Glomerulonephritis Flashcards
What are the different types of glomerular disease?
- Diabetic Nephropathy
- Glomerulonephritis (GN)
- Amyloid/ Light Chain Nephropathy
- Transplant Glomerulopathy
Define glomerulonephritis
Immune-mediated disease of the kidneys affecting the glomeruli
What can occur secondary to glomerulonephritis
secondary tubulointerstitial damage
What are the 3 ways in which the immune system can cause glomerulonephritis?
- Antibody (Humoral)
- T cell
- Inflammatory mediators and complement
Damage to endothelial or mesangial cells causes what to appear in the urine?
red cells
Protein appears in the urine if what cells are damaged?
Podocytes
Injury to the podocytes causes what cellular changes?
Atrophy
Loss of charge specific barrier
Damage to the mesangium causes what cellular changes?
Proliferate and release Ang2
=> Chemokine release.
=> Attract inflammatory cells
Damage to the endothelial cells in the glomerulus causes what effect?
Vasculitis
What investigations are used for diagnosis of GN?
Urinalysis (blood/protein)
Urine microscopy - abnormal RBCs/ granular casts/ lipids
Urine Protein: Creatinine Ratio
24hr urine to quantify protein
What indicates a nephritic syndrome?
- Acute Renal Failure
- Oliguria
- Oedema/ Fluid retention
- Hypertension
- abnormal RBC’s, WBC’s, red cell casts
What indicates a nephrotic syndrome?
- Proteinuria >3 g/day
- Hypoalbuminaemia (<30)
- Oedema
- Hypercholesterolaemia
- Sometimes normal renal function
What are the main complications of nephrotic syndrome
- Infection (due to loss of Ab in urine)
- Renal vein thrombosis
- Pulmonary emboli
- Volume depletion
- Vit D deficiency
- Subclinical hypothyroidism
What systemic diseases can cause secondary GN?
ANCA - associated vasculitis
Lupus
Goodpastures
HSP
How is a renal biopsy analysed?
Light Microscopy
Immunofluorescence
EM
What is the difference between Focal and Diffuse GN?
Focal < 50% glomeruli affected
Diffuse > 50% glomeruli affected
What is the difference between Global and Segmental GN?
Global = all of glomerulus affected Segmental = part of glomerulus affected
What does the presence of crescents indicate?
epithelial cell extracapillary proliferation
What non-immunosuppressive agents are used to treat GN?
- Anti-hypertensives
- ACE inhibitors/ ARBs
- Diuretics
- Statins
What immunosuppressive agents can be used to treat GN?
- Corticosteroids
- Azathioprine
- Alkylating agents
- Calcineurin inhibitors
- Mycophenolate Mofetil
- Therapeutic plasma exchange
- IV Immunoglobulin
What general treatments are advised in nephrotic syndrome?
- Fluid/salt restriction
- Diuretics
- ACE Inhibitors/ ARBs
? Anticoagulation - IV Albumin
What levels indicate partial or complete remission of proteinuria?
complete remission <300 mg/day
partial remission <3000mg/day
What is minimal change syndrome?
Commonest cause of nephrotic syndrome in children
Most of minimal change nephropathy is cleared with oral steroids. TRUE/FALSE?
TRUE
94 % complete remission with oral steroids
Minimal change nephropathy can cause progressive renal failure. TRUE/FALSE?
FALSE
Does NOT cause progressive renal failure
What is the most common cause of nephrotic syndrome in adults?
Focal Segmental Glomerulosclerosis (FSGS)
What percentage of patients with FSGS progress to end stage renal failure?
50% progress to ESRF after 10 years
What are the secondary causes of membranous nephropathy ?
- infections (Hep B/ parasites)
- connective tissue diseases (e.g. Lupus)
- malignancies (Carcinomas/ Lymphoma)
- drugs (gold/penicillamine)
How is rapidly progressive glomerulonephritis treated?
prompt Tx
strong immunosuppression
+ supportive care including dialysis if needed
