Glomerulonephritis Flashcards
Definition of glomerulonephritis
Inflammatory lesions of the glomerulus
Does not include:
- Non-inflammatory lesions affecting the Glomerulus
- Hypertension, diabetes, haematological malignancy
- Rhabdomyolysis
- AKI associated glomerulonephritis
Nephrotic syndrome definition
Preserved renal function
- Characterised by proteinuria. (>3g/day)
- Decreased serum albumin and total protein
Features
- Oedema
- UPCR> 300mg/mmol
- ACR> 180mg/mmol
Nephritic syndrome definition
Impaired renal function characterised by:
- Proteinuria
- Haematouria
- Leucosuria
Glomerulus anatomy
Blood enters the apparatus via the afferent arteriole and undergoes filtration through the glomerulus
Inner lining= endothelial cells
Middle layer= basement membrane
Outer layer=Epithelial foot processes (podocytes). Wraps around capillaries, leaving slits.
Histological categories for glomerular disease
Focal or diffuse
Segmental or global
Crescents
Minimal changes
Structures affected: Mesangium, basement membrane, epithelial comma and a video.
Symptoms of glomerulonephritis
- Systemic, flulike symptoms
- rash
- arthralgia
- swelling
Investigations into glomeurulonephritis
Urine analysis
Blood tests
- Serum albumin and protein
- Renal function tests
- Autoimmune screen
Renal biopsy analysis
- Light Microscopy
- immunohistology
- electron microscopy
Urine analysis results
- Nephrotic syndrome
- Nephritic syndrome
Nephrotic
- Significant proteinuria
- Blood and leucocytes may be present.
- No nitrites
Nephritic
- Haematuria
- Proteinuria
- Leucouria
- No nitrites.
Causes of GN
Idiopathic
Infection: HBV, HCV, Strep, HIV
Autoimmune: SLE, Goodpasteurs, Vasculitis
Drugs: penicillamine, gold
Amyloidosis
Minimal change GN
- Associations
- Histology
Most common cause of nephrotic syndrome in children.
Associations
- NSAIDs
- Allergy
- Lithium, gold
- Hodgkin’s
Histology
- Electron microscopy: fusion of podocytes, loss of foot processes
- Appears normal in light microscopy.
Minimal change GN
- Presentation
- Treatment
Presentation
- Nephrotic syndrome: oedema, hypoalbuminaemia, proteinuria
- Frothy urine
- Preserved renal function
Treatment
- Steroids
- Calcinuerin inhibitors, i.e tacrolimus.
Membranous GN
- Associations
- Histology
Cause of nephrotic syndrome in 20-30% adults.
Associations
- Drugs: penicillamine, gold, captopril, mercury
- Paraneoplastic: colon, breast, lung
- Autoimmune: Sjorgen’s, SLE, RA, ank spondy
- Idiopathic
- Infection: Hep B, C
Histology
- Silver stain–> Sub-epithelial deposits of immune complex
Membranous GN
- Presentation
- Treatment
Presentation
- Nephrotic syndrome
- AKI
- CKD
Treatment
- Treat underlying cause
- Steroids
- Calcineurin inhibitors
- Blood pressure control.
Mesangial proliferative GN
- Pathology
- Causes
- Presentation
Mesangial proliferation and matrix desposits
- Due to increased IgA
- mesangial cells proliferate when IgA increases
Causes
- Thyphoid
- malaria
- IgA nephropathy
Presentation
- AKI
- haematuria
- CKD
- Hypertensive crisis
Diffuse proliferative nephritis (DPN)
- Pathology
- Causes
- Treatment
Commonly affects people with SLE
- Endothelial and mesangial proliferation
- Can show crescents filling Bowman’s space
- IgM, IgG, C3 deposits.
Causes
- Endocarditis
- Post-strep GN
Treatment
- Treat underlying infection
Focal segmental glomerulosclerosis (FSGS)
- Causes
- Pathology
Primary= Idiopathic
Secondary causes:
- Familial: after transplantation.
- Viral infection: HIV
- Drugs: Heroin, pamidronate.
- Obesity
- HTN
- Atheroemboli
- SCD
Pathology
- Segmental scarring of glomerulus.
Rapidly progressing glomerulonephritis (Crescentic GN)
- Pathology
Anti-neutrophil cytoplasmic antibodies (ANCA) interact with antigens in neutrophil’s cytoplasm.
-Neutrophils release lytic enzymes, causing glomerular crescents containing parietal epithelial cells (Bowman’s capsule) and sometimes podocytes.
Rapidly progressing glomerulonephritis (Crescentic GN)
- Associations
ANCA related small vessel vasculitis
- Granulomatosis with polyangitis (GPA)
- Microscopic polyangitis
Goodpastuer’s
Agressive IgA nephropathy
- As seen with SLE
Idiopathic
Treatment for RPGn
Strict blood pressure control
ACEi if proteinuria >1g/day
Immunsuppresions
Immunosuppressive drugs used for crescentic GN
Steroids
Cyclophosphamide
Azathiprine
Mycophenolate mofetil
Rituximab
Membranoproliferative/ Mesangiocapillary GN
- Causes
- Pathology
Primary= idiopathic Secondary causes - Hep C - Endocarditis - Viral infections - Malaria - SCD
Pathology
- Deposits in intraglomerular mesangium.
Membranoproliferative/ Mesangiocapillary GN
- Presentation
- AKI, CKD
- Nephrotic syndrome
Membranoproliferative/ Mesangiocapillary GN
- Treatment
Strict BP control
ACE inhibitors for proteinuria >1g/day
Immunosuppression. (similar to crescentic)
- Steroids
- CNIs
- Mycophenolate mofetil
- Rituximab
