glomerulonephritis Flashcards
what are the signs of nephrotic syndrome?
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
what are the causes of nephritic syndrome?
- 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
what are the classic signs of nephritic syndrome?
haematuria (the main differentiating factor to nephrotic syndrome)
On dipstick mild proteinuria and blood
hypertension
oliguria
microscopy of urina, see red cell cast
what are the complications of nephrotic syndrome?
- higher risk of infection
- venous thromboembolism
- progression of CKD
- hypertension
- hyperlipidaemia
what are the clinical signs and symptoms of nephrotic syndrome?
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
what are the clinical signs and symptoms of nephrotic syndrome?
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)
what will an nephrotic urinalysis show?
Proteinuria (protein ++++)
Frothy appearance
what are the signs and symptoms of nephrotic syndrome?
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)
what will a nephritic urinalysis show?
- Haematuria (blood +++)
- Proteinuria (mild – protein ++)
- Red cell casts – distinguishing feature of nephritic syndrome, form in nephrons and indicate glomerular damage
what supportive therapy is used for glomerulonephritis?
- 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
what immunosuppressive therapy can be used for glomerulonephritis?
- 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
what is the relation between glomerulonephritis and nephritic and nephrotic syndrome?
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
what invasive therapy can be used to treat glomerulonephritis?
- Renal replacement therapy/haemodialysis for those in severe AKI or ESRF
- Plasma exchange for AAV, anti-GBM,
what is post streptococcal GN and how is it treated?
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
what is an IgA nephropathy and how is it treated?
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
what is small vessel vasculitis and how is it treated?
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
what is anti GBM disease (good pastures syndrome) and how is it treated?
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
what is thin basement membrane disease and how is it treated?
a cause of nephritic syndrome
hereditary
abnormalities of type IV collagen
treat my monitoring renal function and supportive treatment
what is aport syndrome and how is it treated?
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)
What is lupus nephritis and how is it treated?
can be nephritic or nephrotic
complication of SLE
treatment is
- supportive
- immunosuppressive, dependent on classification and presentation
