Glomerulonephritis And Nephrotic Syndromes Flashcards
What is glomerulonephritis?
Inflammation of the glomeruli in the kidneys
What is the overall general treatment principles for glomerulonephritis?
Treat targeted at underlying cause
Supportive care and immunosuppression like corticosteroids
What is nephritic syndrome?
A group of features that occurs with nephritis (inflammation of the kidney)
What are the features of nephritic syndrome?
Haematuria
Oliguria (significantly reduced urine. Output)
Proteinuria
Fluid retention
HTN
What is nephrotic syndrome?
When the basement membrane of the glomerulus becomes highly permeable causing significant proteinuria
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)
What effect does significant protienuria in nephrotic syndrome have on the urine?
Makes it frothy
What are some complications of nephrotic syndrome?
Thrombosis
HTN
High cholesterol
Immunosuppression
What is the most common nephrotic syndrome in kids (2-5)?
How would it present?
Minimal change disease
Odema
Proteinuria
Low albumin
How would you treat minimal change disease?
Corticosteroids
What are some nephrotic syndromes for adults?
Diabetic nephropathy
Focal Segmental Glomerulosclerosis
Membranous glomerulonephritis
Infection
Lupus nephritis
Amyloidosis
Medication inflicted
What is the pathophysiology of minimal change disease?
Foot processes damaged
So gaps in basement membrane large allowing protien leakage
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)
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
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
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
What is a typical presentation of Goodpasture syndrome?
20-60y/o patient
Acute Kidney Failure and Haemoptysis
What is rapidly progressive glomuerlonephritis?
How does it look on histology?
Severe glomerular injury
Crescent shaped masses on histology
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
What are some systemic disease that can cause glomerulonephritis?
HSP (Henoch-Schonlein purpura)
Vasculitis
Lupus nephritis
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 do you diagnose the cause of a nephrotic or nephritic syndrome?
Renal biopsy for Histology
How do you manage nephrotic or nephritic syndromes?
Supportive care:
-HTN management (ACEi)
-Diuretics if oedematous
-DIALYSIS in severe cases
Immunosupression:
-corticosteroids
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
