Glomerulonephritis Flashcards
what are 5 examples of glomerular disease
diabetic nephropathy, pyelonephritis (infection), glomerulonephritis (inflamm), amyloid nephropathy, transplant nephropathy
what is glomerulonephritis
inflammation of the glomeruli usually by an autoimmune response
what are types of glomerulonephtis (4)
nephritic syndrome (proteinuria), nephritic syndrome (haematuria), mixed, rapidly progressive
what antibody mediated responses can cause glomerulonephritis (4)
intrinsic antigen, deposition of immune complexes, T cell mediated
what can cause circulating immune complexes
infection eg hep C, HIV // drugs eg gold // cancer eg lymphoma
what types of vasculitis can cause glomerulonephritis
GPA and MPA
what secondary causes can cause glomerulonephritis
infection, drugs, malignancies, systemic eg ANCA vasculitis GPA and MPA, LUPUS
what are symptoms of glomerulonephritis
haematuria (nephritic syndrome), proteinuria (nephrotic syndrome), HYPERTENSION, AKI, CDK, ESRD
how do you diagnose glomerulonephritis
BP, bloods, urinalysis, kidney biopsy
what investigations are done on the kidney biopsy
light microscopy, electro-microscopy, immunofluorescence
what is seen in light microscopy
hypercellularity, inflamm cells, sclerosis and crescents (bad)
what is seen in electron microscopy
basement membrane deposits
what is seen in immunoflueroscence
antibody type
what is proliferative glomerulonephritis
proliferation of mesengial cells
what is focal vs diffuse disease
focal <50% of glomeruli affected and diffuse >50%
what are crescents associated with
bad prognosis
what are the treatment aims of glomerulonephritis
reduce proteinuria, induce remission, preserve long-term renal function
what non-immunosuppresive treatment can be used in glomerulonephritis
anti-hypertensives, ACEi/ ARBs, diuretics, statins
what immunosuppressive drugs are used to treat glomerulonephritis (6)
steroids eg prednisolone, azathioprine, cyclophosphate, caclineurin inhibitors, IV immunoglobulin, plasmapheresis
what cells are the site of injury in nephrotic syndrome and what does this result in
podocytes: protein in urine and atrophies and loss of charge barriers
is nephrotic syndrome proliferative or non-proliferative
non-proliferative
what are the signs of nephrotic syndrome (5)
proteinuria >3g/day, hypoalbuminaemia, oedema, hypercholestraemia, normal renal function
what is the main protein lost in nephrotic syndrome
albumin
what are complications of nephrotic syndrome
infection, renal vein thrombosis, PE, volume depletion
what are the 3 main categories of nephrotic syndrome
minimal change, focal segmental glomerulosclerosis, membranous
what is the most common cause of nephrotic syndrome in children
minimal change
what is the most common cause of nephrotic syndrome in adults
FSGS
what is the 2nd most common cause of nephrotic syndrome in adults
membranous
what types of nephrotic syndrome are likely to cause progressive renal failure
FSGS: 50% get ESRF in 10 years // membranous: 40% get ESRF with slow progression
what type of renal biopsy do you do in minimal change nephrotic syndrome and what does it show
light microscopy - looks normal and is associated with good prognosis
how do you treat minimal change nephrotic syndrome
oral steroids (94% remission) 2nd line cyclophosphamide
what type of renal biopsy do you do in FSGS nephrotic syndrome and what does it show
immunoflueroscence: minimal Ig // light: rosneal appearance
how do you treat FSGS
60% remission with steroids. 2nd line ciclosporin
what does a renal biopsy show membranous nephrotic syndrome
sub-epithelial immune complex in basement
how do you treat membranous nephrotic syndrome
steroids/ alkylating agents eg cyclophosphamide + all on ACEi’s
what cells are the site of injury in nephritic syndrome and what does this result in
mesangial cells: release chemokines –> inflamm /// endothelial –> vasculitis
is nephritic syndrome proliferative or non-proliferative
proliferative - due to mesangial cell involvement
how does nephritic syndrome present (6)
hypertension + haematuria, acute renal failure oliguria, oedema, henoch schonlein purpura (HSP)
what is the most common cause of GN in the world
IgA nephropathy (nephritic)
what are the symptoms if IgA nephropathy
asymptomatic haematuria, macroscopic haematuria after resp/ GI infection, HSP
what is seen on a renal biopsy for IgA nephropathy
IgA deposits in mesangium and mesangial hypercellularity
how commonly does IgA nephropathy progress to ESRF
25%
how do you treat IgA nephropathy
BP control, ACE/ARBs, fish oil
what is membranoproliferative GN
mixed nephrotic and nephritic syndrome
what is seen in a biopsy of membranoproliferative GN
hypercellular glomeruli + thick membranes
what is rapidly progressive GN
rapid deterioration of acute renal failure that is treatable
what is rapidly progressive GN associated with
active urinary sediment, glomerular crescent on biopsy
what are ANCA+ive causes of rapidly progressive GN
GPA, MPA
what are ANCA-ive causes of rapidly progressive GN
goodpastures, HSP, SLE
how do you treat rapidly progressive GN
steroids + cyclophsophamide/ azathioprine + supportive dialysis
