Glomerulonephritis And Nephrotic Syndromes Flashcards by Callum Donoher

What is glomerulonephritis?

Inflammation of the glomeruli in the kidneys

How well did you know this?

Not at all

Perfectly

What is the overall general treatment principles for glomerulonephritis?

Treat targeted at underlying cause
Supportive care and immunosuppression like corticosteroids

How well did you know this?

Not at all

Perfectly

What is nephritic syndrome?

A group of features that occurs with nephritis (inflammation of the kidney)

How well did you know this?

Not at all

Perfectly

What are the features of nephritic syndrome?

Haematuria
Oliguria (significantly reduced urine. Output)
Proteinuria
Fluid retention

HTN

How well did you know this?

Not at all

Perfectly

What is nephrotic syndrome?

When the basement membrane of the glomerulus becomes highly permeable causing significant proteinuria

How well did you know this?

Not at all

Perfectly

What are the features of nephrotic syndromes?

Significant proteinuria
Low serum albumin (lost in urine)
Peripheral odema (loss of oncotic pressure due to hypoalbuminaemia)
Hypercholesterolaemia (due to inc albumin production)

How well did you know this?

Not at all

Perfectly

What effect does significant protienuria in nephrotic syndrome have on the urine?

Makes it frothy

How well did you know this?

Not at all

Perfectly

What are some complications of nephrotic syndrome?

Thrombosis
HTN
High cholesterol
Immunosuppression

How well did you know this?

Not at all

Perfectly

What is the most common nephrotic syndrome in kids (2-5)?

How would it present?

Minimal change disease

Odema
Proteinuria
Low albumin

How well did you know this?

Not at all

Perfectly

How would you treat minimal change disease?

Corticosteroids

How well did you know this?

Not at all

Perfectly

What are some nephrotic syndromes for adults?

Diabetic nephropathy
Focal Segmental Glomerulosclerosis
Membranous glomerulonephritis
Infection
Lupus nephritis
Amyloidosis
Medication inflicted

How well did you know this?

Not at all

Perfectly

What is the pathophysiology of minimal change disease?

Foot processes damaged
So gaps in basement membrane large allowing protien leakage

How well did you know this?

Not at all

Perfectly

How to remember main difference in presentation for Nephritic and Nephrotic syndromes?

NephItic = Inflammation of glomerular basement membrane causing Haematuria

NephrOtic = POdOcyte damage of basement membrane. Causing Odema (charge of podocytes not repelling albumin)

How well did you know this?

Not at all

Perfectly

What are some types of glomerulonephritis?

IgA nephropathy (bergers disease)
Goodpastures syndrome (anti-GBM glomerular basement membrane)
Rapidly progressing glomerulonephritis
Post streptococcal glomerulonephritis
Lupus nephritis

How well did you know this?

Not at all

Perfectly

What is IgA nephropathy?

How does it typically present?

IgA immune deposits in mesangial cells and mesangial proliferation. Usually a couple days (1-3days) post Upper Respiratory tract infection

20yr old
Haematuria
Most common cause of primary glomerulonephritis

How well did you know this?

Not at all

Perfectly

What is Goodpasture syndrome?

Anti-GBM antibodies attack glomerulus (Type IV collagen in basement membrane) and pulmonary basement membrane leading to glomerulonephritis. And pulmonary haemorrhage

How well did you know this?

Not at all

Perfectly

What is a typical presentation of Goodpasture syndrome?

20-60y/o patient
Acute Kidney Failure and Haemoptysis

How well did you know this?

Not at all

Perfectly

What is rapidly progressive glomuerlonephritis?
How does it look on histology?

Severe glomerular injury

Crescent shaped masses on histology

How well did you know this?

Not at all

Perfectly

What is post streptococcal glomerulonephritis?
What is recovery like?

1-3 weeks after infection by group A Beta haemolytic streptococcal infection of pharynx,tonsils or skin

Kidneys normally fully recover after Abx given to treat remaining infection

How well did you know this?

Not at all

Perfectly

What are some systemic disease that can cause glomerulonephritis?

HSP (Henoch-Schonlein purpura)
Vasculitis
Lupus nephritis

How well did you know this?

Not at all

Perfectly

What antibodies can you test for to determine cause of kidney injury?

Anti-GBM. Antibodies = Goodpasture syndrome
P-ANCA = microscopic polyangiitis (Vasculitis)
C-ANCA = granulomatosis with polyangiits (vasculitis)
ANA = Lupus screen
IgA = IgA nephropathy
Anti-streptolysin = post streptococcal glomerulonephritis

How well did you know this?

Not at all

Perfectly

How do you diagnose the cause of a nephrotic or nephritic syndrome?

Renal biopsy for Histology

How well did you know this?

Not at all

Perfectly

How do you manage nephrotic or nephritic syndromes?

