Glomerulonephritis Flashcards

1
Q

What are the different types of glomerular disease?

A
  • Diabetic Nephropathy
  • Glomerulonephritis (GN)
  • Amyloid/ Light Chain Nephropathy
  • Transplant Glomerulopathy
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2
Q

Define glomerulonephritis

A

Immune-mediated disease of the kidneys affecting the glomeruli

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3
Q

What can occur secondary to glomerulonephritis

A

secondary tubulointerstitial damage

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4
Q

What are the 3 ways in which the immune system can cause glomerulonephritis?

A
  • Antibody (Humoral)
  • T cell
  • Inflammatory mediators and complement
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5
Q

Damage to endothelial or mesangial cells causes what to appear in the urine?

A

red cells

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6
Q

Protein appears in the urine if what cells are damaged?

A

Podocytes

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7
Q

Injury to the podocytes causes what cellular changes?

A

Atrophy

Loss of charge specific barrier

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8
Q

Damage to the mesangium causes what cellular changes?

A

Proliferate and release Ang2
=> Chemokine release.
=> Attract inflammatory cells

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9
Q

Damage to the endothelial cells in the glomerulus causes what effect?

A

Vasculitis

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10
Q

What investigations are used for diagnosis of GN?

A

Urinalysis (blood/protein)
Urine microscopy - abnormal RBCs/ granular casts/ lipids
Urine Protein: Creatinine Ratio
24hr urine to quantify protein

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11
Q

What indicates a nephritic syndrome?

A
  • Acute Renal Failure
  • Oliguria
  • Oedema/ Fluid retention
  • Hypertension
  • abnormal RBC’s, WBC’s, red cell casts
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12
Q

What indicates a nephrotic syndrome?

A
  • Proteinuria >3 g/day
  • Hypoalbuminaemia (<30)
  • Oedema
  • Hypercholesterolaemia
  • Sometimes normal renal function
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13
Q

What are the main complications of nephrotic syndrome

A
  • Infection (due to loss of Ab in urine)
  • Renal vein thrombosis
  • Pulmonary emboli
  • Volume depletion
  • Vit D deficiency
  • Subclinical hypothyroidism
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14
Q

What systemic diseases can cause secondary GN?

A

ANCA - associated vasculitis
Lupus
Goodpastures
HSP

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15
Q

How is a renal biopsy analysed?

A

Light Microscopy
Immunofluorescence
EM

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16
Q

What is the difference between Focal and Diffuse GN?

A

Focal < 50% glomeruli affected

Diffuse > 50% glomeruli affected

17
Q

What is the difference between Global and Segmental GN?

A
Global = all of glomerulus affected
Segmental = part of glomerulus affected
18
Q

What does the presence of crescents indicate?

A

epithelial cell extracapillary proliferation

19
Q

What non-immunosuppressive agents are used to treat GN?

A
  • Anti-hypertensives
  • ACE inhibitors/ ARBs
  • Diuretics
  • Statins
20
Q

What immunosuppressive agents can be used to treat GN?

A
  • Corticosteroids
  • Azathioprine
  • Alkylating agents
  • Calcineurin inhibitors
  • Mycophenolate Mofetil
  • Therapeutic plasma exchange
  • IV Immunoglobulin
21
Q

What general treatments are advised in nephrotic syndrome?

A
  • Fluid/salt restriction
  • Diuretics
  • ACE Inhibitors/ ARBs
    ? Anticoagulation
  • IV Albumin
22
Q

What levels indicate partial or complete remission of proteinuria?

A

complete remission <300 mg/day

partial remission <3000mg/day

23
Q

What is minimal change syndrome?

A

Commonest cause of nephrotic syndrome in children

24
Q

Most of minimal change nephropathy is cleared with oral steroids. TRUE/FALSE?

A

TRUE

94 % complete remission with oral steroids

25
Minimal change nephropathy can cause progressive renal failure. TRUE/FALSE?
FALSE | Does NOT cause progressive renal failure
26
What is the most common cause of nephrotic syndrome in adults?
Focal Segmental Glomerulosclerosis (FSGS)
27
What percentage of patients with FSGS progress to end stage renal failure?
50% progress to ESRF after 10 years
28
What are the secondary causes of membranous nephropathy ?
- infections (Hep B/ parasites) - connective tissue diseases (e.g. Lupus) - malignancies (Carcinomas/ Lymphoma) - drugs (gold/penicillamine)
29
How is rapidly progressive glomerulonephritis treated?
prompt Tx strong immunosuppression + supportive care including dialysis if needed