Glomerulonephritis Flashcards
Define Glomerulonephritis?
An immunologically mediated inflammation of the renal glomeruli
What are some types of Glomerulonephritis caused by?
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
What is Glomerulonephritis associated with?
Bacteria (e.g. Streptococcus viridans, Staphylococci)
Viruses (e.g. HBV, HCB, measles, mumps, EBV)
Protozoal (e.g. Plasmodium malariae, schistosomiasis)
Inflammatory/Systemic diseases (e.g. SLE, vasculitis, cryoglobulinaemia)
Drugs (e.g. gold, penicillinamine)
Tumour
What is the classification of Glomerulonephritis based on?
Site of nephron pathology and its distribution
What are the different types of Glomerulonephritis?
Minimal-change Glomerulonephritis
Membranous Glomerulonephritis
Membranoproliferative Glomerulonephritis (MPGN)
Focal segmental glomerulosclerosis
Focal segmental proliferative Glomerulonephritis
Diffuse proliferative Glomerulonephritis
IgA Nephropathy
Crescentic Glomerulonephritis
Focal Segmental Necrotising Glomerulonephritis
What do we see in microscopy for Minimal-change Glomerulonephritis?
Light microscopy - minimal change
Electron microscopy - loss of epithelial foot process
What are the characteristcs of Membranous Glomerulonephritis?
Thickening of glomerular basement membrane (GBM) from immune complex deposition
Assoiated with Goodpasture’s Syndrome
What are the characteristics of Membranoproliferative Glomerulonephritis (MPGN)?
Thickening of GBM
Mesangial cell proliferation and interdeposition
What are the characteristcs of Focal segmental Glomerulosclerosis?
Glomerular scarring
Associated with HIV
What are the characteristics of Focal segmental proliferative Glomerulonephritis?
Mesangial and endothelial cell proliferation
Focal = involvement of some glomeruli
Segmental = involvement of parts individual glomeruli
What are the characteristics of Diffuse Proliferative Glomerulonephritis?
Same as Focal Segmental Proliferative Glomerulonephritis but affects ALL glomeruli
What are the characteristcs of IgA Nephropathy?
Mesangial cell proliferation
Mesangial IgA and C3 deposits
What are the characteristcs of Crescentic Glomerulonephritis?
Crescent formation by macrophages and epithelial cells, which fills up Bowman’s space
What are the characteristcs of Focal Segmental Necrotising Glomerulonephritis?
Peripheral capillary loop necrosis (occurs in granulomatosis with polyangiitis, microscopy polyarteritis and other vasculitides)
Often evolves into crescentic Glomerulonephritis
What are Cryoglobulins?
Are immunoglobulins that precipitate in the cold
What is the epidemiology of Glomerulonephritis?
Accounts for 25% of the cases of chronic renal failure
What are the presenting symptoms of Glomerulonephritis?
Haematuria Subcutaneous oedema Polyuria or oliguria History of recent infection Symptoms of uraemia or renal failure (acute and chronic)
What are the signs of Glomerulonephritis?
Hypertension
Proteinuria
Haematuria (especially in IgA nephropathy)
Renal failure
What does Nephrotic Syndrome consist of?
A Triad:
Proteinuria > 3.5 g/24 hrs
Low serum albumin < 24 g/L
Oedema
What is the consequence of Hypoalbuminaema?
The liver tries to compensate and increases production of lipids, causing hyperlipidaemia
What investigations do you do for Glomerulonephritis?
Bloods Urine Imaging Renal Biopsy Investigations for associated conditions (e.g. HBV, HCV and HIV serology)
What bloods do you do for Glomerulonephritis?
FBC U&Es + creatinine LFTs (check albumin) Lipid profile Complement studies Antibodies
What antibodies do we check for Glomerulonephritis?
ANA Anti-dsDNA ANCA Anti-GBM antibody Cryoglobulins
What do we look for in the Urine for Glomerulonephritis?
Microscopy - check for red cell casts
24 hr collection: creatinine clearance and protein
What imaging do we do for Glomerulonephritis?
Renal tract US to exclude other pathology (e.g. obstruction)
Why do we do a Renal Biopsy for Glomerulonephritis?
For microscopy
