Glomerulonephritis and Nephrotic Syndrome Flashcards
Classification?
- prerenal
- intrarenal
- postrenal
Functional unit of the kidney?
nephron
Causes of kidney injury?
- Acute Glomerulonephritis (5%)
- Acute Tubular Necrosis
a. toxin (35%)
b. ischemic (50%) - Acute Interstitial Nephritis (10%)
Causes of acute glomerulonephritis?
causes can be primary or secondary
1. Anti-Glomerular Basement Membrane antibody diseases
2. Immune Complex GN
3. Pauci-immune GN
Primary causes of glomerulonephritis?
- Membranous proliferative GN
- IgA nephropathy
- Cresentic GN
- Fibrillary GN
Secondary causes of glomerulonephritis?
- SLE
- Post-streptococcal GN
- Hep C
- Medicine toxicities
- Amyloidosis
- Vascular e.g. Wegners Granulomatosus
- Infective endocarditis
When does post-streptococcal GN occur?
- 6-10 days after throat infection
- 10-14 days after skin infection
Epidemiology of post-streptococcal GN?
Common in children 6-10 years old
Diagnosing post-streptococcal GN microscopically?
- Nephritogenic streptococci identified
- Shows sub-epithelial humps on electron Microscopy
Diagnosing acute GN?
- Red Blood Cell casts
- Rapidly increasingly creatinine
- Renal biopsy findings
What can be seen in urine microscopy when diagnosing GN?
Different types of casts
1. Epithelial
2. Red Cell
3. Leucocyte
4. Granular
5. Hyaline
Characteristic features of nephrotic syndrome?
- Massive proteinuria >3.5g/dy
- Hypoalbuminemia
- Hyperlipidemia
- Edema
- Frequently associated with underlying glomerular disease
- It’s a non-inflammatory process
Characteristic features of nephritic syndrome?
- Hallmark - Hematuria/ Red Cell Casts
- Low Grade proteinuria
- Hypertension
- Edema
- Decreasing renal function
- Can be primary kidney disease or from another systemic disease
- Its an inflammatory process
Causes of nephrotic syndrome?
- minimal change disease
- focal segmental glomerulosclerosis
- membranous
- diabetic nephropathy
- amyloid
- membrano-proliferative GN
- HIV associated nephropathy
Causes of hypocomplementemia in renal disease?
- SLE
- MPGN
- Cryoglobulinemia (Hep C)
Investigations for nephrotic syndrome?
- FBC, ESR, LFT, RFT
- ANA, ANCA,
- Serum complement studies
- Hepatitis studies
- HIV serology
- Serum cryoglobulins
- Rheumatoid Factor
- Serum Electrophoresis and Urine Protein electrophoresis
- HbA1c
When is it important to do a renal biopsy?
Important in nephrotic range proteinuria for
1. diagnosis of actual cause and prognosis
2. also important to assess possible recurrence of disease in transplanted kidney
When is it not important to do a renal biopsy?
Not important in sub-nephrotic range proteinuria
- These cases are usually tubulointerstitial diseases and biopsy findings are not specific unlike in the glomerular diseases
Complications of NS/GN?
- Edema and ascites
- Progression to ESRD
- Low immunity – reduction in C3 and 4 through C4, immunoglobulin loss in urine
- Hypercoagulability including Pulmonary embolism and Renal vein Thrombosis
- Hyperlipidemia and accelerated atherosclerosis
- Hypertension
Treatment in GN and NS?
Supportive –
1. HTN + proteinuria - ACEi/ARBs
2. edema - loop diuretics: furosemide
3. lipids - statins
4. coagulation - prophylactic low molecular weight heparin
Treatment in NS?
- immunosupressants
- Methylprednisolone
- Cyclophosphamide
- Mycophenolate Mofetil
- Immuran
- Cyclosporine
Plasmapharesis
- anti-GBM disease
Thrombolysis
- Asa, Warfarin
