Glomerulonephritis Flashcards
What is Glomerulonephritis?
Inflammation of the glomerulus or nephron which presents with or without urine sediments
What are the presentations of Glomerulonephritis?
AKI (all symptoms)
Proteinuria
Haematuria
Compensatory Hypertension
What are the main types of Glomerulonephritis?
Focal Segmental
Membranous
Minimal Change
all tend to present as nephrotic syndrome
What is Minimal Change Glomerulonephritis?
Treatment?
Only visible on Electron Microscopy
In children most commonly
Effacement of the podocytes
Responds to steroids
If relapses a lot then can give calcineurin inhibitor or cyclophosphamide
What is Membranous Glomerulonephritis?
Treatment?
More often adults
IgG and protein deposits in the glomerulus, thickens the BM
Can be seen under light microscopy
Doesn’t respond well to steroids but can try them
1/3 better, 1/3 same, 1/3 progress to renal failure
What is Focal Segmental Glomerulonephritis?
How do you treat it?
Most common adult cause
Get changes in less than 50% of the glomerulus
Causes ESRF
Poor response to steroids
How do you investigate GN?
Bloods - albumin, FBC, LFTs, Igs, autoantibodies, glucose, U+Es
BP
Urine Dipstick - glucose, protein, blood
Renal Biopsy!
What is nephrotic syndrome?
Proteinuria >3.5g
Oedema
Hypoalbuminaemia (+Hypercholesterolaemia)
What is nephritic syndrome?
Proteinuria <3.5g
Haematuria
Due to podocyte damage
Tend to get higher BP than nephrotic syndrome and worse eGFR
What are the main risk factors for Glomerulonephritis?
Male
Smoker
Age
Diabetic
What are the glomerular changes in diabetes?
Kimmel Stein deposits in the glomerulus
Bright pink, large deposits
What are the main causes of a nephritic presentation?
IgA nephropathy
Goodpastures
Alports
Vasculitis (Wegeners)
What organs are affected by Alport’s disease?
Ears
Kidneys
What is Alport disease?
A X linked mutation
leading to a defect in collagen type IV
Leads to a split/laminated basement membrane and hearing loss
Causes Renal Failure
What is Goodpasture’s disease?
Anti-GBM IgG antibodies are produced which attack and damage the basement membrane
Cause nephritic presentation
What organs are affected in Goodpasture’s disease?
Lungs - pulmonary hemorrhages in smokers
Kidneys
What are the changes in Vasculitis?
Inflammation of the blood vessels causing destruction and haemorrhage
What is Henoch Schonlein Purpura?
A vasculitis caused by IgA nephropathy
Has a characteristic purpuric rash down the back and thighs
Presents in young males
Why does protein leak into the urine? (why not normally?)
Damage to the basement membrane make gaps wider so larger proteins can go through the gaps.
The damage also means the membrane has less of a negative charge which usually repels the proteins.
What is IgA nephropathy?
How do you treat it?
Deposits of IgA antibodies in the mesangium of the glomerulus
Episodic
Tend to be well between episodes
Young males get episodes of haematuria
Control the BP to treat (immunosuppress if nephritic)
Which Glomerulonephritis’ progress rapidly?
Goodpastures
Necrotising GN
Vasculitis
(Haemolytic Uraemic Syndrome)
What is Haemolytic Uraemic Syndrome?
Often in Kids
Haemolytic Anaemia
Thrombocytopenia
Nephropathy
What conditions are linked with Focal Segmental Glomerulonephritis?
(2)
HIV
Obesity
What can membranous Glomerulonephritis be secondary to?
Malignancy - Lymphoma
Hepatitis
Symptoms of Nephrotic Syndrome?
Flash and Facial Oedema (Periorbital)
SOB - pulmonary oedema
Frothy Urine
AKI
Complications of Proteinurea?
Thromboembolism - loss of protein C and S lead to a hypercoagulable state
Pulmonary Oedema
Treating Nephrotic Syndrome?
Oedema - loop diuretics, ACE-i/ARB (also help reduce protein loss)
Immunosuppression - steroids
BP and CVS risk - statins, aspirin (anti-platelet), low Na+ diet
Which organs does vasculitis tend to affect?
ELK
ENT (Upper airways)
Lungs
Kidneys
What are secondary causes of a Nephrotic presentation?
Diabetes Amyloidosis Malignancy Drugs - Lithium, NSAIDS, COX2i Infection - Hep B and C Autoimmune - RA, SLE, Grave's
