Glomerulonephritis Flashcards
What is glomerulonephritis?
This denotes glomerular injury and applies to a group of diseases that are generally characterised by inflammatory changes in the glomerular capillaries and the glomerular basement membrane (GBM).
The injury can involve a part or all of the glomeruli or the glomerular tuft.
The inflammatory changes are mostly immune mediated.
What diseases are included with glomerulonephritis?
Membranous GN Minimal change disease FSGS IgA nephropathy Rapidly progressive GN (vasculitis and anti-GBM disease) SLE Diabetes Amyloidosis Myeloma
What is the cause of glomerulonephritis?
The disease can result from renal-limited glomerulopathy or from glomerulopathy-complicating systemic disease: SLE and vascular.
Glomerular injury may be caused by inflammation due to leukocyte infiltration, antibody deposition and complement activation.
Commonly idiopathic, although increasingly it is possible to identify underlying causes.
Other causes include infections such as syphillis, vasculitis such as SLE, RA, GBM disease, Henoch-Schonlen purpura and HUS, Drugs such as penicillamine and NSAIDs, DM, HTN, lung and colorectal cancer and amyloidosis.
Pathophysiology of glomerulonephritis
Most are triggered by immune-mediated injury exhibiting both humeral and cellular components.
Cellular immune response contributes to the infiltration of glomeruli by circulating mononuclear inflammatory cells such as lymphocytes and macrophages and crescent formation in the absence of antibody deposition.
Humeral response leads to immune deposit formation and complement formation activation in glomeruli
Antibodies can be deposited within the glomerulus (anti-GBM or membranous nephropathy) or with external antigens that are trapped within the glomerulus (post-infectious GN)
Signs and symptoms of GN
Haematuria Oedema HTN Oliguria Anorexia Nausea Malaise Weight loss Fever Skin rash (vasculitis) Arthralgia (vasculitis) Sore throat Abdominal pain Haemoptysis (anti-GBM)
Risk factors for GN
Group A strep. Resp infections GI infections Hep. B Hep.C Lung cancer HIV SLE Systemic vasculitis HL Colorectal cancer Infective endocarditis NHL Leukaemia Thymoma HUS
Investigations for GN
Urinalysis- dysmorphic RBCs, sub-nephrotic proteinuria Comprehensive metabolic profile such as elevated creatinine GFR may be normal or reduces FBC may show normocytic anaemia Myeloma screen Immunology screen Renal profile Renal biopsy
Differentials for GN
Nephrolithiasis
Bladder cancer
Renal cancer
Pre-post renal failure
Management of GN
Treat underlying cause
If nephrotic syndrome present then treat
Anti-GBM: plasmapheresis and corticosteroid, prophylactic trimethoprim
SLE: immunosuppressants
Complications of GN
Acute renal failure Hypervolaemia Hypercholesterolaemia Hypercoagulability CVD CKD Susceptibility to infection
