Glomerulonephritis Flashcards
what types of glomerular disease are there
Diabetic nephropathy
Glomerulonephritis
Amyloid/light chain nephropathy
Transplant glomerulopathy
what is glomerulonephritis
one type of glomerular disease
immune-mediated disease of the kidneys affected the glomeruli causing inflammation (and secondary tubulointerstitial damage)
what is the second most common cause of end stage renal failure
chronic glomerulonephritis
what is acute glomerulonephritis
a treatable cause of acute renal failure
why does the site and type of injury to the glomerulus give different clinical presentations
because different cells in the glomerulus respond to damage in different ways
what happens to endothelial cells when they are damaged
cell injury causes vasculitis - this leads to rapid ischaemia and death of the glomerulus and BLOOD in urine
what happens to mesangial cells when they are damaged
a proliferative lesion is formed and red blood cells AND protein are found in urine
also causes high BP
what happens to podocyte cells when they get damage
non-proliferative lesion
small podocyte cells allow proteins to slip through but not RBCs
protein in urine
how does glomerulonephritis present (clinically)
- haematuria
- proteinuria
- dysmorphic red blood cells on urine microscopy
- red cell casts
- Impaired renal function (AKI, CKD, ESRD)
- hypertension
- nephritic syndrome or nephrotic syndrome or nephrotic-nephritic syndrome
how does the haematuria present in glomerulonephritis
asymptomatic microscopic haematuria
episodes of painless macroscopic haematuria
what are the stages of proteinuria
Microalbuminuria (30-300mg/day)
Asymptomatic proteinuria (<1g/day)
heavy proteinuria (1-3g/day)
nephrotic syndrome (>3g/day)
how can you tell if the blood in the urine is coming from the glomerulus
If the red blood cells on microscopy are dysmorphic (look squished)
if there are red cell casts
if the cells look normal on microscopy then the bleeding is coming from further down
what is nephritic syndrome
symptoms/signs involving loss of a lot of BLOOD in kidney disease
suggests disease in the ENDOTHELIAL CELLS
what are the symptoms/signs of nephritic syndrome
AKI Oliguria Oedema/fluid retention Hypertension Active urinary sediment -RBCs, RBC and granular casts
What is nephrotic syndrome
symptoms/signs involving loss of a lot of PROTEIN in kidney disease
caused by disease in the podocytes
what are the signs/symptoms of nephrotic syndrome
Proteinuria >3g/day Hypoalbuminaema (<30) Oedema (due to low osmolarity of the blood bc of lack of protein pushing water out) Hypercholesterolaemia Normal renal function
what are some complications of nephrotic syndrome
Infections (loss of opsonising antibodies)
Renal vein thrombosis
Pulmonary emboli
Volume depletion (overaggressive use of diuretics)
Via D deficiency
Subclinical hypothyroidism
what is one of the main differences between glomerular disease and non-glomerular kidney disease
you don’t get blood in the urine in non-glomerular disease just glomerular
what are the 2 main classifications of glomerulonephritis
Primary (idiopathic) most common!!
