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BPT Renal > Glomerulonephritis > Flashcards

Glomerulonephritis Flashcards

1
Q

What is glomerulonephritis?

A

kidney disease that result from immunologic and inflammatory injury to the glomeruli

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2
Q

What are the features of nephrotic syndrome?

A

proteinuria, hypoalbuminaemia, oedema, hyperlipidaemia, variable haematuria, normo or hypertensive, variable GFR decline

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3
Q

What are the features of nephritic syndrome?

A

haematuria, hypertension, rapidly progressive GFR, may have nephrotic range proteinuria

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4
Q

What are the pathogenic types of GN?

A

immune complex GN, pauci-immune GN, anti GBM GN, monoclonal Ig GN, C3 glomerulopathy

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5
Q

What is immune complex GN?

A

characterised by granular deposits of polyclonal Ig

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6
Q

What are the main types of immune complex GN?

A

IgA nephropathy, lupus nephritis, fibrillary GN, infection related GN

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7
Q

What is the most common cause of primary GN?

A

IgA nephropathy

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8
Q

Which patients typically get IgA nephropathy?

A

males in teens to 20s

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9
Q

How do most patients with IgA nephropathy present?

A

with macroscopic haematuria

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10
Q

What are other less common ways that IgA nephropathy can present?

A

flank pain, fever, microscopic haematuria, mild proteinuria, malignant HTN, AKI

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11
Q

What other diseases is IgA nephropathy associated with?

A

cirrhosis, coeliac disease, HIV, minimal change disease, membranous GN, GPA

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12
Q

What are the indications for renal biopsy in IgA nephropathy?

A

persistent protein excretion, elevated serum creatinine, new onset hypertension, significant elevation in BP above previous stable baseline

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13
Q

When does lupus nephritis usually develop?

A

within 3-36 months of diagnosis of SLE

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14
Q

What regular testing should be done for patients with SLE?

A

urinalysis, spot PCR, serum creatinine, eGFR, dsDNA, complement levels

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15
Q

Which SLE patients should get a renal biopsy?

A

most patients who develop evidence of renal involvement (not if protein <0.5g/day)

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16
Q

What are the characteristic histopathological findings on renal biopsy for lupus nephritis?

A

glomerular deposits that stain predominantly for IgG but have co-deposits of IgA, IgM, C3 and C1q

17
Q

How do you diagnosis infection related GN?

A

kidney biopsy, preceding or concurrent infection, low C3

18
Q

What is the differential diagnosis for infection related GN?

A

SLE, cryoglulinaemia, C3 glomerulopathy, IgA, ANCA

19
Q

What are the risk factors for infection related GN?

A

male, diabetes, immunocompromised, alcoholism, malignancy, malnutrition, synthetic heart valve, IVDU, AIDS, TB

20
Q

What is pauci immune GN?

A

characterised by negative or few Ig deposits on IF (can be either ANCA positive or negative)

21
Q

Which ANCA do patients with GPA usually have?

A

PR3-ANCA

22
Q

Which ANCA do patients with MPA usually have?

A

MPO-ANCA

23
Q

Which has higher relapse rates GPA or MPA?

A

GPA

24
Q

Which histological subtype of pauci immune GN has the best survival?

A

focal

25
Q

Which histological subtype of pauci immune GN has the worst survival?

A

sclerotic

26
Q

What is anti GBM GN?

A

characterised by linear deposits of Ig and frequently C3 along the GBM

27
Q

What blood test confirms anti GBM GN?

A

anti GBM antibodies

28
Q

What is the histological pattern of anti GBM GN?

A

severe necrotising and crescentic pattern

29
Q

What are the associations with anti GBM GN?

A

smoking, hydrocarbons, alemtuzumab, HLA DR2

30
Q

How do patients with anti GBM GN usually present?

A

with rapidly progressive GN and often with alveolar haemorrhage

31
Q

What is the treatment for anti GBM GN?

A

plasma exchange, steroids, cytotoxic therapy

32
Q

What is monoclonal Ig GN?

A

Monotypic Ig deposits in the kidney often associated with underlying monoclonal gammopathy

33
Q

What are cryoglobulins?

A

circulating immunoglobulins that reversibly precipitate on cooling of the serum and redissolve on rewarming

34
Q

What are the 3 types of cryoglobulins?

A

type 1 - single monoclonal immunoglobulin, due to underlying haematologic malignancy
type 2 - mixed cryoglobulin, associated with underlying viral infections, dysproteinaemias or autoimmune diseases
type 3 - mixed cryoglobulin associated with autoimmune diseases or infections

35
Q

What causes C3 glomerulopathy?

A

dysregulation and persistent activation of the alternative complement pathway

BPT Renal (9 decks)

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