glomerulonephritis Flashcards

1
Q

what are the signs of nephrotic syndrome?

A

Proteinuria which results in hypoalbuminaemia

Also, because extracellular oncotic pressure is higher than plasma oncotic pressure, you get oedema.

The definition of nephrotic syndrome includes both massive proteinuria (≥3.5 g/day) and hypoalbuminaemia (serum albumin ≤30 g/L).

Urine PCR (protein:creatinine ratio) will be >350

hypercholesteraemia also

hyper coagulability as blood gets thicker as fluid going out

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2
Q

what are the causes of nephritic syndrome?

A
  • Anti GBM disease aka goodpastures autoantibody against basement membrane, also in lungs
  • post streptococcal glomerulonephritis, with deposition of immune complex in the glomerular basement membrane
  • IgA nephropathy
  • small vessel vasculitis
  • thin basement disease
  • alport syndrome
  • lupus nephritis
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3
Q

what are the classic signs of nephritic syndrome?

A

haematuria (the main differentiating factor to nephrotic syndrome)

On dipstick mild proteinuria and blood

hypertension

oliguria

microscopy of urina, see red cell cast

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4
Q

what are the complications of nephrotic syndrome?

A
  • higher risk of infection
  • venous thromboembolism
  • progression of CKD
  • hypertension
  • hyperlipidaemia
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5
Q

what are the clinical signs and symptoms of nephrotic syndrome?

A

Symptoms

  • Peripheral oedema
  • Facial oedema
  • Frothiness of urine
  • Fatigue
  • Poor appetite
  • Recurrent infections (due to immune dysfunction)
  • Venous or arterial thrombosis (e.g. myocardial infarction, deep vein thrombosis) due to hypercoagulability
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6
Q

what are the clinical signs and symptoms of nephrotic syndrome?

A

Symptoms

  • Peripheral oedema
  • Facial oedema
  • Frothiness of urine
  • Fatigue
  • Poor appetite
  • Recurrent infections (due to immune dysfunction)
  • Venous or arterial thrombosis due to hypercoagulability

Signs

  • Oedema
  • Xanthelasma and/or xanthoma
  • Leukonychia
  • Shortness of breath (with associated chest signs of pleural effusion – e.g. stony dullness in lung bases)
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7
Q

what will an nephrotic urinalysis show?

A

Proteinuria (protein ++++)

Frothy appearance

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8
Q

what are the signs and symptoms of nephrotic syndrome?

A

Symptoms

  • Haematuria (can be frank or microscopic)
  • mild oedema
  • Reduced urine output
  • Uraemic symptoms (e.g. reduced appetite, fatigue, pruritus, nausea)

Signs

  • Haematuria (either visible or detectable on urinalysis)
  • Oedema
  • Hypertension
  • Oliguria (<300mls/day)
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9
Q

what will a nephritic urinalysis show?

A
  • Haematuria (blood +++)
  • Proteinuria (mild – protein ++)
  • Red cell casts – distinguishing feature of nephritic syndrome, form in nephrons and indicate glomerular damage
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10
Q

what supportive therapy is used for glomerulonephritis?

A
  • If suspect GN – discuss with Renal team
  • MDT approach depending on underlying diagnosis
  • ACEi/ARB for proteinuria
  • Control BP
  • Salt and water restriction if volume overloaded
  • Diuretics for fluid overload
  • If hypoalbuminaemic <20g/dl then higher risk for VTE (as a result of hyper hypercoagulability )– consider therapeutic LMWH
  • Statins for hypercholesterolaemia
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11
Q

what immunosuppressive therapy can be used for glomerulonephritis?

A
  • Specific to cause of GN – decided by Renal team (+/- Respiratory / Rheumatology teams if lung or systemic
    involvement )
  • Oral Corticosteroids, IV pulsed methylprednisolone, Cyclophosphamide, Tacrolimus, Ciclosporin, Rituximab, MMF,
    Azathioprine
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12
Q

what is the relation between glomerulonephritis and nephritic and nephrotic syndrome?

A

nephritic and nephrotic syndrome = collection of signs and symptoms

things that cause nephritic and nephrotic syndrome also cause glomerulonephritis in the process = inflammation of the glomeruli

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13
Q

what invasive therapy can be used to treat glomerulonephritis?

A
  • Renal replacement therapy/haemodialysis for those in severe AKI or ESRF
  • Plasma exchange for AAV, anti-GBM,
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14
Q

what is post streptococcal GN and how is it treated?

A

a cause of nephritic syndrome

associated with group A B- haemolytic strep infections e.g tonsillitis/pharangitis/ impetigo/cellulitis

usually self limiting
can use supportive therapy

  • ACEi/ARB for proteinuria and hypertension
  • low sodium diet

if proceeds to ESRF, RRT

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15
Q

what is an IgA nephropathy and how is it treated?

A

a cause of nephritic syndrome

most common idiopathic glomerulonephritis

get gross haematuria during/after URT or GI infections, or strenuous exercise

have high serum IgA which deposits in glomerulus = damage

supportive treatment is

  • ACEi/ARB for proteinuria and hypertension
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16
Q

what is small vessel vasculitis and how is it treated?

A

a cause of nephritic syndrome

includes

  • granulomatosis with polyangitis
  • microscopic polyangitis
  • eosinophilic granulomatosis with polyangitis

usually has some for of respiratory involvement

treat with immunosupression

17
Q

what is anti GBM disease (good pastures syndrome) and how is it treated?

A

a cause of nephritic syndrome

antibodies against type iv collagen react with pulmonary basement membrane = pulmonary haemorrhage (haemoptysis)

also does this in the kidneys. can cause rapidly progressive glomerulonephritis

treat with

  • plasma exchange
  • immunosuppression
18
Q

what is thin basement membrane disease and how is it treated?

A

a cause of nephritic syndrome

hereditary
abnormalities of type IV collagen

treat my monitoring renal function and supportive treatment

19
Q

what is aport syndrome and how is it treated?

A

a cause of nephritic syndrome

  • x linked
  • affects type V collagen
  • GBM structure is compromised
  • often leads to ESRF

treatment is

  • supportively
  • RRT
  • renal transplant, but this can lead to good pasture syndrome (anti GBM disease)
20
Q

What is lupus nephritis and how is it treated?

A

can be nephritic or nephrotic

complication of SLE

treatment is

  • supportive
  • immunosuppressive, dependent on classification and presentation