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Renal > Glomerulonephritis > Flashcards

Glomerulonephritis Flashcards

1
Q

Define glomerulonephritis

A

Immune mediated disease of the kidneys affecting the glomeruli

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2
Q

What does damage to endothelial/mesengial cells causes?

A

Proliferative lesion and RBC in urine

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3
Q

What does damage to podocytes cause?

A

Non proliferative lesion and protein in urine as cell atrophies and loses size/charge specific barrier

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4
Q

Name the different parts of the glomerular apparatus

A

Podocyte
Mesangium
Endothelial cell

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5
Q

How does the mesangium response to injury?

A

Releases angiotensin II and chemokines which attracts inflammatory cells leading to proliferation

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6
Q

What is the effect of endothelial response to injury?

A

Vasculitis

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7
Q

Name seven ways in which glomerulonephritis can present

A
  • haematuria
  • proteinuria
  • impaired renal function
  • hypertension
  • nephrotic syndrome
  • nephritis syndrome
  • nephrotic-nephritic syndrome
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8
Q

State two types of haematuria

A

Asymptomatic microscopic

Painless macroscopic

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9
Q

What is microalbuminuria?

A

30-300mg/day

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10
Q

Describe nephritic syndrome

A

Acute renal failure, oliguria, oedema/fluid retention, hypertension, active urinary sediment (RBC, granular casts)

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11
Q

What is nephritic syndrome indicative of?

A

Proliferative process affecting endothelial cells

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12
Q

Describe nephrotic syndrome

A

Proteinuria >3g/day, hypolabuminaemia <30, oedema, hyperchoelsterolaemia, normal renal function

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13
Q

What does nephrotic syndrome indicate?

A

Non-proliferative process affecting the podocytes

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14
Q

State six complications of nephrotic syndrome

A
  • infection (loss of antibodies)
  • renal vein thrombosis
  • pulmonary emboli
  • volume depletion
  • vit D deficiency
  • subclinical hypothyroidism
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15
Q

How is glomerulonephritis investigated?

A

Renal biopsy

Light microscopy, immunofluorescence, EM

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16
Q

What is the commonest cause of nephrotic syndrome in kids?

A

Minimal Change Nephropathy

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17
Q

What is minimal change nephropathy associated with?

A

Atopy
Post URTI
NSAIDs

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18
Q

Describe the biopsy of minimal change nephropathy

A

Normal on LM and IF

EM, podocyte apoptosis - gaps between podocytes

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19
Q

What is the immunology behind minimal change nephropathy?

A

Unknown antigen and antibody but possible caused by IL13

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20
Q

What is the 1st line treatment for minimal change nephropathy?

A

Oral steroids

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21
Q

What is the second line treatment for minimal change nephropathy?

A

Cyclophosphamide

22
Q

Does minimal change nephropathy cause progressive renal failure?

A

No

23
Q

What is the commonest cause of nephrotic syndrome in adults?

A

Focal Segmental Glomerulosclerosis

24
Q

What can cause Focal Segmental Glomerulosclerosis?

A

Primary

Secondary to HIV, heroine use, obesity, reflux nephropathy

25
Q

What will the biopsy of Focal Segmental Glomerulosclerosis show?

A

LM - sclerosis and mesangial collapse

EM - podocyte fusion (diffuse in primary, limited to sclerotic area in secondary)

26
Q

How is Focal Segmental Glomerulosclerosis treated?

A

Prolonged steroids

27
Q

What is the prognosis for Focal Segmental Glomerulosclerosis?

A

50% progress to ESRF after 10 years

28
Q

How does membranous nephropathy present?

A

Proteinuria and often renal impairment - common cause of nephrotic syndrome in older patients

29
Q

What may membranous nephropathy be secondary to?

A

Infections (HBV, parasites)
Connective tissue disease (SLE)
Malignancies (carcinomas/lymphomas)
Drugs (gold, penicillamine)

30
Q

What will a biopsy of membranous nephropathy show?

A

EM Sub epithelial immune complex deposition in basement membrane
LM thickening of GBM
IF IgG/C3 granular deposits

31
Q

How is membranous nephropathy treated?

A

Steroids, alkylating agents, B cell monoclonal antibodies

32
Q

What antibody is membranous nephropathy associated with?

A

Anti PLA2r - deposits in blood and glomeruli

33
Q

What is the commonest glomerulonephropathy?

A

IgA nephropathy

34
Q

How does IgA nephropathy present?

A
  • Macroscopic haematuria after resp/GI infection
  • asymptomatic microhaematuria and maybe proteinuria
  • AKI
  • CKD
35
Q

What disease is IgA nephropathy associated with?

A

Henoch Schonlein Purpura

36
Q

How does HSP present?

A

Children with a purpuric rash, colitis, arthritis and may have fluid retention or hypertension

37
Q

What does a biopsy of IgA nephropathy show?

A

LM- mesangial IgA
IF - IgA and C3
EM - Deposits in mesangium

38
Q

Describe the pathophysiology of IgA nephropathy

A
  1. Increased circulating levels of Gd-IgA1
  2. Production of Anti-IgA1 antibodies
  3. Immune complexes form in circulation and in situ
  4. Local immune activation and injury
39
Q

What disease is associated with crescents on biopsy?

A

Rapidly Progressive Glomerulonephritis

40
Q

Name two types of vasculitis that cause RPG

A
  • granulomatosis with polyangitis

- microscopic polyangitis

41
Q

What ANCA negative diseases can cause RPG?

A
  • goodpastures
  • HPA
  • SLE
42
Q

What are crescents?

A

Collections of cells epithelium, inflammatory cell… that adhere to the glomerular tuft and bowman’s capsule

43
Q

What can the crescents do?

A

Close the capillary lumen

44
Q

Describe the pathological steps in ANCA positive RPG

A
  1. Priming of neutrophils induces PR3 and MPO to the cell surface where they interact with ANCA
  2. Promotes adherence of neutrophils to endothelial cells
  3. Further priming induces the release of proteolytic enzymes and reactive oxygen species
  4. ANCA activated neutrophils promote inflammation
45
Q

What treatment can nephrotic patients receive?

A 
Fluid salt restrictions 
Diuretics 
ACEi/ARB
IV albumin if volume depleted 
Immunosuppression
46
Q

What is complete remission of nephrotic syndrome?

A

<300mg/day

47
Q

What is partial remission of nephrotic syndrome?

A

<3g/day

48
Q

What immunosuppressive treatments are available for glomerulonephritis?

A 
Corticosteroids 
Azathioprine 
Alkylating agents (cyclophosphamide/chlorambucil)
Calcineurin inhibitors 
MMF
49
Q

In severe glomerulonephritis what are the treatment options?

A

Plasmapheresis
IV immunoglobulin
Monoclonal antibodies

50
Q

What is the treatment for RGP?

A

Strong immunosuppression - steroids or cytotoxins

51
Q

Name three cytotoxins

A
  • cyclophosphamide
  • MMF
  • Azathioprine
52
Q

If immunosuppressants fail what is the last line treatment for glomerulonephritis?

A

Plasmapheresis/dialysis

Renal (20 decks)

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