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Renal > Glomerulonephritis > Flashcards

Glomerulonephritis Flashcards

1
Q

What is glomerulonephritis

A

Immune-mediated disease of the kidneys affecting the glomeruli
Also causes secondary tubulointerstitial damage

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2
Q

What type of glomerulonephritis does damage to endothelial or mesangial cells cause

A

Proliferative

Get an influx of inflammatory cells and RBC in the urine

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3
Q

What type of glomerulonephritis does damage to podocytes cause

A

Non-proliferative lesions
Not as extreme an inflammatory response
Protein in the urine

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4
Q

Why do damaged podocytes lead to proteinuria

A

The finger like projections atrophy which reduces the effectiveness of the barrier
Larger molecules such as proteins can now filter through

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5
Q

Which urine tests can be done to diagnose GN

A

Urinalysis - haematuria and proteinuria
Urine microscopy - RBC (dysmorphic), RBC & granular casts, lipiduria
Urine Protein: Creatinine Ratio or 24hr urine - quantify proteinuria

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6
Q

What type of haematuria will GN cause

A

Asymptomatic microscopic

Or painless macroscopic

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7
Q

Why do RBC become dysmorphic if found in urine

A

Squeezed out of shape as they have passed through the nephron – come from glomerulus

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8
Q

What are the signs of nephritic syndrome

A 
Acute renal failure 
Oliguria - not peeing as much 
Oedema - fluid retention 
Hypertension 
RBC and casts in urine
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9
Q

What does nephritic syndrome suggest

A

A proliferative process of GN

Likely the endothelial cells affected

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10
Q

What are the signs of nephrotic syndrome

A 
Proteinuria 
Hypalbuminaemia
Oedema 
Hypercholesterolaemia 
Normal renal function and BP
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11
Q

What does nephrotic syndrome suggest

A

A non-proliferative process of GN

Affects the podocytes

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12
Q

How are hypoalbuminaemia and hypercholesterolaemia connected in GN

A

Liver cannot produce enough albumin to keep up with loss so become hypoalbuminaemia
High cholesterol from liver trying to increase function

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13
Q

List complications of nephrotic syndrome

A

Infections - lose antibodies
Renal vein thrombosis
Pulmonary emboli
Volume depletion - BE CAREFUL with diuretics

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14
Q

What is primary GN

A

Idiopathic

Majority of cases

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15
Q

What is secondary GN

A

Caused by something such as infection or drugs
Associated with malignancy
May be part of systemic disease - ANCA vasculitis, lupus, goodpastures etc

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16
Q

What are the aims of GN treatment

A

Reduce degree of proteinuria
Induce remission of nephrotic syndrome
Preserve longterm renal function

17
Q

How do you treat GN in a non-immunosuppressive manner

A

Anti-hypertensives - ACEi, ARB, diuretic
Statins
May need anticoagulants/ antiplatelet

18
Q

How do you treat GN with immunosuppression

A 
Corticosteroids 
Azathioprine 
Alkylating agents 
Calcineurin inhibitors - cyclosporin 
MMF 
Plasmapheresis 
IV immunoglobulins 
Monoclonal antibodies
19
Q

How do you manage nephrotic patients

A 
Fluid and salt restriction 
Diuretics 
ACEi/ARB 
IV albumin if volume depleted 
May need anti-coagulation
Immunosuppression
20
Q

Describe minimal change nephropathy

A

Comments type in kids
Most recover with oral steroids
Some need second line drugs
Don’t cause progressive renal failure

21
Q

Describe focal segmental glomerulosclerosis

A

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

22
Q

Describe membranous nephropathy

A

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

23
Q

What is the most common type of GN in the world

A

IgA nephropathy

24
Q

What is IgA nephropathy associated with

A

Henoch-Schonlein Purpura (HSP)

25
Q

How does IgA nephropathy present

A

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

26
Q

How do you treat IgA nephropathy

A

BP control/ ACE inhibitors & ARBs/ Fish oil

27
Q

How does Henoch-Schonlein Purpura (HSP) present

A

Purpuric skin rash
Colitis
Arthritis

28
Q

What is Rapidly Progressive Glomerulonephritis (RPGN)

A

Rapid deterioration in renal function over days/weeks
Cause of acute renal failure
May be part of systemic disease - vasculitis
Treatable

29
Q

What is the classic sign of RPGN

A

Glomerular crescents on biopsy.

30
Q

How do you treat RPGN

A

Strong immunosuppression:
Steroids - prednisolone
Cytotoxic - azathioprine
Plasmapheresis

May need dialysis

Renal (18 decks)

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