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Renal > Glomerulonephritis > Flashcards

Glomerulonephritis Flashcards

1
Q

What is Glomerulonephritis?

A

inflammation of glomeruli in kidney

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2
Q

what is the filter barrier in the glomerulus made up of?

A

endothelial cell cytoplasm

basal lamina

podocyte

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3
Q

what are mesangial cells?

A

‘tree-like’ group of cells which support capillaries

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4
Q

Outline the classification of glomerulonephritis

A

Primary - only kidneys involved

Secondary- kidneys involved as part of disease affecting other parts of body

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5
Q

in glomerulonephritis, what is the most likely presentation of haematuria?

A

microscopic

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6
Q

Ix for glomerulonephritis?

A
  • Bloods
    • ​renal profile
    • blood film
    • ABG- metabolic acidosis
    • C3&C4- low
    • antibodies
      • ANA
      • C & P ANCA
      • Anti-GBM
      • ASO titres
  • Urine
    • ​24hr urine collection
    • urine dipstick
    • urine MC&S
    • protein & Cr clearance
  • Imaging
    • ​Renal tract USS
  • Histology
    • ​renal biopsy
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7
Q

Outline features of Nephritic Syndrome

A

Proteinuria (none or minimal)

Haematuria

Azotaemia

Red cell casts

Anti-strepsolysin O titres

Oliguria

Hypertension​

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8
Q

what are the features of nephrotic syndrome?

A
  • oedema
  • proteinuria
  • hypoalbuminaemia
  • hyperlipidaemia
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9
Q

what are the 2 main categories of glomerulonephritis and what is their definition?

A
  • proliferative - excessive numbers of cells in glomeruli
  • non-prolfierative - glomeruli look normal or have areas of scarring. Normal numbers of cells.
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10
Q

What are the types of proliferative glomerulonephritis? (4 categories and 2 subtypes)

A
  • IgA nephropathy
  • Rapidly Progressive (crescentic) Glomerulonephritis
  • Granulomatosis w Polyangiitis
  • Microscopic polyangiitis
  • Goodpasture’s syndrome
  • Mesangio-capillary glomerulonephritis
  • Post-infective glomerulonephritis
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11
Q

how does proliferative glomerulonephritis usually present? ie nephrotic or nephritic

A

NEPHRITIC syndrome

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12
Q

describe IgA nephropathy ie:

  • epidemiology
  • histology
  • prognosis
A
  • most common cause of primary GN
  • peak age= 20s
  • on histology
    • IgA deposits & glomerular mesangial proliferation
  • self-limiting but ACEI significantly improve outcome
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13
Q

when does IgA nephropathy typically develop?

A

After an infection (soon after- maybe 2-3days ago) parituclarly URTI/GI, as levels of IgA in blood will be elevated

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14
Q

Describe post infective glomerulonephritis

A

aka diffuse proliferating GN

  • occurs 1-3weeks post strep infection
  • haematuria –> smoky urine
  • mild HT
  • raised ASOT
  • Rx= supportive
  • resolves over 6-8weeks
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15
Q

what group of bacteria trigger post infective glomeurlonephritis ?

A

mainly group A streptococci ie strep pyogenes

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16
Q

Pathology + Aetiology of Mesangio-capillary glomerulonephritis

A

Pathology:

subendothelial deposition of immune complexes –> mesangium AND basement membrane thickened

this is a crossover between nephrotic AND nephritic picture!!

Aetiology:

Hep C

Hep B

17
Q

Describe Rapidly Progressive (crescentic) glomerulonephritis

A

NOT a type of GN- it is a histological description

  • v acute illness w sick patients
  • medical emergency- rapidly progresses to esrf
  • responds well to Rx if started early enough
  • occurs due to
    • goodpastures syndrome
    • wegeners or MP
    • complication of other types of GN
18
Q

what is Wegener’s granulomatosis?

A

a form of vasculitis affecting the lungs, kidneys and nose

19
Q

how does Wegener’s present?

A

nasal sniffles, penumonia like symptoms and acute renal failure

20
Q

what could be done to test for Wegener’s?

A

ANCA - c-ANCA positive in most cases

21
Q

What is treatment for Wegener’s?

A

Cyclophosphamide

22
Q

What is microscopic polyangitis?

A

a small vessel vasculitis affecting any organ system

23
Q

what test could be done to test for microscopic polyangitis?

A

ANCA - P-ANCA positive in most cases

24
Q

What is Goodpasture’s Syndrome caused by?

A
  • circulating anti-GBM (glomerular basement membrane) antibodies, that attack glomerulus & pulmonary basement membranes
  • this causes glomerulonephritis & pulmonary haemorrhage
    • will present as haematuria + haemoptysis
25
Q

if no haemoptysis, but only renal failure, what would it be called?

A

anti-GBM glomerulonephritis

26
Q

What is treatment of Good pastures Syndrome?

A

Plasma exchange + immunosuppression

27
Q

What are the 3 types of non-proliferative glomerulonephritis?

A
  • minimal change disease
  • focal and segmental glomerulosclerosis
  • membranous nephropathy
28
Q

how do non-proliferative glomerulonephritis usually present?

A

nephrotic syndrome

29
Q

outline some other causes of nephrotic syndrome, other than glomerulonephritis

A
  • amyloid
  • long-standing DM
  • SLE
30
Q

what is the general Mx of nephrotic syndrome?

A
  • oedema - salt and fluid restriction + loop diuretics
  • proteinuria- ACEI
  • hyperlipidaemia- Statins
31
Q

Describe minimal change glomerulonephritis

A
  • mainly in kids
  • responds to steroids
  • idiopathic usually
32
Q

Epi and aetiology of Focal & Segmental Glomerulosclerosis

A

epi: most common cause of nephrotic syndrome in adults
aetiology: Heroin, HIV, Pamidronate

33
Q

what is treatment for Focal & Segmental Glomerulosclerosis?

A
  • general measures
  • trial steroids BUT often steroid resistant
    • alternatively: immunosuppression
  • if creatinine still rising, transplant
34
Q

epidemiology of membranous nephropathy

A
  • most common type of GN overall
  • bimodal age peak : 20s and 60s
35
Q

What causes membranous nephropathy? ie pathology

A
  • IgG deposits on BM
  • this results in complement activation against glomerular basement membrane
  • complement ‘punches holes’ in basement membrane
  • leaky filter= nephrotic syndrome
36
Q

aetiology of membranous nephropathy

A
  • mostly idiopathic
  • some occur secondary to other causes:
    • lupus
    • malignancy
      • lung, colon, haematological
    • hep B/C
    • RA
    • drugs
37
Q

What is seen on immunofluorescence in membranous nephropathy?

A

spikes around deposits

38
Q

what investigation could be done for membranous nephropathy?

A

Anti-phospholipase A2 receptor antibody positive typically

39
Q

what is treatment for membranous nephropathy?

A
  • steroids
  • immunosuppression if persistent symptomatic

Renal (20 decks)

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