Glomerulonephritis Flashcards
What is nephritis?
Inflammation of the kidneys
Very non-specific descriptive term and is not a diagnosis or syndrome
What is nephritic syndrome?
Refers to a group of symptoms, not a diagnosis - fit a clinical picture of having inflammation of their kidney
Features:
Haematuria means blood in the urine. Microscopic or macroscopic
Oliguria
Proteinuria < 3g / 24 hours. Any more and it starts being classified as nephrotic syndrome
Fluid retention
What is nephrotic syndrome?
Refers to a group of symptoms:
Peripheral oedema
Proteinuria > 3g / 24 hours
Serum albumin < 25g / L
Hypercholesterolaemia
What is glomerulonephritis?
Umbrella term applied to conditions that cause inflammation of or around the glomerulus and nephron
What are the specific types of glomerulonephritis? (8)
Minimal change disease
Focal segmental glomerulosclerosis
Membranous glomerulonephritis
IgA nephropathy (AKA mesangioproliferative glomerulonephritis or Berger’s disease)
Post streptococcal glomerulonephritis (AKA diffuse proliferative glomerulonephritis)
Mesangiocapillary glomerulonephritis
Rapidly progressive glomerulonephritis
Goodpasture Syndrome
What is glomerulosclerosis?
Term to describe the pathological process of scarring of the tissue in the glomerulus
Not a diagnosis in itself - term used to describe the damage and scarring done by other diagnoses
Caused by any type of glomerulonephritis or obstructive uropathy and specifically by FSGS
Treatment of glomerulonephritis
Most types of glomerulonephritis are treated with:
Immunosuppression (e.g. steroids)
Blood pressure control by blocking the renin-angiotensin system (i.e. ACE inhibitors or angiotensin-II receptor blockers)
How does nephrotic syndrome present?
Usually presents with oedema
Frothy urine (proteinuria)
Predisposes patients to thrombosis, hypertension and high cholesterol
Most common causes of nephrotic syndrome
Children
Minimal Change Diseaase
Usually:
Idiopathic (no identified cause)
Treated successfully with steroids
Adults
FSGS
What is IgA nephropathy? (AKA Berger’s disease)
Most common cause of primary glomerulonephritis
Histology shows “IgA deposits and glomerular mesangial proliferation”
Peak age at presentation is 20s
What is Membranous glomerulonephritis? (5)
Most common type of glomerulonephritis overall
There is a bimodal peak in age in the 20s and 60s
Histology shows “IgG and complement deposits on the basement membrane”
The majority (~70%) are idiopathic
Can be secondary to malignancy, rheumatoid disorders and drugs (e.g. NSAIDS)
What is Post streptococcal glomerulonephritis (AKA diffuse proliferative glomerulonephritis)?
Patients are typically under 30 years. It presents as:
1-3 weeks after a streptococcal infection (e.g. tonsillitis or impetigo)
They develop a nephritic syndrome
There is usually a full recovery
What happens in Goodpasture’s syndrome?
Anti-GBM (glomerular basement membrane) antibodies attack glomerulus and pulmonary basement membranes
Causes glomerulonephritis and pulmonary haemorrhage
What diagnosis should come to mind if patient presents with acute renal failure and haemoptysis?
Goodpasture syndrome (anti-GBM antibodies)
Granulomatosis with polyangiitis (AKA Wegener’s granulomatosis) ( anti-neutrophil cytoplasmic antibodies (ANCA))
Patients with Wegener’s granulomatosis may also have a wheeze, sinusitis and a saddle-shaped nose
What is Rapidly progressive glomerulonephritis?
Histology shows “crescentic glomerulonephritis”
Presents with a very acute illness with sick patients but it responds well to treatment
Often secondary to Goodpasture syndrome
