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Phase 2 - General Medicine > Glomerulonephritis > Flashcards

Glomerulonephritis Flashcards

1
Q

What is Glomerulonephritis?

A

Inflammation of the glomerulus or nephron which presents with or without urine sediments

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2
Q

What are the presentations of Glomerulonephritis?

A

AKI (all symptoms)
Proteinuria
Haematuria
Compensatory Hypertension

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3
Q

What are the main types of Glomerulonephritis?

A

Focal Segmental
Membranous
Minimal Change

all tend to present as nephrotic syndrome

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4
Q

What is Minimal Change Glomerulonephritis?

Treatment?

A

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

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5
Q

What is Membranous Glomerulonephritis?

Treatment?

A

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

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6
Q

What is Focal Segmental Glomerulonephritis?

How do you treat it?

A

Most common adult cause
Get changes in less than 50% of the glomerulus
Causes ESRF

Poor response to steroids

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7
Q

How do you investigate GN?

A

Bloods - albumin, FBC, LFTs, Igs, autoantibodies, glucose, U+Es

BP

Urine Dipstick - glucose, protein, blood

Renal Biopsy!

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8
Q

What is nephrotic syndrome?

A

Proteinuria >3.5g
Oedema
Hypoalbuminaemia (+Hypercholesterolaemia)

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9
Q

What is nephritic syndrome?

A

Proteinuria <3.5g
Haematuria
Due to podocyte damage
Tend to get higher BP than nephrotic syndrome and worse eGFR

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10
Q

What are the main risk factors for Glomerulonephritis?

A

Male
Smoker
Age
Diabetic

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11
Q

What are the glomerular changes in diabetes?

A

Kimmel Stein deposits in the glomerulus

Bright pink, large deposits

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12
Q

What are the main causes of a nephritic presentation?

A

IgA nephropathy
Goodpastures
Alports
Vasculitis (Wegeners)

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13
Q

What organs are affected by Alport’s disease?

A

Ears

Kidneys

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14
Q

What is Alport disease?

A

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

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15
Q

What is Goodpasture’s disease?

A

Anti-GBM IgG antibodies are produced which attack and damage the basement membrane
Cause nephritic presentation

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16
Q

What organs are affected in Goodpasture’s disease?

A

Lungs - pulmonary hemorrhages in smokers

Kidneys

17
Q

What are the changes in Vasculitis?

A

Inflammation of the blood vessels causing destruction and haemorrhage

18
Q

What is Henoch Schonlein Purpura?

A

A vasculitis caused by IgA nephropathy
Has a characteristic purpuric rash down the back and thighs
Presents in young males

19
Q

Why does protein leak into the urine? (why not normally?)

A

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.

20
Q

What is IgA nephropathy?

How do you treat it?

A

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)

21
Q

Which Glomerulonephritis’ progress rapidly?

A

Goodpastures
Necrotising GN
Vasculitis
(Haemolytic Uraemic Syndrome)

22
Q

What is Haemolytic Uraemic Syndrome?

A

Often in Kids
Haemolytic Anaemia
Thrombocytopenia
Nephropathy

23
Q

What conditions are linked with Focal Segmental Glomerulonephritis?
(2)

A

HIV

Obesity

24
Q

What can membranous Glomerulonephritis be secondary to?

A

Malignancy - Lymphoma

Hepatitis

25
Q

Symptoms of Nephrotic Syndrome?

A

Flash and Facial Oedema (Periorbital)
SOB - pulmonary oedema
Frothy Urine
AKI

26
Q

Complications of Proteinurea?

A

Thromboembolism - loss of protein C and S lead to a hypercoagulable state
Pulmonary Oedema

27
Q

Treating Nephrotic Syndrome?

A

Oedema - loop diuretics, ACE-i/ARB (also help reduce protein loss)

Immunosuppression - steroids

BP and CVS risk - statins, aspirin (anti-platelet), low Na+ diet

28
Q

Which organs does vasculitis tend to affect?

A

ELK
ENT (Upper airways)
Lungs
Kidneys

29
Q

What are secondary causes of a Nephrotic presentation?

A 
Diabetes
Amyloidosis
Malignancy
Drugs - Lithium, NSAIDS, COX2i
Infection - Hep B and C
Autoimmune - RA, SLE, Grave's

Phase 2 - General Medicine (6 decks)

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