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Urinary clinical conditions > Glomerulonephritis > Flashcards

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
Q

what is the commonest form of glomerulonephritis in children?

A

minimal change disease

26
Q

what is the treatment for minimal change disease?

A

prednisolone

1mg/kg for up to 16 weeks

27
Q

what does minimal change disease present like?

A

nephrotic syndrome

28
Q

what is the treatment for focal and segmental glomerulonephritis?

A

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
Q

what serological markers are found in membranous nephropathy?

A

anti-phospholipase A2 receptor (PLA2R)

thrombospondin type 1 domain containing 7A (THSD7A)

30
Q

what are the secondary causes of membranous glomerulonephritis?

A

malignancy
drugs i.e. NSAIDS, gold, penicillamine
autoimmune i.e. SLE, rheumatoid arthritis, thyroid
hepatitis B

31
Q

what is the treatment for membranous glomerulonephritis?

A

general measures plus;

  • immunosuppression
  • cyclophosphamide
  • cyclosporin
  • rituximab
32
Q

what is the key investigation for diagnosing glomerulonephritis?

A

Renal biopsy

33
Q

what are the complications of nephrotic syndrome?

A

increased susceptibility to infection
thromboembolism
hypercholesterolaemia

34
Q

what is the prognosis for crescentic glomerulonephritis?

A

5 year survival 80%

35
Q

what is the treatment for membranous glomerulonephritis?

A

general measures
cyclophosphamide + steroids
rituximab (ani-phospholipase A2 positive)

Urinary clinical conditions (17 decks)

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