Supportive care:
-HTN management (ACEi)
-Diuretics if oedematous
-DIALYSIS in severe cases

Immunosupression:
-corticosteroids

How well did you know this?

Not at all

Perfectly

What kidney disease is linked to IBD?

IgA nephropathy (glomerulonephritis)

How would you investigate a patient presenting with blood in their urine 3 days after a URTI?

FBC U+Es (creatinine, eGFR, albumin/creatine ratio) Urine dip Serological tests (IgA)

How does membranous glomuerlonephritis present?

Oedema Proteinuria Hypoalbuminaemia

What investigations would you do. For a patient presenting with. Odema, and frothy urine?

U+Es Urine dip Serum albumin Albumin/creatinine ratio Lipid profile Renal USS Renal biopsy

How do you manage a patient with membranous glomerulonephritis?

BP control (ACEi) Lipid control (anti-hyperlipidaemia drugs) Diuretics for oedma (furosemide) Anticoagulation (reduce VTE risk)

What is Henoch Schonlein purpura?

Type of IgA vasculitis common in children

How does Heneooch Schonlein purpura present?

Palpable purpura of the skin May or may not have renal disease

What happens in post streptococcal glomerulonephritis?

Infection in the kidneys leads to oedematous glomeruli and neutrophil infiltration 1-3weeks after the URTI

What investigations are done when ?post streptococcal glomerulonephritis?

BP Urine. Dip U+E Serology = Anti streptolysin Renal biopsy

How may a lupus nephritis present?

B - symptoms/constitutional symptoms: -fatigue -fever -weight loss -night sweats -chills -lethargy Haematuria Proteinuria

What Investigations would you want to do if you are suspecting a potential lupus nephritis?

Urine dipstick FBC U+Es LFT MCS of urine Albumin/creatinine ratio Glucose Serum albumin Serology: -ANA screen -Anti dsDNA -anti-sm Biopsy

What is the most common finding on biopsy of a kidney with lupus nephritis?

Antigen-antibody complexes

What is the gold standard investigation pathway if a patient presents with oedema?

Urine dip If abnormal with blood or protien do ALBUMIN TO CREATININE RATIO

What investigations would you do for a patient preventing with oedema and frothy urine?

Glucose U+Es Urine dip Albumin to creatinine ratio (STANDARD SCREENING TOOL) Serum albumin Lipid profile

Why if a patient has oedema and frothy urine is it important to check the blood glucose?

Most common cause for nephrotic syndromes is DIABETIC NEPHROPATHY

How does diabetic nephropathy appear on biopsy?

Kimmelsteil Wilson nodules

What serological test would you do for membranous glomerulonephritis?

PLAR2 gene

What medications are most commonly associated with causing Nephrotic syndromes?

NSAIDs

What screen would you give if you think Amyloidosis might be the cause of the nephrotic syndrome?

Myeloma screen

What would a kidney look like on biopsy that had Amyloidosis causing the nephrotic syndrome?

Fibrils

If a patient has high proteinuria but no oedema is this still nephrotic syndrome? If not what is it called?

No its not Nephrotic range proteinuria

What is a good rule to follow in terms of proteinuria?

If the patient doesn’t have proteinuria, it’s not a renal issue

Why is immunosuppression a potential complication of nephrotic syndrome?

Immunoglobulins are a type of protein that can also be lost in the urine

Why is thrombosis/clot formation like DVTs a complication of nephrotic syndromes?

Fibrinolytic proteins are lost more than pro-thrombotic proteins

What is considered a normal range for JVP?

-1 to 3 cm of H20

How does IgA nephropathy appear on biopsy?

IgA immune deposits in mesangial cells Proliferation of mesangial cells Crescent moon shapes

How does post-streptococcal glomerulonephritis appear on biopsy?

Neutrophil infiltration Antibody + Antigen complex Oedematous glomeruli

How is lupus nephritis managed?

Immunosupression Corticosteroids DMARDs

What is pauci-immune Glomerulonephritis?

Systemic autoimmune condition that’s a type of vasculitis causing haematuria

What are some symptoms for pauci-immune glomerulonephritis?

B-symptoms: -fever -night sweats -weight loss -chills Epistaxis Nasal disease Sinus disease Cough Sputum SOB Wheeze HTN Haematuria Proteinuria

What would be seen on microscopy of the urine with pauci-immune. Glomerulonephritis?

Dysmmmorphic RBC casts

What serology would be positive with pauci-immune glomerulonephritis?

ANA ANCA

How does a pauci-immune glomerulonephritis biopsy appear? How is this different to lupus nephritis?

Inflammation Fibrinoid crescents Doesn’t have lots of immune deposits like lupus

How is pauci-immune glomerulonephritis managed?

Immunosupression: -Corticosteroids -DMARDs like methotrexate

What affect can lithium, an antipsychotic drug have on the kidneys?

Drug induced diabetes Insipidus Acute interstitial nephritis