Glomerulonephritis Flashcards

1
Q

Definition

A

An immunologically mediated inflammation of the renal glomeruli

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2
Q

Aetiology

A

• There are loads of different types of glomerulonephritis with different aetiologies
• Some types are caused by the deposition of antigen-antibody complexes in the
glomeruli
• This leads to inflammation and activation of complement and coagulation cascades
• The immune complexes may form within the glomerulus (more common) or be deposited from the circulation `

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3
Q

Associations

A

• The antigens to which the antibodies are produced are UNKNOWN but may be
associated with:

o Bacteria (e.g. Streptococcus viridans, Staphylococci)
o Viruses (e.g. HBV, HCB, measles, mumps, EBV)
o Protozoal (e.g. Plasmodium malariae, schistosomiasis)
o Inflammatory/Systemic diseases (e.g. SLE, vasculitis, cryoglobulinaemia)
o Drugs (e.g. gold, penicillinamine)
o Tumour

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4
Q

Classifications

A

Classification is based on the site of nephron pathology and its distribution

o Minimal-change Glomerulonephritis
• Light microscopy - minimal change
• Electron microscopy - loss of epithelial foot process

o Membranous Glomerulonephritis
• Thickening of glomerular basement membrane (GBM) from immune complex deposition
• Associated with Goodpasture’s Syndrome

o Membranoproliferative Glomerulonephritis (MPGN)
• Thickening of GBM
• Mesangial cell proliferation and interdeposition

o Focal segmental glomerulosclerosis
• Glomerular scarring
• Associated with HIV

o Focal segmental proliferative glomerulonephritis
• Mesangial and endothelial cell proliferation
• Focal = involvement of some glomeruli
• Segmental = involvement of parts of individual glomeruli

o Diffuse proliferative glomerulonephritis
• Same as above but affects ALL glomeruli

o IgA Nephropathy
• Mesangial cell proliferation
• Mesangial IgA and C3 deposits

o Crescentic Glomerulonephritis
• Crescent formation by macrophages and epithelial cells, which fills up Bowman’s space

o Focal Segmental Necrotising Glomerulonephritis
• Peripheral capillary loop necrosis (occurs in granulomatosis with polyangiitis, microscopy polyarteritis and other vasculitides)
• Often evolves into crescentic glomerulonephritis

NOTE: cryoglobulins are immunoglobulins that precipitate in the cold

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5
Q

Epidemiology

A

Accounts for 25% of the cases of chronic renal failure

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6
Q

Presenting symptoms

A
  • Haematuria
  • Subcutaneous oedema
  • Polyuria or oliguria
  • History of recent infection
  • Symptoms of uraemia or renal failure (acute and chronic)
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7
Q

Signs on physical examination

A
  • Hypertension
  • Proteinuria
  • Haematuria (especially in IgA nephropathy)
  • Renal failure
  • Nephrotic syndrome
  • Nephritic syndrome
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8
Q

Nephrotic syndrome

A

• Nephrotic syndrome - consists of a TRIAD of:

o Proteinuria > 3.5 g/24 hrs
o Low serum albumin < 24 g/L
o Oedema

o NOTE: due to the hypoalbuminaema, the liver tries to compensate and increases production of lipids, causing hyperlipidaemia

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9
Q

Nephritic syndrome

A

• Nephritic syndrome (TRIAD: hypertension + proteinuria + haematuria)

o Syndrome comprising of signs of nephritis
o Pores in the podocytes are large enough to allow protein AND red blood cells to pass into the urine

o MAIN FEATURE: Haematuria
• This is in contrast to nephrotic syndrome, which is mainly concerned with
proteinuria
o There may also be red cell casts in the urine - indicative of glomerular damage

o Other features:
• Proteinuria
• Hypertension
• Low urine output (due to decreased renal function)

o NOTE: in nephrotic syndrome, only PROTEINS are moving into the urine

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10
Q

Investigations (bloods)

A
o FBC
o U&amp;Es + creatinine
o LFTs (check albumin)
o Lipid profile
o Complement studies
o Antibodies:
• ANA
• Anti-dsDNA
• ANCA
• Anti-GBM antibody
• Cryoglobulins
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11
Q

Investigations (other)

A

• Urine
o Microscopy - check for red cell casts
o 24 hr collection: creatinine clearance and protein

• Imaging
o Renal tract ultrasound to exclude other pathology (e.g. obstruction)

• Renal Biopsy
o For microscopy

• Investigations for associated conditions (e.g. HBV, HCV and HIV serology)

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