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Nephrology and Urology > Glomerulonephritis > Flashcards

Glomerulonephritis Flashcards

1
Q

How are glomerulonephritis classified?

A

Biopsy findings

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2
Q

What cells can be injured in glomerulonephritis?

A

Parietal epithelial cells
Podocytes
Mesangial cells
Endothelial cells

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3
Q

What are the pathological mechanisms by which glomerulonephritis occurs?

A 
Antibodies
Immune complexes
Comeplement
Cell mediated mechanisms (cytokines, growth factors, proteinuria)
Metabolic/genetic/vascular causes
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4
Q

Give examples of possible secondary causes of glomerulonephritis?

A 
Myeloma
Lymphoblastic leukaemia
PRV
Autoimmune liver disease
IBD 
Coeliac disease
Diabetes
NSAIDs
Bisphosphonates
Heroin
RS
Lupus
Amyloid
Connective tissue disease
Hepatitis
HIV
Chronic infections
Antibiotics
Malria
Bronchiectasis
Lung cancer
TB
Renal syndrome
Subacute bacterial endocarditis
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5
Q

What basic investigations should be done in suspected glomerulonephritis?

A 
U&Es
Urinalysis
Quantify proteinuria
Check albumin
Check ultrasound
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6
Q

What is involved in a glomerulonephritis screen?

A 
ANCA
Anti-Gum
ana/DS dna
Complement
Anti-PLA2R
Immunoglobulins
Rheumatoid factor
Virology - hep B, hep C, HIV
HbA1c
Myeloma screen
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7
Q

How is a kidney biopsy examined for possible glomerulonephritis?

A

Light microscopy to look at glomerular and tubular structure
Immunofluorescence looking for Ig and complement
Electron microscopy looking at the glomerular basement membrane and pathological spectrum

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8
Q

Describe the possible presentations of glomerulonephropathies.

A

Incidental finding of urinary abnormalities/impaired kidney function
Visible haematuria
Synpharyngitic
Nephritic syndrome
Nephrotic syndrome
Acutely unwell with rapidly progressive glomerulonephritis

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9
Q

What are the key features of nephrotic syndrome?

A

3.5g of proteinuria in 24 hours
serum albumin <30
Oedema
Usually also hyperlipidaemia

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10
Q

What increased risks are associated with nephrotic syndrome?

A

Risk of venous thromboembolism

Increased risk of infection

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11
Q

Why is there an increased risk of venous thromboembolism and infection in nephrotic syndrome?

A

Natural anticoagulants and immunoglobulin are lost in the urine due to problems with the glomerular filtration barrier

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12
Q

What type of glomerulonephritis can present with nephrotic syndrome?

A

Minimal change
Focal segmental glomerulosclerosis
Membranous glomerulonephritis

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13
Q

What are the key features of nephritic syndrome?

A

Hypertension
Haematuria
Proteinuria

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14
Q

Nephritic syndrome is proliferative. T/F?

A

True

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15
Q

Nephrotic syndrome is proliferative. T/F?

A

False

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16
Q

What can cause nephritic syndrome?

A

IgA
Lupus
Post-infection

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17
Q

What cause of glomerulonephritis is most associated with a synpharyngitic presentation?

A

IgA nephropathy

18
Q

Describe the histological appearance of rapidly progressive glomerulonephritis?

A

Rapid rise in serum creatinine

Crescentic damage due to vasculitis/lupus/IgA

19
Q

What glomerular disease are more likely to present with nephritic syndrome than nephrotic syndrome?

A

Anti-GBM disease
Small vessel vasculitis
Post streptococcal glomerulonephritis
IgA nephropathy

20
Q

What glomerular disease are more likely to present with nephrotic syndrome than nephritic syndrome?

A 
Minimal change nephropathy
Focal segmental glomerulosclerosis
Membranous nephropathy
Diabetic nephropathy
Amyloidosis
21
Q

What systemic disease can present as either nephritic or nephrotic syndrome or a mixture of both?

A

Systemic lupus erythematosus

22
Q

Describe the spectrum of disease in IgA nephropathy?

A 
Minor urinary abnormalities
Hypertension
Renal impairment
Heavy proteinuria
Rapidly progressive glomerulonephritis
23
Q

What is the most common primary glomerular disease?

A

IgA nephropathy

24
Q

Describe the pathogenesis of IgA nephropathy?

A

Can be precipitated by infection and can be secondary to HSP, cirrhosis and coeliac disease
There is abnormal or over-production of IgA 1 which depositis in the mesangium causing proliferation leading to haemturia, hypertension and proteinuria

25
Q

How is IgA nephropathy treated?

A

Antihypertensives, particularly ACE inhibitors aiming for bp <125/75 mmHg

26
Q

What can act as a prognostic indicator in IgA nephropathy?

A

Proteinuria

27
Q

Membranous glomerulonephritis is usually idiopathic but can occur secondary to…?

A

Malignancy
CTD
Drugs

28
Q

What antibody is often present tin membranous glomerulonephritis?

A

Anti-phospholipase A2 receptor antibody

29
Q

Describe the outcome of membranous glomerulonephritis

A

1/3 spontaneously remit
1/3 progress to end stage renal failure
1/3 have persistent proteinuria but maintain GFR

30
Q

Describe the histological appearance of membranous glomerulonephritis?

A

Immune complexes in the basement membrane and sub-epithelial spaces

31
Q

What supportive treatments can be used in membranous glomerulonephritis?

A

ACE inhibitors
Statins
Diuretics
Salt restriction

32
Q

What specific immunotherapies can be used in membranous glomerulonephritis?

A

Steroids
Alkylating agents (cyclophosphamide)
Alternative agents (rituximab, anto-CD20 MAB)
Cyclosporin

33
Q

What is the most common form of glomerulonephritis in children?

A

Minimal change disease

34
Q

Minimal change disease is usually idiopathic but can be secondary to…?

A

Malignancy

35
Q

What immune factors mediate minimal change disease?

A

T cells

Cytokines

36
Q

Describe the histological appearance of minimal change disease?

A

Changes to the glomerular basement membrane can only be seen on electron microscopy where there is fusion of podocytes

37
Q

How is minimal change disease treated?

A

High dose steroids usually prednisolone 1mg/kg for up to 8 weeks

38
Q

Minimal change disease rarely causes renal failure. T/F?

A

True

39
Q

What are the common causes of crescentic glomerulonephritis?

A 
ANCA Vasculitis
Good pasture's syndrome
Lupus nephritis
Infection associated nephritis
HSP nephritis
40
Q

Describe the outcome of crescentic glomerulonephritis?

A

Aggressive disease which progresses to end stage renal failure

Nephrology and Urology (13 decks)

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