Glomerulonephritis Flashcards
what is glomerulonephritis?
immune mediated of the glomeruli and secondary tubulointerstitial damage, eventually leading to damage of the podocytes/basement membrane/mesangial cells. this causes proteinuria/haematuria.
damage to the _____ results in nephrotic syndrome?
podocytes
clinical features of nephrotic syndrome?
damaged podocytes = non proliferative GN proteinuria (>3g/day) FROTHY urine hypoalbuminaemia <25g/L) oedema hyperlipidaemia
kidney function remains normal
damage to ___ results in nephritic syndrome?
damaged endothelial cells = proliferative GN
haematuria (+++) dysmorphic RBCs and RBC casts*
oligouria
mild hypertension
risk of acute renal failure!
which is more serious nephrotic or nephritic syndrome?
nephritic syndrome!! - risk of acute renal failure
renal function remains normal in nephrotic syndrome
diseases that cause primary nephrotic syndrome?
- minimal change GN
- follicular segmental glomerulosclerosis
- Membranous GN
diseases associated with nephritic syndrome?
- IgA nephropathy (days after URTI)
- rapidly progressive (crescentric) GN (vasculitis/goodpasteures)
- membranous proliferative GN (SLE, Hep B/C)
- post infectious GN
- HSP
what investigations can be done on a renal biopsy?
light microscopy
electron microscopy
immunofluorescence
what are the principle aims of GN treatment?
- reduce proteinuria
- induce remission for nephrotic syndrome
- preserve long term kidney function
what are the BP targets for someone with/without proteinuria?
without proteinuria: <130/86
with proteinuria: <120/75
levels of proteinuria for partial vs complete remission?
partial remission: <300mg/day
complete remission: <3mg/day
proteinuria levels for... microalbuminuria? asymptomatic proteinuria? heavy proteinuria? nephrotic syndrome?
microalbuminuria: <300 mg/day
asymptomatic proteinuria: <1g/day
heavy proteinuria: 1-3g/day
nephrotic syndrome: >3g/day
what is the most common type of (non-proliferative) GN in children?
minimal change nephropathy
investigation of choice for minimal change nephropathy?
electron microscopy - fused,flattened podocytes
note: cant see any disease with LM
you can see pathology in minimal change nephropathy using light microscopy?
false! must use electron microscopy
treatment for minimal change nephropathy?
1st line: steroids (complete remission in 90%)
2nd line: cyclophosphamide
does minimal change nephropathy cause renal failure?
no
what is follicular segmental glomerulosclerosis (FSGS)?
non-proliferative GN - nephrotic syndrome
commonest cause of nephrotic syndrome in adults
investigation for FSGS?
light microscopy of renal biopsy = shows effacement of foot processes
causes of FSGN?
genetic or due to HIV, drugs, Hep B/C, reflux nephropathy
treatment for FSGN
steroids, immunosuppression
transplant is often required as 50% end up with renal failure within ten years
findings on renal biopsy of membranous glomerulonephritis?
LM - thickening of the GBM
IF - IgG deposits and C3 along GBM
EM- electron dense sub-epithelial deposits (spike & dome appearance)
what is the most common type of GN worldwide?
IgA nephropathy
when does IgA nephropathy appear?
1-2 days after URTI, GI infection, HSP
findings on renal biopsy of IgA nephropathy?
proliferation of mesangial cells,
IgA and C3 deposits
prognosis for IgA nephropathy?
25% go onto have renal failure in 10-30 years
rapidly progressive GN is also known as?
crescentric GN
a man presents with sob, haemoptysis and haematuria, what does he have?
goodpastures syndrome
what type of hypersensitivity reaction occurs in goodpastures syndrome?
type II hypersensitivity reaction (immune comples), anti-GBM IgG attacks proteins in the alveoli and kidneys
treatment of goodpastures
high dose immunosuppression as any renal damage is irreversible
HSP can cause RPGN. what is HSP?
type of small vessel vasculitis seen in kids after an URTI (group A strep)
IgA attaches to the intestines and kidneys causing bloody diahorrea, haematuria, abdominal pain and a palpable purpuric rash on the buttocks
treatment is supportive
what are some ANCA positive (+) causes of RPGN?
GPA- cANCA, anti-PR3
MPA - pANCA, anti-MPO
what are some ANCA negative (-) causes of RPGN?
goodpastures
HSP
SLE
what type of GN is associated with both nephritic and nephrotic syndrome?
membraneoproliferative GN
most cases of minimal change GN are idiopathic, but some are associated with…
hodgkins lymphoma
how does damage to the podocytes result in albumin leaking out in nephrotic syndrome?
normally the foot processes of the podocytes are negatively charged and repel the albumin (also negatively charged). Immune cells damage the podocytes processes (and removes the repelling force)
treatment for membranous glomerulonephritis?
ACEi for all patients, steroids, anti-coagulate high risk patients
prognosis for membranous glomerulonephritis?
rule of thirds
30% remission, 30% CKD, 30% ESRF
which type of GN typically presents as macroscopic haematuria in a young person, days after an URTI?
IgA nephropathy
IgA nephropathy is a type ___ hypersensitivity reaction?
type 3, immune complex mediated (IgA, C3 deposits)
most common type of GN in adults?
membranous glomerulonephritis (causes nephrotic syndrome)
triad of nephrotic syndrome?
oedema
hypoalbuminaemia (usually less then 30g/L)
heavy urinary protein loss (more than 3g/24hours
some complications of nephrotic syndrome?
VTE and infections (due to loss of immunoglobulins)