Secondary (caused by infections, drugs, malignancies, systemic diseases
what histological test can you do to determine the cause of glomerulonephritis
renal biopsy
- light microscopy
- immunofluorescence
- electron microscope
what are the histological classifications of glomerulonephritis
Proliferative or non-proliferative (usually revers to mesangial cell proliferation)
Focal/diffuse (>or<50% of glomeruli affected)
Global/segmental (all or parts of the glomerulus affected)
Cresentic (presence of crescents - epithelial extra capillary proliferation)
what is the aim of treatment for glomerulonephritis
Reduce protienuria
Induce remission of nephrotic syndrome
preserve long term renal function
what non-immunosuppressive treatments can be used for GN
Anti-hypertensives (target <130/80 or <120/75 if proteinuria)
- ACEi/ARB
- Diuretics
- Statins
- anticoagulants/antiplatlets
what immunosuppressive treatments are used for glomerulonephritis
Corticosteroids Azathioprine Alkylating agents (cyclophosphamide) Calcineurin inhibitors Mycophenolate mofetil
Plasmapharesis
Antibodies
- IV immunoglobin
- monoclonal T or B cell antibodies
what is the general treatment given to nephrotic patients
Fluid restriction Salt restriction Diuretics ACE inhibitors/ARB Anticoagulation IV albumin (Only if volume depletion)
why is immunosuppresing a nephrotic patient risky
because they are already leaking out immunoglobulins so have a v minimal immune system
what are the main types of primary GN (idiopathic)
- Minimal change disease
- Focal Segmental Glomeruloscerosis
- Membranous
- Membranoproliferative
- IgA nephropathy
what is the most common cause of nephrotic syndrome in children
Minimal Change Nephropathy
what does minimal change nephropathy show on histological investigation (renal biopsy)
looks normal on light microscopy and immunofluoroesence
shows foot process fusion on electon microscope
what treatment is given for minimal change nephropathy
corticosteroids
94% complete remission with oral steroids however for the rest
Cyclophosphamide given
minimal change nephropathy can lead to progressive renal failure true/false
FALSE
what could be a possible cause of minimal change nephropathy
IL-13
What is the most common cause of nephrotic syndrome in adults
FSGS
Focal segmental glomerulosclerosis
what can causes FSGS
can be primary (idiopathic)
or secondary to
- HIV
- Heroin
- Obesity
- Reflux nephropathy
what does focal segmental glomerulosclerosis show with renal biopsy
Ig/complement deposition on immunofluorosence
focal segmental glomerulosclerosis on light microscopy
what is the treatment for focal segmental glomerulosclerosis
corticosteroids
-causes remission with prolonged use in 60% of patients
can FSGS progress to end stage renal failure
yes
50% of patient progress to ESRF after 10 years
what is the 2nd most common cause of nephrotic syndrome in adults
Membranous nephropathy
what is membranous nephropathy
immune complex deposits in the nephron get stuck and cause inflammation
what are the causes of membraneous nephropathy
primary (idiopathic)
secondary to:
-infections (hep b/parasites)
- connective tissue disease (lupus)
- malignancies
- drugs (gold/penicillamine)
what does membranous nephropathy show on renal biopsy
sub epithelial immune complex deposition in the basement membrane
how do you treat membranous nephropathy
steroids
alkylating agents
B cell monoclonal Ab
what percentage of those with membranous nephropathy progress to end stage renal failure in 10 years
30%
what is the most common glomerulonephritis in the world
IgA nephropathy
what is IgA nephropathy
when an abnormal IgA forms and deposits in the mesagium of the kidneys
type 3 hypersensitivity disorder
Causes a NEPHRITIC syndrome
what are the signs/symptoms of IgA nephropathy
Asymptomatic microhaematuria
Non-nephrotic range proteinuria
Macroscopic haematuria after rest/GI infection (bc they involve IgA)
what disease is strongly associated with IgA nephropathy
HSP (hence-schonlein pupura)
- arthritis
- colitis
- purpuric skin rash
- vasculitis
what does IgA nephropathy show on renal biopsy
mesangial cell proliferation and expansion on light microscopy
IgA deposits in mesangium on immunofluroesence
treatment for IgA nephroapthy
Once the kidneys have been scarred they can’t be repaired so treatment is just to prevent further damage
BP control
ACE inhibitors and ARBs
Fish oil
what percentage of IgA nephropathies progress to end stage renal failure in 10-30 years
25%
when does IgA nephropathy tend to present
childhood
during an infection
what is rapidly progressive glomerulonephritis (RPGN)
nephritic syndrome caused by crescent shaped proliferation of the glomerulus
causes rapid deterioration in renal function over days/weeks
signs of RPGN
rapid deterioration of kidney function
active urinary sediment (RBCs, RBC and granular casts)
glomerular crescents on biopsy
what are some ANCA positive causes of RPGN
Systemic vasculitis
Granulomatosis with polyangitis
Microscopic polyangitis
what are some ANCA negative causes of RPGN
Goodpastures disease
HSP
Lupus
what antibody causes RPGN in goodpastures disease
anti-GBM (glomerular basement membrane)
Treatment for RPGN
Strong immunosuppression with supportive care and dialysis if needed
Steroids
Cytotoxics
Plasmapharesis
