Glomerulonephritis Flashcards
What are the functions of the kidney?
Waste excretion Water balance Salt balance Acid base control Endocrine functions
What are the components of the glomerular filtration barrier?
Endothelial cell
Glomerular basement membrane
Podocytes
Describe the endothelial cells in the glomerular filtration barrier?
Fenestrated
Bulnerable to immune mediated attack
What are the components of the glomerular basement membrane?
Type IV collagen
Laminin
Mesangial cells
What are mesangial cells?
Glomerular structural support
Embedded in glomerular basement membrabe
Regulate blood flow of glomerular capillaries
Describe podocites in the glomerular filtration barrier?
Proteins containing slit diaphragms
What is glomerulopathy?
Proteinuria and haematuris in varying amounts
What does increasing proteinuria suggest?
Nephrotic
What does increasing haematuria suggest?
Nephritic
What is the presentation of nephrotic syndrome?
Well, normally 2-5 year olds Oedema- periorbital, pitting oedema of legs Ascites, small pleural effusions Frothy urine Proteinuria Intravascular depletion
What are the types of causes of nephrotic syndrome?
Idiopathic
Acquired
Congenital
What are the idiopathic causes of nephrotic syndrome?
Minimal change disease
Focal segmental glomerulosclerosis
Membranoproliferative glomerulonephritis
What are the most common causes of acquired nephrotic syndrome?
IgA related vasculitis
Lupus
Post infective
What does IgA vasculitic affect?
Mesangial cells
What does lupus affect?
Endothelial cells
What does post infective glomerulonephritis affect?
Basement membrane and endothelial cells
What are congenital nephrotic syndromes?
rare, congenital
Affecting podocyte, endothelium and microvascular integrity and basement membrane proteins
What investigations are done for nephrotic syndrome?
Dipstick
Protein creatinine ratio
24 hour urine collection
Bloods- albumin and ceratinine
What would a nephrotic protein creatinine ratio be?
> 250 normal <20
What is the treatment of nephrotic syndrome?
Prednisolone 8 weeks
Frequent long term relapses or steroid resistant- immunosuppression
What are the common causes of nephritic syndrome?
Glomerulonephritis
UTI
Trauma
Stones
What types of glomerulonephritis common cause nephritic syndrome?
Post infective
IgA related vasculitis
IgA neohropathy
How can the causes of nephritic syndrome be differentiated?
UTI= associated dysuria Sones= associated pain
What is the presentation of nephritic syndrome?
Increasing haematuria
proteinuria
Intravascular overload- hypertension, raised JVP, oedema
Oliguria
What investigations are done for nephritic syndrome?
Bloods- FBC, creatinine, albumin
Urine dipstick and culture
Renal US
What is the most common cause of post infective glomerulonephritis?
Usually group A strep
Throat infection in last 7-10 days
Skin infection in last 2-4 weeks
What is the differential for post infective glomerulonephritis?
IgA nephropathy
membranoprolifeartive glomeruloneohropathy
Lupus
How is post infective glomerulonephritis diagnosed?
Bacterial culture
ASOT +
What is the treatment of post infective glomerulonephritis?
Antibiotics
Support renal function
Diuretics if overload/hypertension
What is IgA nephropathy?
Most common glomerulonephritis, normally occurring 1-2 days after a URTI
Usually older children and adults
What are the features of IgA nephropathy?
Recurrent macroscopic haematuria
+/- chronic microscopic haematuria
Varying degree of proteinuria
What is the diagnosis of IgA neohropathy?
Negative autoimmune, normal compliment
rarely confirmation biopsy
What is the treatment of IgA neohropathy?
Mild- ACE inhibitor
Mod to severe- immunosuppression
What is IgA related vasculitis?
Dilatation of capillaries due to autoimmune IgA response
Age of onset 5-15
What are the features of IgA vasculitis?
Palpable purpura plus 1 of
- abdo pain
- renal involvement
- arthritis or arthralgia
- IgA deposition on biopsy
What are the common triggers for IgA vasculitis?
Viral URTI
Strep
Drugs
What is the treatment of IgA vasculitis?
Symptomatic
GI involvement- glucocorticoid
Mod to severe renal= immunosuppression
Long term hypertension and proteinuria screening
What are the most common causes of nephritis syndrome?
Post infection GN
IgA vasculitis
IgA nephropathy
What are the most common causes of nephrotic syndrome?
focal segmental GN
Minimal change disease
