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Y2 RENAL > Glomerulonephritis > Flashcards

Glomerulonephritis Flashcards

1
Q

Chronic glomerulonephritis is the most common cause of end-stage renal failure (chronic kidney disease). True/False?

A

False

2nd most common, after diabetic nephropathy

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2
Q

Glomerulonephritis is caused by infection. True/False?

A

False

Immune-mediated destruction with secondary tubulointerstitial damage

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3
Q

Which aspects of the immune system cause glomerulonephritis?

A

Antibodies
T-cell mediated
Inflammatory cells, mediators, complement

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4
Q

Which part of the glomerulus is disrupted in glomerulonephritis?

A

Disruption of glomerular basement membrane and/or podocytes, leading to leakage of protein/blood

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5
Q

The site and type of injury determines the clinical presentation of glomerulonephritis. Damage to endothelial/mesangial cells leads to what?

A

Proliferative lesion, causing haematuria

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6
Q

The site and type of injury determines the clinical presentation of glomerulonephritis. Damage to podocytes leads to what?

A

Non-proliferative lesion, causing proteinuria

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7
Q

What might be found on urinalysis in glomerulonephritis?

A

Proteinuria

Haematuria

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8
Q

What might be found on urine microscopy in glomerulonephritis?

A

Dysmorphic RBCs
RBC casts
Lipiduria

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9
Q

What ratio is measured over 24 hours to quantify proteinuria?

A

Urine protein : creatinine ratio

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10
Q

What is the definitive investigation for glomerulonephritis? List other investigations

A

Kidney biopsy
Urinalysis
Urine microscopy
24hr urine protein: creatinine ratio

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11
Q

Microalbuminuria is low amounts of albumin in the urine and is an early sign of what?

A

Diabetic nephropathy

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12
Q

How much protein is classed as heavy proteinuria?

A

1-3 g/day

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13
Q

What is meant by “red cell casts”?

A

Red cells stuck with other cells in a matrix formed by Tamm-Horsfall protein

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14
Q

List the components that define nephrotic syndrome. What is the site of injury?

A

Proteinuria over 3 g/day
Hypoalbuminaemia
Oedema (typically periorbital, face)
Hypercholesterolaemia

Podocytes (non-proliferative lesion)

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15
Q

Renal function is usually normal in nephrotic syndrome. True/False?

A

True

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16
Q

List the components that define nephritic syndrome

What is the site of injury?

A

Acute renal failure
Oliguria (<400ml urine/day)
Oedema
Haematuria

Endothelial cells (proliferative lesion)

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17
Q

List the main complications of nephrotic syndrome

A 
Pulmonary emboli
Infection
Renal vein thrombosis
Hypovolaemia
Vitamin D deficiency
Subclinical hypothyroidism
18
Q

The majority of glomerulonephritis is idiopathic (primary). True/False?

A

True

19
Q

List non-idiopathic (secondary) causes of glomerulonephritis

A 
Drugs
Malignancy
ANCA-vasculitis
SLE
Goodpasture's syndrome
20
Q

Once renal biopsy is taken, what histological investigations may be done on the biopsy?

A

Light microscopy
Immunofluorescence
Electron microscopy

21
Q

What is meant by focal and diffuse glomerulonephritis?

What is meant by global and segmental glomerulonephritis?

A

Focal = less than 50% glomeruli affected
Diffuse = more than 50% glomeruli affected
All or parts of glomerulus affected?

22
Q

What is meant by crescentic glomerulonephritis?

A

Presence of crescents - epithelial cell extra-capillary proliferation

23
Q

What are the principal aims of glomerulonephritis treatment? (RRP)

A

Reduce proteinuria
Reverse nephrotic syndrome
Preserve renal function

24
Q

What is the target BP for glomerulonephritis with and without proteinuria?

A

Less than 130/80 if no proteinuria

Less than 120/75 if proteinuria

25
Q

Which class of drug may help control BP in glomerulonephritis?

A

ACE inhibitors

Also consider diuretics/statins

26
Q

Outline medical management of glomerulonephritis

A 
Corticosteroid (prednisolone oral/methylprednisolone IV)
Azathioprine
Cyclophosphamide (alkylating agent)
Cyclosporin (calcineurin inhibitor)
IV immunoglobulin
Plasmapharesis
27
Q

Outline management of nephrotic syndrome. What is 1st line?

A

Fluid + salt restriction
Diuretic (1st line)
ACE inhibitor
IV albumin if hypovolaemia

28
Q

What is the commonest type of idiopathic glomerulonephritis in children?

A

Minimal-change nephropathy

normal renal biopsy

29
Q

Which interleukin might be associated with minimal-change nephropathy?

A

IL-13

30
Q

What is the commonest glomerulonephritic cause of nephrotic syndrome in adults?

A

Focal segmental glomerulonephritis

31
Q

What is focal segmental glomerulonephritis associated with?

A 
HIV
Heroin use
Obesity
Reflux
Nephropathy
32
Q

What is the 2nd commonest glomerulonephritic cause of nephrotic syndrome in adults?

A

Membranous nephropathy, involving immune-complex deposition at basement membrane

33
Q

What is membranous nephropathy associated with?

A

Infection (hep B)
CTDs
Malignancy
Drugs - gold, penicillamine

34
Q

Which antibody is present in over 70% of primary membranous nephropathy?

A

Anti-PLA2r antibody

35
Q

What is the commonest type of glomerulonephritis in the world?

A

IgA nephropathy involving mesangial proliferation with IgA deposits

36
Q

Which skin condition is associated with IgA nephropathy?

A

Henoch-Schonlein Purpura

37
Q

Rapidly progressive glomerulonephritis involves rapid deterioration in renal function over days/weeks. What are the 2 main classifications and their causes?

A

ANCA-positive (vasculitis - GPA/MPA)

ANCA-negative (Goodpasture’s, Henoch-Schonlein, SLE)

38
Q

Which antibody is associated with Goodpasture’s disease? What are the clinical signs?

A

Anti-GBM (anti-glomerular-basement-membrane)

AKI, haematuria, haemoptyisis

39
Q

List contraindications to renal biopsy

A 
Thrombocytopaenia/ coagulation defects
Single kidney
Small kidneys
Prolonged hypertension
Untreated UTI
40
Q

What is the appearance of RPGN on biopsy?

A

Glomerular crescents

41
Q

Outline the management options for RPGN

A

Immunosupressants (steroids - IV methylpred, pred PO, cytotoxics (cyclophosphonamide, myclophenolate, azathioprine)
Plasmapharesis
Supportive dialysis

42
Q

What are the main clinical signs of IgA nephropathy?

A

Macroscopic haematuria

Typically with URTI

Y2 RENAL (17 decks)

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