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Renal 2020 > Glomerulonephritis (GN) > Flashcards

Glomerulonephritis (GN) Flashcards

1
Q

define GN

A

immune-mediated disease of the kidneys affecting the glomerular capillary wall

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2
Q

how do endothelial cells respond to injury?

A

vasculitis

haematuria

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3
Q

how do podocytes respond to injury?

A

atrophies increase gap size of the barrier

proteinuria

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4
Q

how does the mesangium respond to injury?

A

proliferation and chemokines

haematuria

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5
Q

presentation of GN

A

haematuria
proteinuria
nephrotic/nephritic syndrome
hypertension

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6
Q

classification of proteinuria

A

Microalbuminuria (30-300mg albuminuria/day)
Asymptomatic proteinuria (<1g/day)
Heavy proteinuria (1-3g/day)
Nephrotic syndrome (>3g/day)

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7
Q

diagnosis of GN

A

urinarlysis (haematuria, proteinuria, granular casts, RBCs, lipiduria)
bloods
kidney biopsy (LM, IF, EM)

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8
Q

non-immunosuppressant management options of GN

A 
anti-hypertension (<130/80, <120/75 if proteinuria)
ACEI/ARB
diuretics
statins
anticoagulants
antiplatelets
fish oil
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9
Q

immunosuppressant management options for GN

A 
corticosteroids 
azathioprine
alkylating agents (cyclophosphamide)
calcineurin inhibitors (cyclosporin)
plasmapheresis (TPE)
antibodies
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10
Q

what are granular casts?

A

precipitation of Tamm-Horsfall mucoprotein in low pH

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11
Q

types of casts

A

hyaline (benign)
red cells (pathological)
leucocytes (infection/inflammation)
granular (chronic disease)

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12
Q

what does the presence of RBC casts in urine prove?

A

haematuria is glomerular

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13
Q

two classes of GN

A

primary

secondary

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14
Q

examples of secondary causes of GN

A

infection
drugs
systemic-ANCA, SLE, GP, HSP

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15
Q

what are the five types of idiopathic/ primary GN?

A
  1. minimal change
  2. focal segmental glomerulosclerosis (FSGS)
  3. membranous nephropathy
  4. IgA nephropathy
  5. membranoproliferative
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16
Q

who does minimal change present in?

A

children

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17
Q

presentation of minimal change GN

A

facial/ generalised oedema

nephrotic proteinuria

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18
Q

diagnosis of minimal change GN

A

normal renal biopsy with slight gaps between podocytes

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19
Q

management of minimal change GN

A

complete remission with steroids

20
Q

causes of FSGS

A

obesity
HIV
sickle cell
IV drug users

21
Q

what is the commonest cause of nephrotic syndrome in adults?

A

FSGS

22
Q

diagnosis of FSGS

A

renal biopsy LM shows minimal Ig/complement deposition with podocyte fusion/sclerosis

23
Q

management of FSGS

A

some have remission on steroids

can progress to ESRF

24
Q

two types of membranous nephropathy

A
  1. primary

2. secondary

25
Q

secondary causes of membranous nephropathy

A 
HepB
parasites
SLE
carcinoma of lung, colon
melanoma
lymphoma
syphilis
NSAIDs
captopril
gold 
penicillamine
26
Q

diagnosis of membranous nephropathy

A

immune complex deposition (anti-PLA2r Ab and C3) in BM with thickened membrane on silver stain (spiky)

27
Q

management of membranous nephropathy

A

steroids
alkylating agents
B cell monoclonal Ab

28
Q

what can membranous nephropathy progress to?

A

ESRF

29
Q

which is the commonest type of GN?

A

IgA nephropathy

30
Q

presentation of IgA nephropathy

A 
non-nephrotic proteinuria
haematuria following resp/GI infection
AKI/CKD
Coeliac's
HSP
31
Q

diagnosis fo IgA nephropathy

A

biopsy shows mesangial cell proliferation

LM IgA deposits in mesangium

32
Q

management of IgA nephropathy

A

BP control
ACEI/ARB
fish oil

33
Q

what can IgA nephropathy progress to?

A

ESRF

34
Q

causes of membranoproliferative GN

A

hep C
SLE
malignancy

35
Q

who gets membranoproliferative GN?

A

adults and children

36
Q

presentation of membranoproliferative GN

A

nephritic

nephrotic

37
Q

diagnosis of membranoproliferative GN

A

thick membranes- tram tracks

38
Q

what is rapidly progressive GN (RPGN)?

A

rapid deterioration of renal function over days/weeks

39
Q

diagnosis of RPGN

A

active urinary sediment (RBCs, granular casts)

glomerular crescents on biopsy

40
Q

causes of RPGN

A

any GN

ANCA +ve and -ve

41
Q

management of RPGN

A

immunosuppression
plasmapheresis
dialysis if needed

42
Q

presentation of nephritic syndrome

A 
renal failure (high K+)
oliguria
haematuria
oedema
hypertension
43
Q

diagnosis of nephritic syndrome

A

active urinary sediment (RBCs, granular casts)

44
Q

nephrotic syndrome presentation

A

proteinuria
can have normal renal function
facial swelling
oedema

45
Q

diagnosis of nephrotic syndrome

A

proteinuria >3g/day
hypoalbuminuria (<30)
low complement
hypercholesterolaemia

46
Q

complications of nephrotic syndrome

A 
infections
renal vein thrombosis 
PE
volume depletion (diuretics)
vitamin D deficiency
hypothyroidism
47
Q

management of nephrotic syndrome

A 
fluid and salt restriction
diuretics
ACEI/ARB
anticoagulants
immunosuppression

Renal 2020 (26 decks)

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