Glomerulonephritis Flashcards

1
Q

what are the main presenting features of glomerulonephritis?

A
haematuria
proteinuria (heavy or slowly progressive)
acute kidney injury 
hypertension
renal insufficiency
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2
Q

how many RBC’s are present in microscopic haematuria ?

A

< 5 RBC per high power field

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3
Q

in glomerulonephritis, does it present with micro or macroscopic haematuria?

A

microscopic

dysmorphic RBC

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4
Q

what is defined as renal insufficiency?

A

rising creatinine

normal range 60-110

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5
Q

what are the features of nephrotic syndrome?

A

proteinuria >3.5g/day
hypoalbuminaemia
oedema
hyperlipidaemia

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6
Q

what are the features of nephritic syndrome?

A
haematuria 
dysmorphic RBCs in urine
cellular class in urine
hypertension
renal impairment
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7
Q

what are the differential diagnoses of nephrotic syndrome?

A

congestive heart failure

hepatic disease

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8
Q

is hyperlipidaemia found in nephrotic or nephritic syndrome and why?

A

nephrotic syndrome

due to the loss of protein in the urine, the liver tries to compensate and as a result causes production of lipids

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9
Q

what is the difference between proliferative and non-proliferative glomerulonephritis?

A

non-proliferative shows a normal looking glomerulus with normal number of cells (may have some scarring)
whereas proliferative shows excessive numbers of cells which include infiltrating leukocytes

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10
Q

in what types of glomerulonephritis do you find nephrotic syndrome?

A

minimal change disease

membranous nephropathy

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11
Q

in what types of glomerulonephritis do you find nephritic syndrome?

A

ANCA associated glomerulonephritis (Crescentic GN)
post-infective glomerulonephritis
IgA glomerulonephritis

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12
Q

what are 4 types of proliferative glomerulonephritis ?

A

post infective nephritis
IgA glomerulonephritis
crescentic granulonephritis

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13
Q

what is the most common causative organism of post-infective glomerulonephritis?

A

group A streptococci

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14
Q

what is the treatment for post-infection glomerulonephritis?

A

anti biotics
loop diuretics i.e.frusemide
vasodilators i.e. amlodipine

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15
Q

in what sex and age is IgA glomerulonephritis more common?

A

males > females

2nd / 3rd decade

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16
Q

what is the presentation of IgA glomerulonephritis?

A

haematuria (microscopic)
hypertension
renal insufficiency;
may have proteinuria and nephrotic syndrome if advanced = IgA crescentic glomerulonephritis

17
Q

what is the treatment for IgA glomerulonephritis?

A
ACE inhibitor (hypertension )
if advanced may need transplantation
18
Q

what is the treatment for anti-glomerular basement membrane disease?

A

immunosuppression i.e. steroids
plasma exchange
cyclophosphamide

19
Q

what are the 2 peaks of prevalence of anti-glomerular BM disease?

A

3rd decade and 6th/7th decade

20
Q

does anti-glomerular basement membrane disease present as nephrotic or nephritic syndrome?

A

nephritic syndrome

21
Q

does proliferative diseases present with nephrotic or nephritic syndrome?

A
proliferative = nephritic syndrome;
- haematuria
- dysmorphic RBC
- cellular clasts in urine
- hypertension 
renal insufficiency
22
Q

what are 3 main types of non-proliferative glomerulonephritis?

A

minimal change disease
focal segmental glomerulonephirtis
membranous nephropathy

23
Q

do non-proliferative glomerulonephritis present with nephrotic or nephritic syndrome?

A

nephrotic syndrome;

  • protienuria
  • hypoalbuminaemia
  • oedema
  • hyperlipidaemia
24
Q

what are the general measures for treating nephrotic syndrome?

A
reducing Na and fluid intake
ACE inhibitors / ARB's
heparin / warfarin 
reduce risk of infection with pneumococcal vaccine
statins
25
what is the commonest form of glomerulonephritis in children?
minimal change disease
26
what is the treatment for minimal change disease?
prednisolone | 1mg/kg for up to 16 weeks
27
what does minimal change disease present like?
nephrotic syndrome
28
what is the treatment for focal and segmental glomerulonephritis?
trial with steroids (generally resistant) if resistant try; cyclophosphamide cyclosporin rituximab - loop diuretics i.e. frusemide - reduce Na and fluid intake - ACE inhibitors / ARB's if hypertensive
29
what serological markers are found in membranous nephropathy?
anti-phospholipase A2 receptor (PLA2R) | thrombospondin type 1 domain containing 7A (THSD7A)
30
what are the secondary causes of membranous glomerulonephritis?
malignancy drugs i.e. NSAIDS, gold, penicillamine autoimmune i.e. SLE, rheumatoid arthritis, thyroid hepatitis B
31
what is the treatment for membranous glomerulonephritis?
general measures plus; - immunosuppression - cyclophosphamide - cyclosporin - rituximab
32
what is the key investigation for diagnosing glomerulonephritis?
Renal biopsy
33
what are the complications of nephrotic syndrome?
increased susceptibility to infection thromboembolism hypercholesterolaemia
34
what is the prognosis for crescentic glomerulonephritis?
5 year survival 80%
35
what is the treatment for membranous glomerulonephritis?
general measures cyclophosphamide + steroids rituximab (ani-phospholipase A2 positive)