Glomerulonephritis Flashcards
features of nephritic syndrome?
haematuria (can be microscopic or macroscopic)
oliguria
proteinuria (not as much as nephrotic so must be <3g)
fluid retention (can be central/peripheral/anywhere)
features of nephrotic syndrome?
peripheral oedema
proteinuria (3g or more in 24 hrs)
serum albumin <25g/L
hypercholesterolaemia
how are most types of glomerulonephritis treated?
immunosuppression (eg steroids) BP control (ACE inhibitors or ARBs)
what does nephrotic syndrome predispose to?
thrombosis
hypertension
high cholesterol
most common cause of nephrotic syndrome in children?
minimal change disease
what usually causes minimal change disease?
idiopathic
how is minimal change disease usually treated?
steroids
most common cause of nephrotic syndrome in adults?
focal segmental glomerulosclerosis
what is IgA nephropathy also known as?
bergers disease
most common cause of primary glomerulonephritis (not caused by another disease)?
IgA nephropathy
peak age of presentation of IgA nephropathy?
20s
what does histology show in IgA nephropathy?
IgA deposits
glomerular mesangial proliferation
most common glomerulonephritis overall?
membranous glomerulonephritis
peak incidence of membranous?
bimodal peak
in 20s and 60s
what does histology show in membranous?
IgG and complement deposits on basement membrane
what causes membranous?
70% are idiopathic
can be secondary to malignancy, rheumatic disorders and drugs (eg NSAIDs)
how does post-strep glomerulonephritis present?
patients usually under 30
1-3 weeks after strep infection (tonsillitis or impetigo)
develop nephritic syndrome
usually a full recovery
what happens in goodpastures syndrome?
anti GBM antibodies attach glomerulus and pulmonary basement membranes
this causes glomerulonephritis and pulmonary haemorrhage
classic picture of goodpastures disease?
acute kidney failure and haemoptysis
what will histology show in rapidly progressive glomerulonephritis?
crescentic glomerulonephritis
how does rapidly progressive glomerulonephritis usually present?
very acute illness with sick patients
often secondary to goodpastures
what is glomerulonephritis?
group of kidney diseases mainly characterised by inflammatory disease primarily affecting the glomeruli
can be primary or secondary to other systemic disorder such as diabetes
how can glomerulonephritis present?
nephrotic or nephritic
types of primary glomerulonephritis?
membranous nephropathy minimal change disease focal segmental glomerulosclerosis mesenagiocapillary (membranoproliferative) IgA nephropathy rapidly progressive glomerulonephritis
which types of primary glomerulonephritis present with nephrotic syndrome?
membranous nephropathy
minimal change disease
focal segmental glomerulosclerosis
mesenagiocapillary (membranoproliferative)
which types of primary glomerulonephritis present with nephritic syndrome?
IgA nephropathy
rapidly progressive glomerulonephritis
types of rapidly progressive glomerulonephritis?
type 1 = anti-GBM disease
type 2 = immune complex (SLE, HSP, IgA)
type 3 = vasculitis
main cause of glomerulonephritis in kids?
minimal change disease
main cause of glomerulonephritis in adults in overall?
IgA nephropathy
how do most glomerulonephritis develop?
result of immune dysregulation which can be due to inappropriate response to self antigen or foreign antigen
diagnostic features of minimal change disease?
electron microscopy might show effacement of podocytes but light microscopy and immunofluorescence dont show any changes
second most common cause of glomerulonephritis in adults?
membranous
which type of glomerulonephritis can present nephrotic or nephritic?
mesangiocapillary (membranoproliferative)
what cause mesangiocapillary (membranoproliferative) glomerulonephritis?
immune deposition in the glomerulus, thickening of basement membrane and activation of complement pathway leads to glomerular damage
which type of glomerulonephritis is most associated with hep C?
mesangiocapillary (membranoproliferative)
diagnostic features of IgA nephropathy?
IgA deposition seen in glomerulus
presents with haematuria 1-2 days after symptoms of a URTI
how is glomerulonephritis diagnosed?
urinalysis routine bloods for renal function, clotting, LFTs, glucose and inflammatory markers immuno-serological screen imaging renal biopsy
how is urinalysis used in glomerulonephritis?
dipstick for urine anf blood
culture and cytology
microscopy can show dysmorphic red blood cells (low MCV) and casts
types of serology screening in glomerulonephritis?
ANCA anti-GBM ANA anti-dsDNA C3 and C4 HBV, HCV and HIV serum immunoglobulins and urine electrophoresis (exclude myeloma)
how is glomerulonephritis managed non pharmacologically?
lifestyle changes can help cases secondary to chronic disease (eg diabetes)
salt and water restriction
how can glomerulonephritis be managed pharmacologically?
ACEi can decrease proteinuria and improve mortality
steroids reduce immunological factors and induce remission
diuretics help with oedema and BP control
statins help lipids
anticoagulation in nephrotic syndrome as it causes hypercoagulability
cyclophosphamide can be used in resistant cases (immune related)
surgical management of glomerulonephritis?
renal transplant
types of secondary glomerulonephritis that present nephrotic?
diabetes
SLE class 5-6
amylooid
hepatitis B/C
what types of secondary glomerulonephritis present nephritic?
post-strep
SLE class 1-4
vasculitis (HSP, GPA)
goodpastures disease (anti-GBM)
