Glomerulonephritis (GN) Flashcards
define
immune-mediated disease of the kidneys that affects the glomerular capillary wall
how do endothelial cells in the glomerulus respond to damage?
vasculitis (haematuria)
how do podocytes in the glomerulus respond to damage?
atrophies increasing gap size of barrier leading to proteinuria
how does the mesangium in the glomerulus respond to damage?
proliferation and chemokines (haematuria)
presentation of GN
haematuria
proteinuria
nephrotic/nephritic syndrome
hypertension
classes of proteinuria
microalbuminuria 30-300mg/ day albuminuria
asymptomatic <1g/day
heavy 1-3g/day
nephrotic syndrome 3g/day
diagnosis of GN
urinalysis (haematuria, proteinuria, granular casts, RBCs, lipiduria)
kidney biopsy
bloods
non-immunosuppressive management of GN
hypertension <130/80 or <120/75 if proteinuria) ACEI/ARB diuretics statins anticoagulants/ antiplatelets fish oil
immunosuppressive management of GN
corticosteroids azathioprine alkylating agents (cyclophosphamide) calcinuerin inhibitors (cyclosporin) plasmapheresis (TPE) antibodies
what are granular casts?
precipitation of Tamm-Horsall mucoprotein in low pH
types of casts in urine
- hyaline (benign)
- red cells (pathological)
- leucocytes (infection/ inflammation)
- granular (chronic disease)
what does presence of RBC casts in urine prove?
haematuria is glomerular
main types of idiopathic GN
minimal change focal segmental glomerulosclerosis (FSGS) membranous nephropathy IgA nephropathy Membranoproliferative Rapidly progressive GN (RPGN)
causes of GN
idiopathic
infection
drugs
systemic (ANCA vasculitis, SLE, Goodpasture’s and HSP)
presentation of minimal change
children
facial/generalised oedema
nephrotic proteinuria
diagnosis of minimal change
biopsy has minimal change with slight gaps between podocytes
management of minimal change
most have complete remission with steroids (PPI for peptic ulceration)
this type does not progress to renal failure
causes of FSGS
obesity
HIV
sickle cell
IV drug users
presentation of FSGS
commonest cause of nephrotic syndrome in adults
diagnosis of FSGS
renal biopsy on LM shows minimal Ig/ complement deposition with podocyte fusion/sclerosis
management of FSGS
some have remission with prolonged steroids
can progress to ESRF
causes of membranous nephropathy
HepB parasites SLE carcinoma of lung, colon, melanoma, lymphoma syphilis NSAIDs captopril gold penicillamine
diagnosis of membranous nephropathy
renal biopsy shows immune complex deposition (anti-PLA2r Ab and C3) in BM with thickened membranes on silver stain (spiky)
management of membranous nephropathy
steroids
alkylating agents
B cell monoclonal antibody
can progress to ESRF
which is the commonest idiopathic GN?
IgA nephropathy
presentation of IgA nephropathy
non-nephrotic proteinuria
haematuria
following respiratory/ GI infection
AKI/CKD, Coeliac’s, HSP
diagnosis of IgA nephropathy
biopsy shows mesangial cell proliferation and IgA deposits in mesangium
management of IgA nephropathy
BP control
ACEI/ARB
fish oil
can progress to ESRF
causes of membranoproliferative
infection (hep C)
SLE
malignancy
who does membranoproliferative affect?
adults and children
presentation of membranoproliferative?
nephritic and nephrotic
diagnosis of membranoproliferative
thick membranes= tram tracks
define rapidly progressive GN (RPGN)
rapid deterioration of renal function over days/weeks
diagnosis of RPGN
active urinary sediment (RBCs, granular casts)
glomerular crescents on biopsy
causes of RPGN
ANCA positive (GPA, MPA) ANCA negative (Goodpasture's, HSP, SLE) vasculitis
management of RPGN
immunosuppression (steroids, alkylating agents)
plasmapheresis
dialysis
presentation of nephritic syndrome
renal failure (think if high K+) oliguria haematuria oedema hypertension
diagnosis of nephritic syndrome
active urinary sediment with RBCs and granular casts
presentation of nephrotic syndrome
proteinuria >3g/day can have normal renal function hypoalbuminuria (facial swelling, low complement- immunosuppressed) oedema hypercholesterolaemia
complications of nephrotic syndrome
infections (loss of antibodies- protein) renal vein thombosis (proteins in clotting cascade) PE volume depletion (diuretics) vitamin D deficiency hypothyroidism
management of nephrotic syndrome
fluid and Na+ restriction
diuretics, ACEI/ARB
anticoagulants
immunosuppression give pneumococcal vaccine
which type is associated with hep B?
membranous
which type is associated with hep C?
membranoproliferative
