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2 RENAL > Glomerulonephritis > Flashcards

Glomerulonephritis Flashcards

1
Q

what types of glomerular disease are there

A

Diabetic nephropathy
Glomerulonephritis
Amyloid/light chain nephropathy
Transplant glomerulopathy

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2
Q

what is glomerulonephritis

A

one type of glomerular disease

immune-mediated disease of the kidneys affected the glomeruli causing inflammation (and secondary tubulointerstitial damage)

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3
Q

what is the second most common cause of end stage renal failure

A

chronic glomerulonephritis

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4
Q

what is acute glomerulonephritis

A

a treatable cause of acute renal failure

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5
Q

why does the site and type of injury to the glomerulus give different clinical presentations

A

because different cells in the glomerulus respond to damage in different ways

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6
Q

what happens to endothelial cells when they are damaged

A

cell injury causes vasculitis - this leads to rapid ischaemia and death of the glomerulus and BLOOD in urine

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7
Q

what happens to mesangial cells when they are damaged

A

a proliferative lesion is formed and red blood cells AND protein are found in urine

also causes high BP

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8
Q

what happens to podocyte cells when they get damage

A

non-proliferative lesion

small podocyte cells allow proteins to slip through but not RBCs

protein in urine

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9
Q

how does glomerulonephritis present (clinically)

A
  • 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
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10
Q

how does the haematuria present in glomerulonephritis

A

asymptomatic microscopic haematuria

episodes of painless macroscopic haematuria

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11
Q

what are the stages of proteinuria

A

Microalbuminuria (30-300mg/day)

Asymptomatic proteinuria (<1g/day)

heavy proteinuria (1-3g/day)

nephrotic syndrome (>3g/day)

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12
Q

how can you tell if the blood in the urine is coming from the glomerulus

A

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

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13
Q

what is nephritic syndrome

A

symptoms/signs involving loss of a lot of BLOOD in kidney disease

suggests disease in the ENDOTHELIAL CELLS

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14
Q

what are the symptoms/signs of nephritic syndrome

A 
AKI 
Oliguria 
Oedema/fluid retention 
Hypertension 
Active urinary sediment 
-RBCs, RBC and granular casts
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15
Q

What is nephrotic syndrome

A

symptoms/signs involving loss of a lot of PROTEIN in kidney disease

caused by disease in the podocytes

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16
Q

what are the signs/symptoms of nephrotic syndrome

A 
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
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17
Q

what are some complications of nephrotic syndrome

A

Infections (loss of opsonising antibodies)

Renal vein thrombosis

Pulmonary emboli

Volume depletion (overaggressive use of diuretics)

Via D deficiency

Subclinical hypothyroidism

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18
Q

what is one of the main differences between glomerular disease and non-glomerular kidney disease

A

you don’t get blood in the urine in non-glomerular disease just glomerular

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19
Q

what are the 2 main classifications of glomerulonephritis

A

Primary (idiopathic) most common!!

Secondary (caused by infections, drugs, malignancies, systemic diseases

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20
Q

what histological test can you do to determine the cause of glomerulonephritis

A

renal biopsy

  • light microscopy
  • immunofluorescence
  • electron microscope
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21
Q

what are the histological classifications of glomerulonephritis

A

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)

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22
Q

what is the aim of treatment for glomerulonephritis

A

Reduce protienuria

Induce remission of nephrotic syndrome

preserve long term renal function

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23
Q

what non-immunosuppressive treatments can be used for GN

A

Anti-hypertensives (target <130/80 or <120/75 if proteinuria)

  • ACEi/ARB
  • Diuretics
  • Statins
  • anticoagulants/antiplatlets
24
Q

what immunosuppressive treatments are used for glomerulonephritis

A 
Corticosteroids 
Azathioprine 
Alkylating agents (cyclophosphamide) 
Calcineurin inhibitors 
Mycophenolate mofetil

Plasmapharesis

Antibodies

  • IV immunoglobin
  • monoclonal T or B cell antibodies
25
Q

what is the general treatment given to nephrotic patients

A 
Fluid restriction 
Salt restriction 
Diuretics 
ACE inhibitors/ARB 
Anticoagulation 
IV albumin (Only if volume depletion)
26
Q

why is immunosuppresing a nephrotic patient risky

A

because they are already leaking out immunoglobulins so have a v minimal immune system

