Glomerulonephritis Clinical Flashcards
What is the presentation of glomerulonephritis?
Haematuria
Proteinuria
Hypertension
Renal Insufficiency
What is nephrotic syndrome?
Massive proteinuria (>3.5 g/day), hypoalbuminaemia, oedema, lipiduria and hyperlipidaemia. Podocyte malfunction or injury is often causative. Can be caused by primary (idiopathic) or secondary glomerular diseases
What are two types of nephritic syndrome?
Glomerulonephritis (nephritic syndrome):
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Acute glomerulonephritis: abrupt onset of glomerular haematuria (red blood cell casts or dysmorphic red blood cells), non-nephrotic-range proteinuria, oedema, hypertension and transient renal impairment, or
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Rapidly progressive glomerulonephritis: features of acute nephritis, focal necrosis with or without crescents, and rapidly progressive renal failure over weeks
What is the difference between proliferative and non proliferative glomerulonephritis?
Proliferative- Excessive numbers of cells in glomeruli. These include infiltrating leucocytes
Non-proliferative- Glomeruli look normal or have areas of scarring. They have normal numbers of cells
How would mixed nephrotic/nephritic syndrome present?
Where glomerulonephritis is part of a systemic disease (lupus nephritis, cryoglobulinaemia and Henoch–Schönlein purpura), a nephritic syndrome is often associated with the nephrotic syndrome
What are four words that can be used to describe glomerulonephritis?
Diffuse: >50% of glomeruli affected
Focal: <50% of glomeruli affected
Global: all the glomerulus affected
Segmental: part of the glomerulus affected
With what pathologies are urinary sedimentation, proteinuria, nephrotic syndrome and nephritic state associated with?
Urinary sediment abnormalities -IgA nephropathy Proteinuria -IgA nephropathy Nephrotic syndrome -Minimal change disease -Membranous nephropathy Nephritic state -Anti-neutrophil cytoplasmic antibody (ANCA) associated glomerulonephritis -Post-infection glomerulonephritis
What are the treatments for post infective glomerulonephritis?
Antibiotics for infection, debatable.
Loop diuretics such as frusemide for oedema
Vasodilator drugs (e.g. amlodipine) for hypertension
How does IgA nephropathy present?
Microscopic haematuria.
Microscopic haematuria + proteinuria
Nephrotic syndrome
IgA crescentic glomerulonephritis
What types of glomerulonephritis can present as crescentic glomerulonephritis?
Microscopic polyangiitis. Granulomatosis with polyangiitis. Eosinophilic granulomatosis with polyangiitis Anti-GBM nephritis Goodpasture’s syndrome IgA vasculitis. Post-infection glomerulonephritis. SLE.
What are the treatments for focal necrotising glomerulonephritis?
High dose steroids
Cyclophosphamide
Plasma exchange
How can anti-GBM present?
Nephritis (anti-GBM glomerulonephritis)
Nephritis and lung haemorrhage (Goodpasture’s syndrome)
Usually presents in either third decade or sixth or seventh
What is the diagnosis and treatment for anti-GBM?
Diagnosed by demonstrating anti-GBM antibodies in serum and kidney
Treatment with aggressive immunesuppression: steroid, plasma exchange, and cyclophosphamide.
What are five possible immunosuppressants to treat crescentic glomerulonephritis?
Corticosteroids Plasma exchange Cytotoxic e.g. Cyclophosphamide B-cell therapy e.g. Rituximab Complement inhibitors
What is the management of nephrotic syndrome?
Treat oedema: salt and fluid restriction and loop diuretics.
Hypertension: use Renin-Angiotensin-Aldosterone-blockade.
Reduce risk of thrombosis: Heparin or Warfarin.
Reduce risk of infection e.g. pneumococcal vaccine.
Treat dyslipidaemia e.g. statins.
Specific therapy towards cause of the non-proliferative glomerulonephritis
