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1. Renal > Glomerulonephritis > Flashcards

Glomerulonephritis Flashcards

1
Q

What is GN?

A

immune mediated disease of the kidneys affecting the glomeruli

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2
Q

What are the two possible pathophysiologies of GN?

A

humoral antibody mediated - antigen recognises the kidney to be forgien in so there are immune complexes deposited and block the sieve
cell mediated - T cells are upregulated causing toxic damage

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3
Q

What is the underlying pathophysiology of GN?

A

distruption to the barrier of the glomerular capillary wall which leads to haematuria and/or proteinuria

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4
Q

What are the 3 cel types that can be damaged in GN?

A

endothelial cells
mesangial cells
podocytes

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5
Q

What is the most common cell to be damaged in GN?

A

mesangial cells

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6
Q

What are the characteristics of endothelial and mesangial cell GN?

A

proliferative lesion
aggressive disease
blood in urine

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7
Q

What are the characteristics of podocyte cell GN?

A

no inflammatory response
non proliferative lesion
protein leak

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8
Q

What do mesangium cells release when they are damaged?

A

Ang 2

chemokine release

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9
Q

What disease does mesangial cell damage commonly present with?

A

HSP

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10
Q

How is GN diagnosed?

A 
painless haematuria
microalbuminuria
asymptomatic proteinuria
nephrotic/nephritic syndrome 
impaired renal function
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11
Q

What do red cell casts in the urine show?

A

endothelial injury

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12
Q

What does nephritic syndrome indicate?

A

endothelial injury

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13
Q

What is nephritic syndrome?

A 
acute renal failure
oliguria and haematuria 
oedema/fluid retention
hypertension 
active urinary sediment - granular casts, RBCs
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14
Q

What does nephrOtic syndrome indicate?

A

podocyte injury

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15
Q

What is nephrOtic syndrome?

A 
proteinuria >3g/day
hypoalbuminuria - causes low oncotic pressure so water is driven out of cells and into tissues
oedema
hypercholesterolaemia
NORMAL RENAL FUNCTION
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16
Q

What are the complications of nephrotic syndrome?

A

infections
renal vein thrombosis
pulmonary emboli in lungs and legs
volume depletion - may lead to AKI

17
Q

What are the blood pressure targets for someone with GN?

A

<130/80

OR <120/75 if proteinuria

18
Q

What are the treatments for GN?

A 
Antihypertensives - ACEis/ARBs (reduce proteinuria)
diuretics
statins
Immunosuppresives 
Plasma pheresis 
IV immunoglobulins
monoclonal T and B cell antibodies
19
Q

What can cause GN?

A

idiopathic - mainly
infections - HIV, hepatitis, bacteria
drugs - gold, penicilamine
malignancies - immune response against abnormal cells
part of systemic disease - GPA, good pastures, HSP

20
Q

How is GM diagnosed and classified?

A

light microscopy
electron microscopy
immunoflurensence

21
Q

What is seen on light microscopy of GN?

A

sclerosis
crescents - BAD
if vasculitis - sarcoid
inflammatory cells and reactive proliferations

22
Q

What is seen on electron microscopy of GN?

A

can look at the basement membrane and see what layers are damaged

23
Q

What is seen on immunofluresence of GN?

A

in good pastures - linear IgG againsts the collagen in the basement membrane

24
Q

What is goodpastures syndrome?

A

IgG antibodies attack the subunit of collagen in the basement membrane in the lungs and kidney

25
Q

How does goodpastures present?

A

haemoptysis

kidney failure

26
Q

How does vasculitis affect the glomerular sieve?

A

distrupts the membrane charges and blocks the membrane and allows things like RBCs and albumin and protien through

27
Q

What are the different types of idiopathic GN?

A 
IgA nephropathy
Focal segmental 
Membranous
Minimal change
Membranoproliferative
28
Q

Describe IgA nephropathy?

A 
commonest GN in the world
mesangial cell proliferation
IgA depostis in mesangium on immunofloresence
BP control/ACEi/ARBS/fish oil
neprhitic syndrome and smokey urine
29
Q

Describe focal segmental GN?

A

adults
- HIV, sickle cell, IV drug users, obesity
nephritic syndrome
remission with prolonged steroids
IgG/complement depositon on immunofluresence

30
Q

Describe Membranous?

A

often caused by lupus
infections, drugs, malignancy, autoimmune
nephrotic syndrome
SPIKEY thick membranes - white spaces are the immune complexes in the basement membranes, antigens stick to and damage podocytes
treament - steroids, ankylating agents, B cell monoclonal antibodies

31
Q

Describe Minimal change?

A 
kids get it!
presents with nephrotic syndrome
good prognosis with steroid treatment 
antibody against Podocytes
normal renal biopsy
32
Q

Describe membranoproliferative?

A

adults and children are affected
can be nephrotic or nephritic
big lobulated hypercellular glomeruli with thick membranes - tram tracks

1. Renal (28 decks)

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