Glomerulonephritis Flashcards
How are glomerulonephritis classified?
Biopsy findings
What cells can be injured in glomerulonephritis?
Parietal epithelial cells
Podocytes
Mesangial cells
Endothelial cells
What are the pathological mechanisms by which glomerulonephritis occurs?
Antibodies Immune complexes Comeplement Cell mediated mechanisms (cytokines, growth factors, proteinuria) Metabolic/genetic/vascular causes
Give examples of possible secondary causes of glomerulonephritis?
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
What basic investigations should be done in suspected glomerulonephritis?
U&Es Urinalysis Quantify proteinuria Check albumin Check ultrasound
What is involved in a glomerulonephritis screen?
ANCA Anti-Gum ana/DS dna Complement Anti-PLA2R Immunoglobulins Rheumatoid factor Virology - hep B, hep C, HIV HbA1c Myeloma screen
How is a kidney biopsy examined for possible glomerulonephritis?
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
Describe the possible presentations of glomerulonephropathies.
Incidental finding of urinary abnormalities/impaired kidney function
Visible haematuria
Synpharyngitic
Nephritic syndrome
Nephrotic syndrome
Acutely unwell with rapidly progressive glomerulonephritis
What are the key features of nephrotic syndrome?
3.5g of proteinuria in 24 hours
serum albumin <30
Oedema
Usually also hyperlipidaemia
What increased risks are associated with nephrotic syndrome?
Risk of venous thromboembolism
Increased risk of infection
Why is there an increased risk of venous thromboembolism and infection in nephrotic syndrome?
Natural anticoagulants and immunoglobulin are lost in the urine due to problems with the glomerular filtration barrier
What type of glomerulonephritis can present with nephrotic syndrome?
Minimal change
Focal segmental glomerulosclerosis
Membranous glomerulonephritis
What are the key features of nephritic syndrome?
Hypertension
Haematuria
Proteinuria
Nephritic syndrome is proliferative. T/F?
True
Nephrotic syndrome is proliferative. T/F?
False
What can cause nephritic syndrome?
IgA
Lupus
Post-infection
What cause of glomerulonephritis is most associated with a synpharyngitic presentation?
IgA nephropathy
Describe the histological appearance of rapidly progressive glomerulonephritis?
Rapid rise in serum creatinine
Crescentic damage due to vasculitis/lupus/IgA
What glomerular disease are more likely to present with nephritic syndrome than nephrotic syndrome?
Anti-GBM disease
Small vessel vasculitis
Post streptococcal glomerulonephritis
IgA nephropathy
What glomerular disease are more likely to present with nephrotic syndrome than nephritic syndrome?
Minimal change nephropathy Focal segmental glomerulosclerosis Membranous nephropathy Diabetic nephropathy Amyloidosis
What systemic disease can present as either nephritic or nephrotic syndrome or a mixture of both?
Systemic lupus erythematosus
Describe the spectrum of disease in IgA nephropathy?
Minor urinary abnormalities Hypertension Renal impairment Heavy proteinuria Rapidly progressive glomerulonephritis
What is the most common primary glomerular disease?
IgA nephropathy
Describe the pathogenesis of IgA nephropathy?
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
How is IgA nephropathy treated?
Antihypertensives, particularly ACE inhibitors aiming for bp <125/75 mmHg
What can act as a prognostic indicator in IgA nephropathy?
Proteinuria
Membranous glomerulonephritis is usually idiopathic but can occur secondary to…?
Malignancy
CTD
Drugs
What antibody is often present tin membranous glomerulonephritis?
Anti-phospholipase A2 receptor antibody
Describe the outcome of membranous glomerulonephritis
1/3 spontaneously remit
1/3 progress to end stage renal failure
1/3 have persistent proteinuria but maintain GFR
Describe the histological appearance of membranous glomerulonephritis?
Immune complexes in the basement membrane and sub-epithelial spaces
What supportive treatments can be used in membranous glomerulonephritis?
ACE inhibitors
Statins
Diuretics
Salt restriction
What specific immunotherapies can be used in membranous glomerulonephritis?
Steroids
Alkylating agents (cyclophosphamide)
Alternative agents (rituximab, anto-CD20 MAB)
Cyclosporin
What is the most common form of glomerulonephritis in children?
Minimal change disease
Minimal change disease is usually idiopathic but can be secondary to…?
Malignancy
What immune factors mediate minimal change disease?
T cells
Cytokines
Describe the histological appearance of minimal change disease?
Changes to the glomerular basement membrane can only be seen on electron microscopy where there is fusion of podocytes
How is minimal change disease treated?
High dose steroids usually prednisolone 1mg/kg for up to 8 weeks
Minimal change disease rarely causes renal failure. T/F?
True
What are the common causes of crescentic glomerulonephritis?
ANCA Vasculitis Good pasture's syndrome Lupus nephritis Infection associated nephritis HSP nephritis
Describe the outcome of crescentic glomerulonephritis?
Aggressive disease which progresses to end stage renal failure
