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Urology > Glomerulonephritis > Flashcards

Glomerulonephritis Flashcards

1
Q

How does blood enter the glomerulus via?

A

Afferent arteriole

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2
Q

How does blood leave the glomerulus?

A

Via efferent arteriole

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3
Q

What will not be filtered at the glomerulus?

A

All proteins equal to or larger than albumin

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4
Q

What are the 3 layers barrier of the glomerulus?

A

Endothelial cell cytoplasma
Basal lamina
Podocyte

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5
Q

What are mesagnial cells?

A

Group of cells which support the capillaries

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6
Q

What is glomerulonephritis?

A

Disease of glomerulus

Either inflammatory or non-inflammatory

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7
Q

What are the potential aetiologies of glomerulonephritis?

A 
Immunoglobulin deposition 
Non-immunoglobulin deposition 
Autoimmune 
Infection 
Malignancy 
Drugs
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8
Q

What are the 2 classifications of glomerulonephritis?

A

Proliferative

Non-proliferative

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9
Q

What is diffuse glomerulonephritis?

A

When >50% of glomerulus is affected

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10
Q

What is focal glomerulonephritis?

A

When <50 % affected

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11
Q

What is global glomerulonephritis?

A

When all glomeruli are affected

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12
Q

What is segmental glomerulonephritis?

A

When part of the glomerulus is affected

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13
Q

What is the common presentation of nephritic disease?

A

Haematura
Light proteinuria
Low urine volume
Hypertensive

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14
Q

What is the common presentation of nephrotic disease?

A

Heave proteinuria
Oedema
Hyperlipidaemia

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15
Q

What are the main causes of haematuria?

A

UTI
UT stone
UT tumour
Glomerulonephritis

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16
Q

What are the primary causes of nephritic disease?

A

Post streptococcal glomerulonephritis
IgA nephropathy
Crescentic glomerulonephritis

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17
Q

What are the primary causes of nephrotic snydrome

A

Minimal change syndrome
Focal and segmental glomerulosclerosis
Membramous nephropathy

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18
Q

What is the most common cause of glomerulonephritis in adults?

A

IgA nephritis

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19
Q

What are the clinical feature of IgA nephropathy?

A

Discolouration of urine
Microscopic haematuria
Nephritis syndrome
Urine culture and USS normal

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20
Q

What are the investigations for IgA nephritis

A

Urine culture
USS normal
Bloods
Renal biopsy

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21
Q

What is the pathology of IgA nephritis?

A

IgA deposits in mesangial matrix causing increased proliferation of mesangial cells
• more matrix is produced also
Excess IgA is sometimes presenting the serum
IgA becomes “stuck” in mesangium and becomes clogged with antibody

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22
Q

What is the prognosis for IgA nephritis?

A

Usually self limiting

However some do go on to develop chronic renal failure

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23
Q

What is membranous glomerulonephritis?

A

Nephrotic syndrome
Where there is abnormality of the glomerular filter
and a thickened glomerular basement membrane

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24
Q

What are the clinical features of membranous glomerulonephritis?

A 
Generally unwell 
Swollen legs 
Low serum albumin 
Heavy proteinuria
That of nephrotic syndrome
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25
Q

What causes membranous glomerulonephritis?

A

Abnormality of glomerular filter
Thickened basement membrane
Deposits of IgG
Stuck in membrane between basal lamina and podocyte

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26
Q

What is activated with deposition of IgG in membranous glomerulonephritis?

A

Complement C3

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27
Q

What is the action of Compliment C3 in glomerulonephritis?

A

Punches holes in filter
Allowing albumin to filter through
Makes membrane thick but leaky

28
Q

What is the prognosis of membranous glomerulonephritis?

A

1/4 progress to chronic renal failure

29
Q

What is the main cause of post-infective nephritis?

A

Post-streptococcal infection

30
Q

How quickly does post infective nephritis follow primary infection?

A

10-21 days

31
Q

What is the treatment for post-infective nephritis?

