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Urinary > Glomerulonephritis > Flashcards

Glomerulonephritis Flashcards

1
Q

Classification of glomerulonephritis

A

Proliferative

Non-proliferative

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2
Q

Appearance of glomerulus, tubules and interstitium in Non-proliferative glomerulonephritis

A

Glomeruli look normal or have areas of scarring. They have normal numbers of cells
Tubules and interstitium may be damaged

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3
Q

Appearance of glomerulus in proliferative glomerulonephritis

A

Excessive number of cells in glomeruli.

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4
Q

What extra cells are also present in proliferative glomerulonephritis

A

Leucocytes

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5
Q

4 types of Proliferative glomerulonephritis

A

Diffuse proliferative - post-infective nephritis
Focal proliferative - mesangial IgA disease
Focal necrotizing (crescentic) nephritis
Membrano-proliferative nephritis

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6
Q

Common presentation of diffuse proliferative glomerulonephritis

A

10-21 days after throat or skin infection

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7
Q

4 presentations of acute nephritis

A 
Fluid retention with oedema
Normal serum albumin
Little proteinuria
Hypertension
Renal impairment
(typical of post infection glomerulonephritis)
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8
Q

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?

A

Post infective glomerulonephritis

FBC, U&E (and creatinine), MSSU Microscopy and Urinalysis (dipstick)

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9
Q

Treatment of post-infective glomerulonephritis

A

Antibiotics for infection
Loop diuretics eg frusemide for oedema
Vasodilator drugs for hypertension
Consider immunosupression for severe disease

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10
Q

Most common cause glomerulonephritis

A

IgA Nephropathy

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11
Q

Presentation of IgA nephropathy

A 
Typically occurs in the young
Presents with MACROSCOPIC haematuria
Provoked by intercurrent infection
Usually not hypertensive
No characteristic serology
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12
Q

How is IgA nephropathy diagnosed

A

Renal biopsy

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13
Q

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?

A

IgA Nephropathy

FBC, U&E (and creatinine), MSSU Microscopy, renal Ultrasound, Urinalysis (dipstick) and RENAL BIOPSY (for diagnosis)

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14
Q

Prognosis of IgA nephropathy

A

Children - good

Adults- 1/4 develop renal failure (treated with ACE-I)

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15
Q

Clinical features of crescentic glomerulonephritis

A

Presents with rapidly progressive glomerulonephritis
May occur in isolation or complicate other diseases, e.g. chronic nephritis, vasculitis
IT IS A MEDICAL EMERGENCY

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16
Q

3 causes of Focal Necrotizing (Crescentic) Glomerulonephritis

A
  1. Anti-glomerular basement membrane antibodies
  2. Associated with systemic vasculitis eg Wegener’s Granulomatosis
  3. As a complication of another type of glomerulonephritis eg mesangial IgA disease
17
Q

What causes goodpastures disease

A

Anti-glomerular basement membrane antibodies

18
Q

Presentation, diagnosis and treatment of Goodpastures disease

A

Presents as nephritis with or without lung haemorrhage
Diagnosed by demonstrating anti-GBM antibodies in serum and kidney
Treated by plasma exchange and immunosupression

19
Q

Management and prognosis of Crescentic glomerulonephritis

A

Immunosuppression (prednisolone)
Plasma exchange
Prognosis is good if treatment is started early enough

20
Q

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

A

Focal necrotizing glomerulonephritis secondary to systemic vasculitis
Anti-neutrophil cytoplasmic antibodies positive, Urinalysis (dipstick)
RENAL BIOPSY
Immunosuppression (prednisolone)

21
Q

Summary of Proliferative glomerulonephritis

A

Presents with nephritic syndrome
Blood on dipstix – none or minimal proteinuria
Can be medical emergency with crescentic glomerulonephritis

22
Q

What causes nephrotic syndrome

A

Non-proliferative Glomerulonephritis

23
Q

Clinical triad of nephrotic syndrome

A

Pitting Oedma
Proteinuria (>5 G)
Hypoalbuminaemia (<30 G/litre: normal >45)

24
Q

Definition of nephrotic syndrome

A

A clinical syndrome in which severe oedema is caused by hypoalbuminia due to loss of protein in the urine.

25
Q

Management of nephrotic syndrome

A

Specific management
Treatment oedema
Prophylaxis against complications

26
Q

What is meant by specific management of nephrotic syndrome

A
  1. Make specific diagnosis, e.g. by renal biopsy
  2. Specific treatment when indicated
  3. Consider Rx with prednisolone if severe.
27
Q

Presentation of minimal change nephrotic syndrome

A

Sudden onset of oedema - days
Proteinuria
2/3 of patients relapsed

28
Q

Treatment of minimal change nephrotic syndrome

A

Prednisolone

Complete loss of proteinuria with steroids

29
Q

Prognosis of minimal change nephrotic syndrome

A

Good

30
Q 
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
A 
Minimal change nephrotic syndrome 
U&amp;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
31
Q

Clinical feature of focal glomerulosclerosis

A

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

32
Q

Focal glomerulosclerosis AKA

A

Steroid resistant nephrotic syndrome

33
Q

Treatment of focal glomerulosclerosis

A

Initial trial of steroids
Continue steroids if clinically useful response
Cyclosporin if steroids fail

34
Q

Prognosis of focal glomerulosclerosis

A

If responds completely to steroids the prognosis is the same as minimal change
If not poor prognosis

35
Q

Clinical features of Membranous nephropathy

A

Commonest cause of nephrotic syndrome in adults

Half of cases are Idiopathic other half are related to other diseases eg Systemic Lupus Erthymetasous (SLE)

36
Q

Management of membranous nephropathy

A

Control nephrotic symptoms

Immunosupression if deteriorating renal function (Prednisolone)

37
Q

Prognosis for membranous nephropathy

A

Resolves spontaneously in 25% over 5-10 years
Prognosis good in treated patients whose proteinuria resolves
About 25% are on dialysis at 10 years

38
Q

66 year old man presents with steadily increasing oedema
Recent change in bowel habit
Proteinuria ++++
Diagnosis and investigations

A

Membranous Nephropathy

U&E’s (and creatinine), FBC, Urinalysis (dipstick), RENAL BIOPSY

39
Q

Summary of glomerulonephritis

A
  1. Glomerulonephritis is an important cause of end stage renal disease
  2. Different types of glomerulonephritis present in different ways and differ in prognosis
  3. Precise diagnosis depends on renal biopsy and the results influence management

Urinary (19 decks)

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