Glomerulonephritis Flashcards
what are the main presenting features of glomerulonephritis?
haematuria proteinuria (heavy or slowly progressive) acute kidney injury hypertension renal insufficiency
how many RBC’s are present in microscopic haematuria ?
< 5 RBC per high power field
in glomerulonephritis, does it present with micro or macroscopic haematuria?
microscopic
dysmorphic RBC
what is defined as renal insufficiency?
rising creatinine
normal range 60-110
what are the features of nephrotic syndrome?
proteinuria >3.5g/day
hypoalbuminaemia
oedema
hyperlipidaemia
what are the features of nephritic syndrome?
haematuria dysmorphic RBCs in urine cellular class in urine hypertension renal impairment
what are the differential diagnoses of nephrotic syndrome?
congestive heart failure
hepatic disease
is hyperlipidaemia found in nephrotic or nephritic syndrome and why?
nephrotic syndrome
due to the loss of protein in the urine, the liver tries to compensate and as a result causes production of lipids
what is the difference between proliferative and non-proliferative glomerulonephritis?
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
in what types of glomerulonephritis do you find nephrotic syndrome?
minimal change disease
membranous nephropathy
in what types of glomerulonephritis do you find nephritic syndrome?
ANCA associated glomerulonephritis (Crescentic GN)
post-infective glomerulonephritis
IgA glomerulonephritis
what are 4 types of proliferative glomerulonephritis ?
post infective nephritis
IgA glomerulonephritis
crescentic granulonephritis
what is the most common causative organism of post-infective glomerulonephritis?
group A streptococci
what is the treatment for post-infection glomerulonephritis?
anti biotics
loop diuretics i.e.frusemide
vasodilators i.e. amlodipine
in what sex and age is IgA glomerulonephritis more common?
males > females
2nd / 3rd decade
what is the presentation of IgA glomerulonephritis?
haematuria (microscopic)
hypertension
renal insufficiency;
may have proteinuria and nephrotic syndrome if advanced = IgA crescentic glomerulonephritis
what is the treatment for IgA glomerulonephritis?
ACE inhibitor (hypertension ) if advanced may need transplantation
what is the treatment for anti-glomerular basement membrane disease?
immunosuppression i.e. steroids
plasma exchange
cyclophosphamide
what are the 2 peaks of prevalence of anti-glomerular BM disease?
3rd decade and 6th/7th decade
does anti-glomerular basement membrane disease present as nephrotic or nephritic syndrome?
nephritic syndrome
does proliferative diseases present with nephrotic or nephritic syndrome?
proliferative = nephritic syndrome; - haematuria - dysmorphic RBC - cellular clasts in urine - hypertension renal insufficiency
what are 3 main types of non-proliferative glomerulonephritis?
minimal change disease
focal segmental glomerulonephirtis
membranous nephropathy
do non-proliferative glomerulonephritis present with nephrotic or nephritic syndrome?
nephrotic syndrome;
- protienuria
- hypoalbuminaemia
- oedema
- hyperlipidaemia
what are the general measures for treating nephrotic syndrome?
reducing Na and fluid intake ACE inhibitors / ARB's heparin / warfarin reduce risk of infection with pneumococcal vaccine statins
what is the commonest form of glomerulonephritis in children?
minimal change disease
what is the treatment for minimal change disease?
prednisolone
1mg/kg for up to 16 weeks
what does minimal change disease present like?
nephrotic syndrome
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
what serological markers are found in membranous nephropathy?
anti-phospholipase A2 receptor (PLA2R)
thrombospondin type 1 domain containing 7A (THSD7A)
what are the secondary causes of membranous glomerulonephritis?
malignancy
drugs i.e. NSAIDS, gold, penicillamine
autoimmune i.e. SLE, rheumatoid arthritis, thyroid
hepatitis B
what is the treatment for membranous glomerulonephritis?
general measures plus;
- immunosuppression
- cyclophosphamide
- cyclosporin
- rituximab
what is the key investigation for diagnosing glomerulonephritis?
Renal biopsy
what are the complications of nephrotic syndrome?
increased susceptibility to infection
thromboembolism
hypercholesterolaemia
what is the prognosis for crescentic glomerulonephritis?
5 year survival 80%
what is the treatment for membranous glomerulonephritis?
general measures
cyclophosphamide + steroids
rituximab (ani-phospholipase A2 positive)