27
Q

what are the main types of primary GN (idiopathic)

A
  • Minimal change disease
  • Focal Segmental Glomeruloscerosis
  • Membranous
  • Membranoproliferative
  • IgA nephropathy
28
Q

what is the most common cause of nephrotic syndrome in children

A

Minimal Change Nephropathy

29
Q

what does minimal change nephropathy show on histological investigation (renal biopsy)

A

looks normal on light microscopy and immunofluoroesence

shows foot process fusion on electon microscope

30
Q

what treatment is given for minimal change nephropathy

A

corticosteroids

94% complete remission with oral steroids however for the rest

Cyclophosphamide given

31
Q

minimal change nephropathy can lead to progressive renal failure true/false

A

FALSE

32
Q

what could be a possible cause of minimal change nephropathy

A

IL-13

33
Q

What is the most common cause of nephrotic syndrome in adults

A

FSGS

Focal segmental glomerulosclerosis

34
Q

what can causes FSGS

A

can be primary (idiopathic)

or secondary to

  • HIV
  • Heroin
  • Obesity
  • Reflux nephropathy
35
Q

what does focal segmental glomerulosclerosis show with renal biopsy

A

Ig/complement deposition on immunofluorosence

focal segmental glomerulosclerosis on light microscopy

36
Q

what is the treatment for focal segmental glomerulosclerosis

A

corticosteroids

-causes remission with prolonged use in 60% of patients

37
Q

can FSGS progress to end stage renal failure

A

yes

50% of patient progress to ESRF after 10 years

38
Q

what is the 2nd most common cause of nephrotic syndrome in adults

A

Membranous nephropathy

39
Q

what is membranous nephropathy

A

immune complex deposits in the nephron get stuck and cause inflammation

40
Q

what are the causes of membraneous nephropathy

A

primary (idiopathic)

secondary to:
-infections (hep b/parasites)

  • connective tissue disease (lupus)
  • malignancies
  • drugs (gold/penicillamine)
41
Q

what does membranous nephropathy show on renal biopsy

A

sub epithelial immune complex deposition in the basement membrane

42
Q

how do you treat membranous nephropathy

A

steroids
alkylating agents
B cell monoclonal Ab

43
Q

what percentage of those with membranous nephropathy progress to end stage renal failure in 10 years

A

30%

44
Q

what is the most common glomerulonephritis in the world

A

IgA nephropathy

45
Q

what is IgA nephropathy

A

when an abnormal IgA forms and deposits in the mesagium of the kidneys

type 3 hypersensitivity disorder

Causes a NEPHRITIC syndrome

46
Q

what are the signs/symptoms of IgA nephropathy

A

Asymptomatic microhaematuria

Non-nephrotic range proteinuria

Macroscopic haematuria after rest/GI infection (bc they involve IgA)

47
Q

what disease is strongly associated with IgA nephropathy

A

HSP (hence-schonlein pupura)

  • arthritis
  • colitis
  • purpuric skin rash
  • vasculitis
48
Q

what does IgA nephropathy show on renal biopsy

A

mesangial cell proliferation and expansion on light microscopy

IgA deposits in mesangium on immunofluroesence

49
Q

treatment for IgA nephroapthy

A

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

50
Q

what percentage of IgA nephropathies progress to end stage renal failure in 10-30 years

A

25%

51
Q

when does IgA nephropathy tend to present

A

childhood

during an infection

52
Q

what is rapidly progressive glomerulonephritis (RPGN)

A

nephritic syndrome caused by crescent shaped proliferation of the glomerulus

causes rapid deterioration in renal function over days/weeks

53
Q

signs of RPGN

A

rapid deterioration of kidney function

active urinary sediment (RBCs, RBC and granular casts)

glomerular crescents on biopsy

54
Q

what are some ANCA positive causes of RPGN

A

Systemic vasculitis
Granulomatosis with polyangitis
Microscopic polyangitis

55
Q

what are some ANCA negative causes of RPGN

A

Goodpastures disease
HSP
Lupus

56
Q

what antibody causes RPGN in goodpastures disease

A

anti-GBM (glomerular basement membrane)

57
Q

Treatment for RPGN

A

Strong immunosuppression with supportive care and dialysis if needed

Steroids
Cytotoxics

Plasmapharesis

2 RENAL (20 decks)

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