Glomerulonephritis Flashcards
a disease of the renal parenchyma is a disease of the…
kidney itself
most common cause of end stage renal failure?
diabetes
2nd most common cause of end stage renal failure?
chronic glomerulonephritis
define GN
immune-mediated disease of the kidneys affecting the glomeruli
what immune cells drives the immunological disease in GN?
antibodies
T cells
describe the role of immune complexes in GN?
antibody binds to antigen and deposits in the kidney
what lines the outside of the glomerulus?
bowmans capsule
what does the bowmans’ space contain?
the tubular fluid
podocytes are present in the glomerulus T or F
T
why do you get leakage of substances in GN?
there is a disruption to the glomerular capillary wall
what would be found on urinalysis of GN?
haematuria
proteinuria (due to wall damage)
damage to podocytes leads to what kind of lesion?
non-proliferative
damage to endothelial and mesangial cells lead to what kind of lesion?
proliferative
a proliferative lesion will lead to ___ on urinalysis
haematuria
a non-proliferative lesion will lead to ___ on urinalysis
proteinuria
what happens to podocytes when they are damaged?
undergo atrophy
normal creatinine along with blood and protein in urine indicates damage to what kind of glomerular cell?
mesangium
consequence of endothelial cell damage in the glomerulus?
vasculitis
name the 3 types of cell in the glomerulus?
endothelial
mesangial
podocyte
what would be found on urine microscopy of GN?
dysmorphic RBCs
granular casts
lipiduria
what kind of urine cast does GN present with?
granular
how is the level of proteinuria quantified in GN?
urine:creatinine ratio
24hr urine test
painless macroscopic haematuria suggests…
infection - immune cells are at work
30 to __ mg of protein in the blood is classed as microalbuminuria
300
how many grams of protein per day in urine equate to nephrotic syndrome?
> 3g
how can you tell the lesion is in the glomerulus from looking at RBCs?
if they are dysmorphic they are from the glomerulus
how much urine is passed per hr in nephritic syndrome?
<30ml per hr
why do you get hypertension in nephritic syndrome?
retaining fluid by not peeing
pt presents with acute renal failure, oliguria, oedema and HT….
nephritic syndrome
why do you get oedema in nephrotic syndrome?
lost so much albumin you lose your oncotic pressure so fluid leaks into the subcut tissues
what glomerular cells does nephritic syndrome affect and what process would this therefore cause?
endothelial cells; proliferative
pt presents with high proteinuria, oedema, hypercholestererolaemia and normal renal function tests…
nephrotic syndrome
why can you get thrombosis and PEs as complications of nephrotic syndrome?
liver makes clotting factors and are putting lots of pressure on it
what glomerular cells does nephrotic syndrome affect and what process would this cause?
podocytes, non-proliferative
if the glomerulus isnt affected, what would not be present in the urine?
RBCs
albumin
primary cause of GN?
idiopathic
secondary causes of GN?
infection drugs malignancy vasculitis lupus
how should GN be investigated?
- renal biopsy (use light microscopy/immunofluorescence/electron microscope)
if a glomerular lesion is described as “focal what does this mean?
<50% of the glomeruli are affected
if a glomerular lesion is described as “diffuse” what does this mean?
> 50% of the glomeruli are affected
if a glomerular lesion is described as global what does this mean?
all of the glomerulus is affected
if a glomerular lesion is described as segmental what does this mean?
part of the glomerulus is affected
main aims of treatment for GN?
reduce proteinuria
stop nephrotic syndrome
preserve renal function
4 non immunosuppresive drugs involved in the Tx of GN?
antihypertensives
ACEi
diuretic
statin
target BP for non-proteinuria GN patients?
<130/80
target BP for proteinuria GN patients?
<120/80
why is immunosuppression the mainstay of GN Tx?
an immune process is the cause of it
what drugs are used for immunosuppression in GN
prednisolone PO
azathioprine
cyclophosphamide
calcineurin inhibitors
what treatment is good for vasculitis as a result of endothelial cell damage?
plasmapharesis
why are calcineurin inhibitors used?
it activates T cells so drugs can stop this
what should you give if a patient with nephrotic syndrome is volume deplete?
IV albumin
Tx of nephrotic patients?
diuretics salt restriction fluid restriction ACEi IV albumin (only if vol deplete)
when is a nephrotic patient said to be in remission?
when their proteinuria is <300mg/day
risks of immunosuppressing a nephrotic patient?
infection (already more prone)
a GN that is normal on microscopy will be in what category of GN?
minimal change nephropathy
name the 5 types of primary GN?
minimal change FSGS membranous membranoproliferative IgA nephropathy
commonest cause of nephrotic syndrome in children?
minimal change nephropathy
what does renal biopsy look like in minimal change nephropathy?
normal
Tx of minimal change nephropathy?
- oral steroid
2. cyclophosphamide
commonest cause of nephrotic syndrome in adults WORLDWIDE?
focal segmental glomerulosclerosis (FSGS)
secondary causes of FSGS?
HIV
heroin use
obesity
reflux nephropathy
is primary or secondary FSGS more common?
primary ++
appearance of FSGS on renal biopsy?
get focal sclerosis- minimal antibody/complement deposition
most common cause of nephrotic syndrome in the UK in adults?
membranous nephropathy
appearance of membranous nephropathy on renal biopsy? what immune cells cause this?
subepithelial immune complex deposition in the basement membrane
are you more likely to progress to ESRF in 10 yrs if you have FSGS or membranous nephropathy?
FSGS
Tx of membranous nephropathy?
steroids
b cell monoclonal Ab
alkylating agents eg cyclophosphamide
what type of antibody is present in most cases of membranous nephropathy?
anti PLA2r antibody
what stain is used to see thickened basement membranes? what condition would this be good for?
silver stain; membranous nephropathy
commonest type of GN in the world?
IgA nephropathy
patient with macroscopic haematuria after a resp/gi infection…
IgA nephropathy
IgA nephropathy is associated with what derm condition?
henoch schonlein purpura
what types of cells are affected in IgA nephropathy?
mesangial
signs of IgA nephropathy?
micro/macro haematuria with AKI or CKD
have henoch schonlein purpura
Tx of IgA nephropathy?
BP control
ACEi
fish oil
immunofluorescence of IgA nephropathy would show…
IgA immune complex deposits in the mesangium
what stain should be used to look for cell proliferation and expansion
H + E stain
what does RPGN stand for when discussing neuropathy?
rapidly progressive glomerulonephritis
pathophysiology of ANCA vasculitis?
plasma cell makes ANCA
binds to neutrophil
makes proteolytic enzymes
burst through the blood vessel wall
characteristic appearance of RPGN on biopsy?
glomerular crescents present
RPGN causes slow deterioration of renal function T or F
F, causes rapid deterioration
how can you tell apart a normal glomerulus from an abnormal one just by appearance?
normal should have white parts in it
what is goodpasture’s syndrome?
“pulmonary-renal syndrome”
Tx of RPGN?
rapid immunosuppression - steroids, cyclophosphamide
dialysis if needed
