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Year 3- Medicine > Glomerulonephritis > Flashcards

Glomerulonephritis Flashcards

1
Q

Define nephrotic syndrome

A

Oedema
Albumin <30
Urine PCR >350 (more than 3.5 grams of protein in 24 hrs)

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2
Q

What are the complications of nephrotic syndrome?

A 
Higher risk of infection
VTE
Progression of CKD
Hypertension 
Hyperlipidaemia
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3
Q

What are the causes of nephrotic syndrome?

A

Minimal change disease (children)
Focal segmental glomerulosclerosis - idiopathic or secondary to: infection, malignancy, drugs etc
Membranous nephropathy idiopathic or secondary to: see above
Membranoproliferatice glomerulonephritis (more commonly-nephritic syndrome)

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4
Q

Name some conditions in which the pt may have nephrotic range proteinuria but not the other features?

A

Amyloidosis
Diabetes
Myeloma

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5
Q

Define the various presentations that can be present in someone with nephritic syndrome

A
  • AKI
  • urine: blood +/- protein
  • mild to moderate oedema
  • proteinuria <3.5g/24hrs
  • hypertension
  • sometimes visible haematuria
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6
Q

What are the associations with post-infectious GN?

A

Present weeks post groups A/B haemolytic streptococci infections

Usually affects children ages 3-12

Can lead to PRGN (rapidly progressing glomerulonephritis)

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7
Q

What are the investigation findings associated with post infectious GN?

A

Positive anti-strep antibodies
Low serum C3
Biopsy: immune complex deposition IgG, IgM, C3

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8
Q

What is the treatment for post infectious GN?

A

Usually self-limiting
Supportive tx:
- ACEi/ARB for proteinuria/hypertension
- low sodium diet

May need renal replacement therapy if it progresses to end stage renal failure

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9
Q

What are the associations with IgA Nephropathy?

A

Episodic gross haematuria during or directly after URTI/ GI infection/ strenuous exercise

Men more than women

10-20 years

25-30% progression to ESRF

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10
Q

What are the investigation findings associated with IgA nephropathy?

A

Haematuria: intermittently visible
Increase serum IgA
Normal C3. C4

Biopsy: mesangial immune complex deposits in the glomeruli

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11
Q

What is the tx for IgA nephropathy?

A

Supportive therapy:

- ACEi/ARB for proteinuria and hypertension

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12
Q

What are the associations with Anti-GBM disease (good pasture syndrome)?

A

20-30 - men more than women
+60- women more than men

Antibodies against type IV collagen - react with pulmonary basement membrane causing haemoptysis

Can lead to RPGN

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13
Q

What are the investigation findings associated with anti-GBM disease (goodpasture syndrome)?

A

Anti-GBM antibodies
Pulmonary infiltrates on CXR

Biopsy: linear deposition of IgG along BM

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14
Q

What is the tx for anti-GBM disease (goodpasture syndrome)?

A

Plasma exchange and immunosuppression

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15
Q

What is the treatment for all types of small vessel vasculitis? (ANCA associated vasculitis)

A

Immunosuppression

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16
Q

What are the associations with thin basement membrane disease?

A

Hereditary

Abnormalities of type IV collagen

Good prognosis

17
Q

What are the investigation findings associated with thin basement membrane disease?

A

Persistent haematuria- possible intermittently visible

Biopsy: diffuse thinning of GBM

18
Q

What is the tx of thin basement membrane disease?

A

Monitor renal function

Supportive tx

19
Q

What are the associations with alport syndrome?

A

X-linked: usually affects males

Mutation in gene coding for type V collagen

Associated with hearing loss and abnormalities of the eyes

Often leads to ESFR

20
Q

What are the investigation findings associated with alport syndrome?

A

Persistent haematuria, intermittently visible

Sensorineural hearing loss

Biopsy: splitting of GBM and alternating thickening and thinning of GBM

Genetic studies- FH

21
Q

What is the tx for alport syndrome?

A

Support tx
RRT

Renal transplant- can lead to development of goodpasture syndrome

22
Q

What is associated with lupus Nephritis?

A

Background of SLE

Nephritic/nephrotic

23
Q

What are the investigation findings of lupus nephritis?

A

ANA and anti-dsDNA positive

24
Q

What is the tx for lupus nephritis?

A

Supportive tx

Immunosuppressive therapy based on classification/presentation

25
Q

What is the supportive treatment for glomerulonephritis?

A

ACEi/ARB for proteinuria
Control BP
Salt and water restrictions if volume overloaded
Diuretics for fluid overload
If low albumin then higher risk of VTE- consider LMWH
Statins for hypercholesterolaemia

26
Q

When would you offer renal replacement therapy/haemodialysis?

A

For pt with severe AKI or ESRF

27
Q

When would you offer plasma exchange?

A

For pt with ANCA associated vasculitis, anti-GBM

Year 3- Medicine (12 decks)

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