Glomerulonephritis Flashcards
What does the term Glomerulonephritis encompasses?
*includes 5 things
- Caused by pathology in glomerulus
- diagnosed on renal biopsy
- causes CKD
- can progress to kidney failure (except minimal change disease)
What Ix would you order for glomerulonephritis?
- Bloods
- FBC, U&E, LFT, CRP, Immunoglobulins, complement (C3,C4), autoantibodies (ANA, ANCA, andti-DSDNA, anti GBM)
- Urinanalysis
- MC&S
- Bence Jones
- A:CR/P:CR
- RBC Cast
- Imaging
- CXR - pulmonary haemorrhage
- Renal USS
- Renal Biopsy (definitive)
What is Nephritic syndrome?
Group of sx, not diagnosis
- Haematuria
- Protenuria (<3.5g/24hrs)
- Low GFR
- Oliguria
- HTN
What is Nephrotic syndrome?
Group of sx, not diagnosis
- Proteinuria (>3g/day)
- Peripheral oedema
- Hypoalbuminamia (<30g/L)
- Hypercholesterolaemia
What is interstitial nephritis?
What are the types of interstitial nephritis?
- inflammation of spaces between cells and tubules
- acute interstitial nephritis & chronic tubulointerstitial nephritis
What is glomerulosclerosis?
What causes golmeruosclerosis?
- Pathological processes of scarring of tissue in the glomerulus
- Any glomerulonephritis, obstructive uropathy, focal segmental glomeruloscelrosis
What causes nephrotic syndrome?
- Primary renal disease
- Minimal Chnage Disease (most common in children)
- Membranous nephorpathy
- Focal Segmental Glomerulosclerosis
- Membranoproliferative GN
- Secondary
- DM
- myeloma
- amyloidosis
What causes proteinuria?
- Damage to podocytes
How would you Mx nephrotic syndrome?
- Reduce odema
- Fluid & salt restriction
- Loop diuretics
- Add thiazide if oedema persist
- Aim 0.5-1kg/day weight loss
- Treat underlying cause
- Corticosteroids - causes remission
- Renal biopsy
- Reduce proteinuria
- ACEi/ARB
- Treat complications
`What are the Cx of nephrotic syndrome?
-
Thromboembolism
- Eg: Renal vein thrombosis, DVT
- Px: anti thrombin 3 loss through filtration in kidneys
- Tx: Warfarin, low dose LMWH
-
Infection
- Eg: RTI, UTI, Cellulitis, CNS infection
-
Hyperlipidaemia
- Px: hepatic synthesis due to low oncotic pressure and dec. lipid breakdown
- Tx: Statin
- HTN & CKD
What is the most common cause of nephrotic syndrome in children?
Minimal Change Disease
What is the Px Minimal Change DIsease?
- T cells release cytokines
- Damage foot processes of podocytes
- Effacement occurs
- Loss of charge barriers
What causes minimal change disease?
- Idiopathic (most)
- NSAIDs, lithium
- Paraneoplastic
- hodgkin’s lymphoma
How would you diagnose MCD?
- Light microscope
- normal
- Electron microscope
- effacemet (narrowing) of podocyte foot process
How would you treat MCD?
- Prednisolone 1mg/kg - 4-16weeks
- If relapse
- cyclophosphamide
- calcineurin inhibitors
What is the most common cause of nephrotic syndrome in adults?
- Membranous nephropathy
What causes Membranous Nephropathy?
- Primary
- idiopathic
- Seconary
- malignancy: lung, breast, GI, prostate
- infection: schistosomiasis, hepatitis b/c strep, malaria
- immunological disease: SLE, RA, sarcoidosis, sjogren
- drug: gold, penicillamine
How would you diagnose MN?
- Bloods
- Antiphospholipase A2 receptor antibody
- Histology
- Thickened GBM
- IgG deposits
- Spikes on silver stain
How would you tx MN?
- ACEi/ARB in all
- Corticosteroid + cyclophosphamide in high risk progression
When would you consider a patient having MN being high risk of progression?
- porteinuria >4g
- no response to ACEi/ARB after 6months
What is the commonest glmerulonephritis seen on renal biopsy?
- Focal segmental glomerulosclerosis
What causes FSGS?
- Idiopathic
- Seconday
- HIV
- Heroin
- Lithium
- Lymphoma
- scarring due to other glomerulonephritis
What are FSGS all at risk of?
