicate other diseases, e.g. chronic nephritis, vasculitis
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3 causes of Focal Necrotizing (Crescentic) Glomerulonephritis
- Anti-glomerular basement membrane antibodies
- Associated with systemic vasculitis eg Wegener’s Granulomatosis
- As a complication of another type of glomerulonephritis eg mesangial IgA disease
What causes goodpastures disease
Anti-glomerular basement membrane antibodies
Presentation, diagnosis and treatment of Goodpastures disease
Presents as nephritis with or without lung haemorrhage
Diagnosed by demonstrating anti-GBM antibodies in serum and kidney
Treated by plasma exchange and immunosupression
Management and prognosis of Crescentic glomerulonephritis
Immunosuppression (prednisolone)
Plasma exchange
Prognosis is good if treatment is started early enough
57 year old woman presents to GP with three month history of increasing tiredness, anorexia and weight loss
Over past 2 weeks she developed cough with haemoptysis
Physical examination revealed a rash on both ankles and lower legs, and bilateral basal crepitations: BP 150/85
Urine dipstix: protein+++ and blood++
Diagnosis, investigations and treatment
Focal necrotizing glomerulonephritis secondary to systemic vasculitis
Anti-neutrophil cytoplasmic antibodies positive, Urinalysis (dipstick)
RENAL BIOPSY
Immunosuppression (prednisolone)
Summary of Proliferative glomerulonephritis
Presents with nephritic syndrome
Blood on dipstix – none or minimal proteinuria
Can be medical emergency with crescentic glomerulonephritis
What causes nephrotic syndrome
Non-proliferative Glomerulonephritis
Clinical triad of nephrotic syndrome
Pitting Oedma
Proteinuria (>5 G)
Hypoalbuminaemia (<30 G/litre: normal >45)
Definition of nephrotic syndrome
A clinical syndrome in which severe oedema is caused by hypoalbuminia due to loss of protein in the urine.
Management of nephrotic syndrome
Specific management
Treatment oedema
Prophylaxis against complications
What is meant by specific management of nephrotic syndrome
- Make specific diagnosis, e.g. by renal biopsy
- Specific treatment when indicated
- Consider Rx with prednisolone if severe.
Presentation of minimal change nephrotic syndrome
Sudden onset of oedema - days
Proteinuria
2/3 of patients relapsed
Treatment of minimal change nephrotic syndrome
Prednisolone
Complete loss of proteinuria with steroids
Prognosis of minimal change nephrotic syndrome
Good
22 year old woman presentes with severe oedema which developed suddenly over a week Breathless with left sided chest pain she also had colicky abdominal pain urine contained ++++ protein Diagnosis, investigations and treatment
Minimal change nephrotic syndrome U&E's (and creatinine ), FBC, Serum albumin, Haemoglobin, Fibrinogen, Cholesterol, Urinalysis (dipstick) and RENAL BIOPSY Immediate management: Diuretics Fluid/salt restriction Pencillin Heparin prophylaxis Daily Weights
Clinical feature of focal glomerulosclerosis
Severe nephrotic syndrome (especially in men in their fourth decade)
Symptoms very disabling.
At best an incomplete response to steroids
Progresses to renal failure over 2-3 years.
Can recur in renal transplants
Focal glomerulosclerosis AKA
Steroid resistant nephrotic syndrome
Treatment of focal glomerulosclerosis
Initial trial of steroids
Continue steroids if clinically useful response
Cyclosporin if steroids fail
Prognosis of focal glomerulosclerosis
If responds completely to steroids the prognosis is the same as minimal change
If not poor prognosis
Clinical features of Membranous nephropathy
Commonest cause of nephrotic syndrome in adults
Half of cases are Idiopathic other half are related to other diseases eg Systemic Lupus Erthymetasous (SLE)
Management of membranous nephropathy
Control nephrotic symptoms
Immunosupression if deteriorating renal function (Prednisolone)
Prognosis for membranous nephropathy
Resolves spontaneously in 25% over 5-10 years
Prognosis good in treated patients whose proteinuria resolves
About 25% are on dialysis at 10 years
66 year old man presents with steadily increasing oedema
Recent change in bowel habit
Proteinuria ++++
Diagnosis and investigations
Membranous Nephropathy
U&E’s (and creatinine), FBC, Urinalysis (dipstick), RENAL BIOPSY
Summary of glomerulonephritis
- Glomerulonephritis is an important cause of end stage renal disease
- Different types of glomerulonephritis present in different ways and differ in prognosis
- Precise diagnosis depends on renal biopsy and the results influence management
