Glomerulonephritis Flashcards
Damage to the glomerulus in glomerulonephritis leads to restriction of blood flow. What does this lead to as a compensatory mechanism?
Hypertension
Damage to the glomerulus in glomerulonephritis leads to loss of the filtration mechanism. What clinical features may this lead to?
Proteinuria and haematuria
Damage to the glomerulus in glomerulonephritis leads to loss of the filtration capacity. What does this cause?
Reduced renal function
What happens to the blood pressure in the nephrotic and nephritic syndromes?
In nephrotic syndrome, BP is normal or mildly increased; in nephritic syndrome, BP is moderately or severely increased
What abnormality is most likely to be found in the urine in the nephrotic and nephritic syndromes?
In nephrotic syndrome, proteinuria is predominant; in nephritic syndrome, haematuria is predominant
What happens to the GFR in the nephrotic and nephritic syndromes?
In nephrotic syndrome, GFR is normal or mildly decreased; in nephritic syndrome, GFR is moderately or severely decreased
What are the 3 common primary causes of nephrotic syndrome?
Minimal change disease, focal segmental glomerulosclerosis (FSGS), membranous glomerulonephritis
What are 2 common secondary causes of nephrotic syndrome?
Diabetic nephropathy, amyloidosis
What are 2 common primary causes of nephritic syndrome?
IgA nephropathy, rapidly progressive glomerulonephritis
What are 2 common secondary causes of nephritic syndrome?
Vasculitis, anti-GBM disease
Which type of primary glomerulonephritis is most likely to present with a mixed nephrotic/nephritic syndrome?
Membranoproliferative glomerulonephritis
What are 2 common secondary causes of mixed nephrotic/nephritic syndrome?
SLE, post-streptococcal glomerulonephritis
Which investigation gives the most information about glomerulonephritis and is used to make an official diagnosis?
Renal biopsy
Why should a renal biopsy only be performed in patients with glomerulonephritis if it is going to alter the management plan?
There is a significant risk of bleeding
The presence of what two things on urine microscopy are most suggestive of bleeding and damage to the glomerulus?
Dysmorphic red cells and red cell casts
What two imaging tests should be performed in individuals with suspected glomerulonephritis?
Renal ultrasound and CXR
Levels of what in the blood can be used to monitor disease progression of glomerulonephritis?
C3
In most patients with glomerulonephritis, what is the target blood pressure?
< 130/80
In patients with glomerulonephritis who have proteinuria > 1g/day, what is the target blood pressure?
< 125/75
What drugs should always be given to patients with glomerulonephritis?
ACE inhibitor or ARB
The presentation of nephrotic syndrome is indicative of a non-proliferative process affecting which cells of the glomerulus?
Podocytes
What are the 3 features of nephrotic syndrome?
Proteinuria (> 3g/day), hypoalbuminaemia, oedema
What is often described as being the fourth feature of nephrotic syndrome?
Hyperlipidaemia
Other than hyperlipidaemia, what are the main complications of nephrotic syndrome?
Increased susceptibility to infection and thromboembolism
With nephrotic syndrome, there is a particular high risk of which thrombotic event?
Renal vein thrombosis
When should a renal biopsy be performed in children?
Only if there is no response to steroid treatment
How is oedema reduced in patients with nephrotic syndrome?
Loop diuretics and salt/fluid restriction
How is proteinuria reduced in patients with nephrotic syndrome?
ACE inhibitor or ARB
In patients with nephrotic range proteinuria, what other medications should be started to reduce the risk of complications?
A statin and an anticoagulant
What is responsible for the damage to podocytes in minimal change disease?
T cells
Selective proteinuria occurs in which type of primary glomerulonephritis?
Minimal change disease
What is the commonest cause of nephrotic syndrome in children?
Minimal change disease
Which type of primary glomerulonephritis has associations with NSAID use and Hodgkin’s lymphoma in adults?
Minimal change disease
In minimal change disease, damage to the glomerulus is only detected on what histological assessment?
Electron microscopy
What is seen on an electron microscopy of minimal change disease?
Effacement of the foot processes of podocytes
What are the first and second line treatments for minimal change disease?
First line is prednisolone, second line is cyclophosphamide
What is the risk of progression to ESRF in patients with minimal change disease?
1%
Hyalinosis on histology is most suggestive of which type of glomerulonephritis?
Focal segmental glomerulosclerosis
Which type of primary glomerulonephritis may occur secondary to sickle cell disease, heroin use, HIV or Alport’s syndrome?
Focal segmental glomerulosclerosis
Which type of primary glomerulonephritis will show small areas of mesangial collapse and sclerosis on light microscopy, and podocyte foot process fusion on electron microscopy?
Focal segmental glomerulosclerosis
Around 30% of cases of focal segmental glomerulosclerosis respond to treatment with what? If this doesn’t work, what should be used next?
30% of cases respond to treatment with steroids. If this doesn’t work, cyclophosphamide or ciclosporin can be used.
Which type of primary glomerulonephritis has a high recurrence rate in transplanted kidneys?
Focal segmental glomerulosclerosis
Which type of primary glomerulonephritis is due to anti-phospholipase A2 autoantibodies?
Membranous glomerulonephritis
Which type of primary glomerulonephritis will show diffuse thickening of the basement membrane and a ‘spike and dome’ appearance with special silver staining on light microscopy?
Membranous glomerulonephritis
Which type of primary glomerulonephritis will show electron dense sub-epithelial deposits on electron microscopy?
Membranous glomerulonephritis
Which type of primary glomerulonephritis will show granular deposits of IgG and C3 along the basement membrane on immunofluorescence?
Membranous glomerulonephritis
When is immunosuppression required in cases of membranous glomerulonephritis?
Only in particularly severe or progressive cases
What are the potential outcomes of membranous glomerulonephritis?
1/3rd resolve spontaneously, 1/3rd respond to cytotoxic drugs, 1/3rd progress to CKD
Which type of primary glomerulonephritis will show mesangial proliferation, thickened capillary walls and a ‘tram track’ basement membrane on light microscopy?
Membranoproliferative glomerulonephritis
Nephritic syndrome is indicative of a proliferative process affecting which cells of the glomerulus?
Endothelial cells
What is the most common nephropathy worldwide?
IgA nephropathy
IgA nephropathy is an example of which type of hypersensitivity reaction?
Type III
Does IgA nephropathy present with nephrotic or nephritic syndrome?
Nephritic syndrome
When does IgA nephropathy typically occur?
During or shortly after a respiratory or GI infection
What is the typical presentation of IgA nephropathy?
Episodic macroscopic haematuria in a young male
Which type of primary glomerulonephritis shows diffuse mesangial IgA deposition and mesangial proliferation on light microscopy, and electron dense deposits in the mesangium on electron microscopy?
IgA nephropathy
What does IgA nephropathy show on immunofluorescence?
IgA and C3 deposition in the mesangium
IgA nephropathy has a similar histological appearance to which systemic condition?
Henoch-Schonlein purpura
What percentage of adults with IgA nephropathy go on to develop end stage renal failure?
20%
When does post-streptococcal glomerulonephritis typically occur?
1 - 12 weeks after a streptococcal throat or skin infection
What serology test will be increased in post-streptococcal glomerulonephritis?
ASOT
What treatment is required for post-streptococcal glomerulonephritis?
Supportive treatment only
What biopsy finding is seen in all cases of rapidly progressive glomerulonephritis?
Crescents
How does rapidly progressive glomerulonephritis tend to present?
AKI +/- systemic features
How is rapidly progressive glomerulonephritis treated?
High dose IV steroids and cyclophosphamide +/- plasma exchange