A

AB for infection
Loop diuretics
Vasodilator drugs

32
Q

Who is minimal change disease commonest in?

33
Q

How does minimal change disease present?

A

Sudden onset oedema

Complete loss of proteinuria with steroids

34
Q

What is the treatment for minimal change nephritis?

A

Steroids

Prednisolone

35
Q

What is the prognosis for minimal change nephritis?

A

Relapses but with good prognosis

36
Q

What is focal and segmental glomerulosclerosis?

A

Syndrome with multiple causes

37
Q

What is the presentation of focal and segmental glomerulosclerosis?

A

Nephrotic syndrome

38
Q

What is the treatment for focal and segmental glomerulosclerosis?

A

Cyclosporin - steroids

Cyclophosphamide and Rituximab

39
Q

What is the prognosis for focal and segmental glomerulosclerosis?

A

High change of progression to end stage kidney disease

40
Q

What is the key clinical feature of diabetic nephropathy?

A

Heavy proteinuria

41
Q

In IgA nephropathy why do blood cells get through but IgA doesnt?

42
Q

What is a main antigen present in membranous glomerulonephritis?

A

Phospholipase A2 receptor

43
Q

What is the prognosis for diabetic nephropathy?

A

Inevitable decline if poor diabetic control

If better diabetic control it wont get any better but wont get any worse either

44
Q

What is the pathology of diabetic nephropathy?

A

Glycated molecules
Deposit in the matrix and basal lamina
Thickened capillary walls which are leaking albumin

45
Q

Why are arterioles thickened in diabetic nephropathy?

A

Due to diabetes contributing to atherosclerosis

46
Q

What is granulomatosis with polyangitis a form of?

A

Vasculitis

47
Q

What is the prognosis of Wegener’s?

A

Fatal if left untreated

With immunosupression 75% complete remission

48
Q

What type of histological appearance is there with granulomatosis with polyangitis?

A

Crescentic

Cellular proliferation and influx of macrophages forming a crescent around glomerular tuft within Bowman’s space

49
Q

Give an example of a cause of crescentic glomerulonephritis?

A

Granulomatosis with polyangitis

50
Q

Where does granulomatosis with polyangitis affect?

A

Vessels
Kidney
Nose
Lungs

51
Q

What is crescentic glomerulonephritis?

A

Any glomerular disease characterised by extensive crescents as the principal histological finding
Rapid loss of renal function

52
Q

What are the clinical features of granulomatosis with polyangitis?

A 
Generally unwell 
Cough 
Raised creatinine
Serum has ANCA antibodies 
Rhinitis
53
Q

Which type of glomerulonephritis is ANCA seen?

A

Granulomatosis with polyangitis

54
Q

What should you check before taking a renal biopsy?

A

Clotting factors

55
Q

What are the key features of glomerulonephritis?

A

Haematuria
o Proteinuria
o Hypertension
o Renal insufficiency

56
Q

What are the types of haematuria?

A

Macroscopic

Microscopic

57
Q

Is haematuria more common in nephritic or nephrotic?

58
Q

What is hypertension classified as/

A

> 14/>80 mmHg

59
Q

Is hypertension more common in nephritic or nephrotic?

60
Q

What are key features of nephritic syndrome?

A

Hameaturia
Dysmorphic RBC
Hypertension

61
Q

What are key features of nephrotic syndrome?

A

Oedema
Proteinuria
Hypoalbuminaemia
Lipidaemia

62
Q

What could be a differential diagnosis for nephrotic disease?

A

Congestive HF

Hepatic Disease

63
Q

How is anti-GBM disease diagnosed?

A

By demonstrating anti-GBM antibodies in serum and kidney

64
Q

What is the treatment for anti-GBM disease?

A

Aggressive immunosuppresion

Steroids

65
Q

What is the treatment for membranous nephropathy?

A

Immunosuppression if symptomatic

Resolves spontaneously in 1/3

Urology (13 decks)

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