Glomerulonephritis Flashcards
What is Glomerulonephritis?
inflammation of glomeruli in kidney
what is the filter barrier in the glomerulus made up of?
endothelial cell cytoplasm
basal lamina
podocyte
what are mesangial cells?
‘tree-like’ group of cells which support capillaries
Outline the classification of glomerulonephritis
Primary - only kidneys involved
Secondary- kidneys involved as part of disease affecting other parts of body
in glomerulonephritis, what is the most likely presentation of haematuria?
microscopic
Ix for glomerulonephritis?
-
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
Outline features of Nephritic Syndrome
Proteinuria (none or minimal)
Haematuria
Azotaemia
Red cell casts
Anti-strepsolysin O titres
Oliguria
Hypertension
what are the features of nephrotic syndrome?
- oedema
- proteinuria
- hypoalbuminaemia
- hyperlipidaemia
what are the 2 main categories of glomerulonephritis and what is their definition?
- proliferative - excessive numbers of cells in glomeruli
- non-prolfierative - glomeruli look normal or have areas of scarring. Normal numbers of cells.
What are the types of proliferative glomerulonephritis? (4 categories and 2 subtypes)
- IgA nephropathy
- Rapidly Progressive (crescentic) Glomerulonephritis
- Granulomatosis w Polyangiitis
- Microscopic polyangiitis
- Goodpasture’s syndrome
- Mesangio-capillary glomerulonephritis
- Post-infective glomerulonephritis
how does proliferative glomerulonephritis usually present? ie nephrotic or nephritic
NEPHRITIC syndrome
describe IgA nephropathy ie:
- epidemiology
- histology
- prognosis
- most common cause of primary GN
- peak age= 20s
- on histology
- IgA deposits & glomerular mesangial proliferation
- self-limiting but ACEI significantly improve outcome
when does IgA nephropathy typically develop?
After an infection (soon after- maybe 2-3days ago) parituclarly URTI/GI, as levels of IgA in blood will be elevated
Describe post infective glomerulonephritis
aka diffuse proliferating GN
- occurs 1-3weeks post strep infection
- haematuria –> smoky urine
- mild HT
- raised ASOT
- Rx= supportive
- resolves over 6-8weeks
what group of bacteria trigger post infective glomeurlonephritis ?
mainly group A streptococci ie strep pyogenes
Pathology + Aetiology of Mesangio-capillary glomerulonephritis
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
Describe Rapidly Progressive (crescentic) glomerulonephritis
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
what is Wegener’s granulomatosis?
a form of vasculitis affecting the lungs, kidneys and nose
how does Wegener’s present?
nasal sniffles, penumonia like symptoms and acute renal failure
what could be done to test for Wegener’s?
ANCA - c-ANCA positive in most cases
What is treatment for Wegener’s?
Cyclophosphamide
What is microscopic polyangitis?
a small vessel vasculitis affecting any organ system
what test could be done to test for microscopic polyangitis?
ANCA - P-ANCA positive in most cases
What is Goodpasture’s Syndrome caused by?
- circulating anti-GBM (glomerular basement membrane) antibodies, that attack glomerulus & pulmonary basement membranes
- this causes glomerulonephritis & pulmonary haemorrhage
- will present as haematuria + haemoptysis
if no haemoptysis, but only renal failure, what would it be called?
anti-GBM glomerulonephritis
What is treatment of Good pastures Syndrome?
Plasma exchange + immunosuppression
What are the 3 types of non-proliferative glomerulonephritis?
- minimal change disease
- focal and segmental glomerulosclerosis
- membranous nephropathy
how do non-proliferative glomerulonephritis usually present?
nephrotic syndrome
outline some other causes of nephrotic syndrome, other than glomerulonephritis
- amyloid
- long-standing DM
- SLE
what is the general Mx of nephrotic syndrome?
- oedema - salt and fluid restriction + loop diuretics
- proteinuria- ACEI
- hyperlipidaemia- Statins
Describe minimal change glomerulonephritis
- mainly in kids
- responds to steroids
- idiopathic usually
Epi and aetiology of Focal & Segmental Glomerulosclerosis
epi: most common cause of nephrotic syndrome in adults
aetiology: Heroin, HIV, Pamidronate
what is treatment for Focal & Segmental Glomerulosclerosis?
- general measures
- trial steroids BUT often steroid resistant
- alternatively: immunosuppression
- if creatinine still rising, transplant
epidemiology of membranous nephropathy
- most common type of GN overall
- bimodal age peak : 20s and 60s
What causes membranous nephropathy? ie pathology
- IgG deposits on BM
- this results in complement activation against glomerular basement membrane
- complement ‘punches holes’ in basement membrane
- leaky filter= nephrotic syndrome
aetiology of membranous nephropathy
- mostly idiopathic
- some occur secondary to other causes:
- lupus
- malignancy
- lung, colon, haematological
- hep B/C
- RA
- drugs
What is seen on immunofluorescence in membranous nephropathy?
spikes around deposits
what investigation could be done for membranous nephropathy?
Anti-phospholipase A2 receptor antibody positive typically
what is treatment for membranous nephropathy?
- steroids
- immunosuppression if persistent symptomatic
