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dk renal > Glomerulonephritis > Flashcards

Glomerulonephritis Flashcards

1
Q

what is glomerulonephritis?

A

immune mediated of the glomeruli and secondary tubulointerstitial damage, eventually leading to damage of the podocytes/basement membrane/mesangial cells. this causes proteinuria/haematuria.

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2
Q

damage to the _____ results in nephrotic syndrome?

A

podocytes

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3
Q

clinical features of nephrotic syndrome?

A 
damaged podocytes = non proliferative GN
proteinuria (>3g/day) FROTHY urine 
hypoalbuminaemia <25g/L)
oedema
hyperlipidaemia

kidney function remains normal

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4
Q

damage to ___ results in nephritic syndrome?

A

damaged endothelial cells = proliferative GN
haematuria (+++) dysmorphic RBCs and RBC casts*
oligouria
mild hypertension

risk of acute renal failure!

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5
Q

which is more serious nephrotic or nephritic syndrome?

A

nephritic syndrome!! - risk of acute renal failure

renal function remains normal in nephrotic syndrome

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6
Q

diseases that cause primary nephrotic syndrome?

A
  • minimal change GN
  • follicular segmental glomerulosclerosis
  • Membranous GN
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7
Q

diseases associated with nephritic syndrome?

A
  • IgA nephropathy (days after URTI)
  • rapidly progressive (crescentric) GN (vasculitis/goodpasteures)
  • membranous proliferative GN (SLE, Hep B/C)
  • post infectious GN
  • HSP
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8
Q

what investigations can be done on a renal biopsy?

A

light microscopy
electron microscopy
immunofluorescence

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9
Q

what are the principle aims of GN treatment?

A
  • reduce proteinuria
  • induce remission for nephrotic syndrome
  • preserve long term kidney function
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10
Q

what are the BP targets for someone with/without proteinuria?

A

without proteinuria: <130/86

with proteinuria: <120/75

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11
Q

levels of proteinuria for partial vs complete remission?

A

partial remission: <300mg/day

complete remission: <3mg/day

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12
Q 
proteinuria levels for...
microalbuminuria?
asymptomatic proteinuria?
heavy proteinuria?
nephrotic syndrome?
A

microalbuminuria: <300 mg/day
asymptomatic proteinuria: <1g/day
heavy proteinuria: 1-3g/day
nephrotic syndrome: >3g/day

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13
Q

what is the most common type of (non-proliferative) GN in children?

A

minimal change nephropathy

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14
Q

investigation of choice for minimal change nephropathy?

A

electron microscopy - fused,flattened podocytes

note: cant see any disease with LM

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15
Q

you can see pathology in minimal change nephropathy using light microscopy?

A

false! must use electron microscopy

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16
Q

treatment for minimal change nephropathy?

A

1st line: steroids (complete remission in 90%)

2nd line: cyclophosphamide

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17
Q

does minimal change nephropathy cause renal failure?

A

no

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18
Q

what is follicular segmental glomerulosclerosis (FSGS)?

A

non-proliferative GN - nephrotic syndrome

commonest cause of nephrotic syndrome in adults

19
Q

investigation for FSGS?

A

light microscopy of renal biopsy = shows effacement of foot processes

20
Q

causes of FSGN?

A

genetic or due to HIV, drugs, Hep B/C, reflux nephropathy

21
Q

treatment for FSGN

A

steroids, immunosuppression

transplant is often required as 50% end up with renal failure within ten years

22
Q

findings on renal biopsy of membranous glomerulonephritis?

A

LM - thickening of the GBM
IF - IgG deposits and C3 along GBM
EM- electron dense sub-epithelial deposits (spike & dome appearance)

23
Q

what is the most common type of GN worldwide?

A

IgA nephropathy

24
Q

when does IgA nephropathy appear?

A

1-2 days after URTI, GI infection, HSP

25
Q

findings on renal biopsy of IgA nephropathy?

A

proliferation of mesangial cells,

IgA and C3 deposits

26
Q

prognosis for IgA nephropathy?

A

25% go onto have renal failure in 10-30 years

27
Q

rapidly progressive GN is also known as?

A

crescentric GN

28
Q

a man presents with sob, haemoptysis and haematuria, what does he have?

A

goodpastures syndrome

29
Q

what type of hypersensitivity reaction occurs in goodpastures syndrome?

A

type II hypersensitivity reaction (immune comples), anti-GBM IgG attacks proteins in the alveoli and kidneys

30
Q

treatment of goodpastures

A

high dose immunosuppression as any renal damage is irreversible

31
Q

HSP can cause RPGN. what is HSP?

A

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

32
Q

what are some ANCA positive (+) causes of RPGN?

A

GPA- cANCA, anti-PR3

MPA - pANCA, anti-MPO

33
Q

what are some ANCA negative (-) causes of RPGN?

A

goodpastures
HSP
SLE

34
Q

what type of GN is associated with both nephritic and nephrotic syndrome?

A

membraneoproliferative GN

35
Q

most cases of minimal change GN are idiopathic, but some are associated with…

A

hodgkins lymphoma

36
Q

how does damage to the podocytes result in albumin leaking out in nephrotic syndrome?

A

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)

37
Q

treatment for membranous glomerulonephritis?

A

ACEi for all patients, steroids, anti-coagulate high risk patients

38
Q

prognosis for membranous glomerulonephritis?

A

rule of thirds

30% remission, 30% CKD, 30% ESRF

39
Q

which type of GN typically presents as macroscopic haematuria in a young person, days after an URTI?

A

IgA nephropathy

40
Q

IgA nephropathy is a type ___ hypersensitivity reaction?

A

type 3, immune complex mediated (IgA, C3 deposits)

41
Q

most common type of GN in adults?

A

membranous glomerulonephritis (causes nephrotic syndrome)

42
Q

triad of nephrotic syndrome?

A

oedema
hypoalbuminaemia (usually less then 30g/L)
heavy urinary protein loss (more than 3g/24hours

43
Q

some complications of nephrotic syndrome?

A

VTE and infections (due to loss of immunoglobulins)

dk renal (5 decks)

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