Glomerulonephritis Flashcards
What is glomerulonephritis
Immune-mediated disease of the kidneys affecting the glomeruli
Also causes secondary tubulointerstitial damage
What type of glomerulonephritis does damage to endothelial or mesangial cells cause
Proliferative
Get an influx of inflammatory cells and RBC in the urine
What type of glomerulonephritis does damage to podocytes cause
Non-proliferative lesions
Not as extreme an inflammatory response
Protein in the urine
Why do damaged podocytes lead to proteinuria
The finger like projections atrophy which reduces the effectiveness of the barrier
Larger molecules such as proteins can now filter through
Which urine tests can be done to diagnose GN
Urinalysis - haematuria and proteinuria
Urine microscopy - RBC (dysmorphic), RBC & granular casts, lipiduria
Urine Protein: Creatinine Ratio or 24hr urine - quantify proteinuria
What type of haematuria will GN cause
Asymptomatic microscopic
Or painless macroscopic
Why do RBC become dysmorphic if found in urine
Squeezed out of shape as they have passed through the nephron – come from glomerulus
What are the signs of nephritic syndrome
Acute renal failure Oliguria - not peeing as much Oedema - fluid retention Hypertension RBC and casts in urine
What does nephritic syndrome suggest
A proliferative process of GN
Likely the endothelial cells affected
What are the signs of nephrotic syndrome
Proteinuria Hypalbuminaemia Oedema Hypercholesterolaemia Normal renal function and BP
What does nephrotic syndrome suggest
A non-proliferative process of GN
Affects the podocytes
How are hypoalbuminaemia and hypercholesterolaemia connected in GN
Liver cannot produce enough albumin to keep up with loss so become hypoalbuminaemia
High cholesterol from liver trying to increase function
List complications of nephrotic syndrome
Infections - lose antibodies
Renal vein thrombosis
Pulmonary emboli
Volume depletion - BE CAREFUL with diuretics
What is primary GN
Idiopathic
Majority of cases
What is secondary GN
Caused by something such as infection or drugs
Associated with malignancy
May be part of systemic disease - ANCA vasculitis, lupus, goodpastures etc
What are the aims of GN treatment
Reduce degree of proteinuria
Induce remission of nephrotic syndrome
Preserve longterm renal function
How do you treat GN in a non-immunosuppressive manner
Anti-hypertensives - ACEi, ARB, diuretic
Statins
May need anticoagulants/ antiplatelet
How do you treat GN with immunosuppression
Corticosteroids Azathioprine Alkylating agents Calcineurin inhibitors - cyclosporin MMF Plasmapheresis IV immunoglobulins Monoclonal antibodies
How do you manage nephrotic patients
Fluid and salt restriction Diuretics ACEi/ARB IV albumin if volume depleted May need anti-coagulation Immunosuppression
Describe minimal change nephropathy
Comments type in kids
Most recover with oral steroids
Some need second line drugs
Don’t cause progressive renal failure
Describe focal segmental glomerulosclerosis
Commonest cause of nephrotic syndrome in adults
Only affects some parts of glomeruli
can be due to HIV, heroin, obesity, reflux
Some can go into remission with steroids
50% will progress to end stage renal failure
Describe membranous nephropathy
2ND commonest cause of nephrotic syndrome in adults
Can be idiopathic or caused by infection (hep B), CTD (lupus), malignancy or drugs
Will see immune complex deposition in basement membrane on biopsy
Treat with Steroids/ Alkylating agents/B cell monoclonal Ab
What is the most common type of GN in the world
IgA nephropathy
What is IgA nephropathy associated with
Henoch-Schonlein Purpura (HSP)
How does IgA nephropathy present
Asymptomatic microhaematuria and non-nephrotic range proteinuria
Macroscopic haematuria after resp or GI infection with kidney pain
AKI or CKD
HSP
Will see IgA deposits and mesangial proliferation on biopsy
Can cause renal failure
How do you treat IgA nephropathy
BP control/ ACE inhibitors & ARBs/ Fish oil
How does Henoch-Schonlein Purpura (HSP) present
Purpuric skin rash
Colitis
Arthritis
What is Rapidly Progressive Glomerulonephritis (RPGN)
Rapid deterioration in renal function over days/weeks
Cause of acute renal failure
May be part of systemic disease - vasculitis
Treatable
What is the classic sign of RPGN
Glomerular crescents on biopsy.
How do you treat RPGN
Strong immunosuppression:
Steroids - prednisolone
Cytotoxic - azathioprine
Plasmapheresis
May need dialysis
