Glomerulonephritis Flashcards
Glumerulonephritis def
Inflammation of glomeruli and nephrons
Consequences of damage to glomerulus
Constriction of blood flow-> raised BP
Protein and blood enter urine
AKI
Nephrotic syndrome sx
BP; normal-mild rise
Urine; proteinuria
GFR; normal-mild drop
Nephritic syndrome sx
BP; mod-severe rise
Urine; haematuria
GFR; mod-severe drop
Primary causes of nephrotic syndrome
Minimal change
FSGS
Membranous
Mesangiocapillary GN
Secondary causes of nephrotic
DM
SLE
Amyloid
Hep B/C
Primary causes of nephritic syndrome
IgA nephropathy
Mesangiocapillary GN
Secondary causes of nephritic syndrome
Post strep
Vasculitis
SLE
Anti-GBM
Cryoglobulinaemia
IgA nephropathy presentation
Young man with micro/macroscopic episodes of haematuria
Rapid recovery between the attacks
Renal biopsy results for IgA nephropathy
IgA and C3 deposits on immunofluorescence
Mesangial proliferation
IgA nephropathy rx
BP control with ACEi (<130/80, or 125/75 with proteinuria)
Henoch Shonlein Purpura features
Systemic variant of IgA nephropathy
Same biopsy results and treatment
HSP sx
purpric rash on extensors (legs esp)
polyarthritis
abdo pain
Anti-GBM aka
anti glomerular basement membrane
Goodpasture’s disease
Cause of anti-GBM
antibodies against IV collagen GBM
Where type IV collagen found
GBM
Lung (haemaptosis)
Anti-GBM rx
Plasma exchange
steroids
+/- cytotoxics
(if started early, good prognosis)
Post-strep GN presentation
Occurs 1-12wks after sore throat/skin infection
Post-strep GN pathogenesis
Streptococcal antigen deposited under skin,
Post-strep GN biposy result
IgA and C3 deposits
Post-strep GN serology
Riased ASOT and C3
Post-strep GN rx
supportive, 95% full recovery
Rapidly progressive GN (RPGN) features
Most aggressive GN
With potential to cause end-stage kidney failure within days
Causes of RPGN
Immune complex
Pauci-immune disease
Anti-GBM disease
Immune complex causes of RPGN
post-infectious
SLE
IgA/HSP
Pauci-immune disease causes of RPGN
Granulomatosis with polyangitis (Wegners),
Microscopic polyangitis
Churg-Strauss disease
Churg-Srauss disease
autoimmine small/medium vessel vasculitis
hx of airway hypersensitivity
Wegner’s disease antibody
ANCA
Microscopic polyangitis antibody
p-ANCA
RPGN rx
Aggressive immunosuppression:
high-dose IV steroids
cyclo- phosphamide
± plasma exchange
Nephrotic triad
Proteinuria
hypoalbuminaemia
oedema
(+ sometimes hyperlipidaemia)
Pathophysiology of nephrotic syndrome
injury to podocytes
leaks protein through
Biopsy for nephrotic syndrome
All adults should get
Children only if unresponsive to steroid treatment
Complications of nephrotic syndrome
VTE
infection
hyperlipidaemia
Rx of nephrotic
- diuretics (furosemide)
- ACEi (for proteinuria)
- Complications: anticoagulant, statins, pneumovax
Minimal change GN electron microscopy
effacement of podocytes (normal under light microscopy)
Minimal change disease rx
steroids
If frequently relapsing: cyclophosphamide or ciclosporin
Membranous neuropathy biopsy results
thick GBM
IgG and C3
Membranous neuropathy rx
ACE/ARB
diuretics