- CKD and Kidney Failure
- high proteinuria worsens prognosis
How would you diagnose FSGS?
- Histology
- focal sclerosis
How would you tx FSGS?
- ACEi/ARB in all
- Corticosteroid
- Calcineurin inhibitor
- Rituximab & palsma exchange in renal transplant
How would you mx pt with renal biopsy?
*think pre and post procedure
- Pre-procedure
- BP - follow local protocol
- FBC - Hb>9, plt>100, clotting (pt&aptt <1.2)
- Consent
- Explain complication
- Stop anticoagulants
- Post procedure
- Bed rest min 4hrs
- Monitor pulse, BP, sx and urine colour
- Macroscopic haematuria settles - can discharge
- Start anticoagulants
What is IgA N also known as?
Berger’s disease
What is the most commonest primary glomerulonephritis in developed countries?
- IgA nephorpathy
How does IgA Nephropathy (Berger’s Disease) present?
- Asymptomatic
- non-visible haematuria
- high BP
- Proteinuria
- slow progression to RF
How would you diagnose IgA N?
- Histology
- IgA in mesangium cells
How would you tx IgA N?
- ACEi/ARB
- Corticosteroid
- Fish oil
What are the examples of diseases causing nephritic syndrome?
- IgA Nephropathy
- Anti-GBM disease (goodpasture syndrome)
- Post-streptococcal GN
- ANCA associated vasculitis
- Granulomatosis c polyangiitis
- Microscopic polyangiitis
- Eosinophilic granulomatosis c polyangiitis (churg strauss syndrome)
- Thin basement membrane disease
- Alport syndrome
- Lupus Nephritis
What is anti-GBM disease previously known as?
- Goodpasture disease
What is the presentation of anti-GBM disease?
Renal pathology
- Oliguria
- Haematuria
- AKI
Lung pathology
- SOB
- Haemoptysis
- pulmonary haemorrhage
What does the anti-GBM antibody target?
- T4 collagen found in glomerular and alveolar basement membranes
How would you diagnose anti-GBM disease?
- Blood
- anti-gbm in circulation
How would you tx anti-gbm disease?
- Plasma exchange
- corticosteroid
- cyclophosphamide
anti-GBM disease and ANCA associated vasculitis (Wegener’s granulomatosis) presents the same. How would you differentiate between the two?
- anti-GBM D: have anti-GBM antibodies
- WG: have Anti Neutrophil Cytoplasmic Antibodies (ANCA)
How does post-streptococcal GN present?
- 2 weeks after throat infection
- 3-6 weeks after skin infection
- haematuria
- oedema
- high BP
- oliguria
How would you diagnose and tx PSGN?
- anti-strep antibodies (ASO titre)
- low C3
- IgG, IgM, C3 deposition on biopsy
- Self limiting
- ACEi/ARB, low sodium diet
- If ESRF - RRT
What causes rapidly progressive GN?
- ANCA vasculitis
- lupus nephritis
- anti-GBM disease
- IgA N
- MN
How would you diagnose RPGN?
- Histology
- cresenteric GN
How would you tx RPGN?
- Corticosteroids
- cyclophosphamide
- plasma exchange - antiGBM/ANCA vasculitis
- monoclonal antibodies - lupus nephritis
What is Henoch-Schonlein Purpura?
- Small vessel vasculitis & systemic variant of IgA N
- IgA deposit in skin/joint/gut/kidney
How does HSP present?
- Purpuric rash on extensor surfaces
- fitting polyarthritis
- abdominal pain
- nephritis
How would you diagnose HSP?
- Clinically
- Skin
- IgA
- C3
- Renal biopsy
How would you tx HSP?
- same as IgA nephropathy
How would you briefly tx Glomerulonephritis?
*Think supportive therapy, immunosuppresive therapy, invasive therapy
-
supportive therapy
- Discuss with renal team
- MDT approach
- ACEi/ARB for proteinuria
- BP control
- Salt, water restriction and diuretics - if fluid overload
- LMWH if hypoalbuminaemia
- Statins for HCL
-
Immunosuppresive therapy
- Oral corticosteroid, IV methylprednisolone, Cyclophosphamide, Tacrolimmus, Ciclosporin, Rituximab, MMF, Azathioprine
-
Invasive therapy
- RRT
- Plasma exchange for AAV, anti-GBM
