Glomerulonephritis Flashcards
Define nephrotic syndrome
Oedema
Albumin <30
Urine PCR >350 (more than 3.5 grams of protein in 24 hrs)
What are the complications of nephrotic syndrome?
Higher risk of infection VTE Progression of CKD Hypertension Hyperlipidaemia
What are the causes of nephrotic syndrome?
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)
Name some conditions in which the pt may have nephrotic range proteinuria but not the other features?
Amyloidosis
Diabetes
Myeloma
Define the various presentations that can be present in someone with nephritic syndrome
- AKI
- urine: blood +/- protein
- mild to moderate oedema
- proteinuria <3.5g/24hrs
- hypertension
- sometimes visible haematuria
What are the associations with post-infectious GN?
Present weeks post groups A/B haemolytic streptococci infections
Usually affects children ages 3-12
Can lead to PRGN (rapidly progressing glomerulonephritis)
What are the investigation findings associated with post infectious GN?
Positive anti-strep antibodies
Low serum C3
Biopsy: immune complex deposition IgG, IgM, C3
What is the treatment for post infectious GN?
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
What are the associations with IgA Nephropathy?
Episodic gross haematuria during or directly after URTI/ GI infection/ strenuous exercise
Men more than women
10-20 years
25-30% progression to ESRF
What are the investigation findings associated with IgA nephropathy?
Haematuria: intermittently visible
Increase serum IgA
Normal C3. C4
Biopsy: mesangial immune complex deposits in the glomeruli
What is the tx for IgA nephropathy?
Supportive therapy:
- ACEi/ARB for proteinuria and hypertension
What are the associations with Anti-GBM disease (good pasture syndrome)?
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
What are the investigation findings associated with anti-GBM disease (goodpasture syndrome)?
Anti-GBM antibodies
Pulmonary infiltrates on CXR
Biopsy: linear deposition of IgG along BM
What is the tx for anti-GBM disease (goodpasture syndrome)?
Plasma exchange and immunosuppression
What is the treatment for all types of small vessel vasculitis? (ANCA associated vasculitis)
Immunosuppression
What are the associations with thin basement membrane disease?
Hereditary
Abnormalities of type IV collagen
Good prognosis
What are the investigation findings associated with thin basement membrane disease?
Persistent haematuria- possible intermittently visible
Biopsy: diffuse thinning of GBM
What is the tx of thin basement membrane disease?
Monitor renal function
Supportive tx
What are the associations with alport syndrome?
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
What are the investigation findings associated with alport syndrome?
Persistent haematuria, intermittently visible
Sensorineural hearing loss
Biopsy: splitting of GBM and alternating thickening and thinning of GBM
Genetic studies- FH
What is the tx for alport syndrome?
Support tx
RRT
Renal transplant- can lead to development of goodpasture syndrome
What is associated with lupus Nephritis?
Background of SLE
Nephritic/nephrotic
What are the investigation findings of lupus nephritis?
ANA and anti-dsDNA positive
What is the tx for lupus nephritis?
Supportive tx
Immunosuppressive therapy based on classification/presentation
