Glomerulonephritis (GN) Flashcards
define GN
immune-mediated disease of the kidneys affecting the glomerular capillary wall
how do endothelial cells respond to injury?
vasculitis
haematuria
how do podocytes respond to injury?
atrophies increase gap size of the barrier
proteinuria
how does the mesangium respond to injury?
proliferation and chemokines
haematuria
presentation of GN
haematuria
proteinuria
nephrotic/nephritic syndrome
hypertension
classification of proteinuria
Microalbuminuria (30-300mg albuminuria/day)
Asymptomatic proteinuria (<1g/day)
Heavy proteinuria (1-3g/day)
Nephrotic syndrome (>3g/day)
diagnosis of GN
urinarlysis (haematuria, proteinuria, granular casts, RBCs, lipiduria)
bloods
kidney biopsy (LM, IF, EM)
non-immunosuppressant management options of GN
anti-hypertension (<130/80, <120/75 if proteinuria) ACEI/ARB diuretics statins anticoagulants antiplatelets fish oil
immunosuppressant management options for GN
corticosteroids azathioprine alkylating agents (cyclophosphamide) calcineurin inhibitors (cyclosporin) plasmapheresis (TPE) antibodies
what are granular casts?
precipitation of Tamm-Horsfall mucoprotein in low pH
types of casts
hyaline (benign)
red cells (pathological)
leucocytes (infection/inflammation)
granular (chronic disease)
what does the presence of RBC casts in urine prove?
haematuria is glomerular
two classes of GN
primary
secondary
examples of secondary causes of GN
infection
drugs
systemic-ANCA, SLE, GP, HSP
what are the five types of idiopathic/ primary GN?
- minimal change
- focal segmental glomerulosclerosis (FSGS)
- membranous nephropathy
- IgA nephropathy
- membranoproliferative
who does minimal change present in?
children
presentation of minimal change GN
facial/ generalised oedema
nephrotic proteinuria
diagnosis of minimal change GN
normal renal biopsy with slight gaps between podocytes
management of minimal change GN
complete remission with steroids
causes of FSGS
obesity
HIV
sickle cell
IV drug users
what is the commonest cause of nephrotic syndrome in adults?
FSGS
diagnosis of FSGS
renal biopsy LM shows minimal Ig/complement deposition with podocyte fusion/sclerosis
management of FSGS
some have remission on steroids
can progress to ESRF
two types of membranous nephropathy
- primary
2. secondary
secondary causes of membranous nephropathy
HepB parasites SLE carcinoma of lung, colon melanoma lymphoma syphilis NSAIDs captopril gold penicillamine
diagnosis of membranous nephropathy
immune complex deposition (anti-PLA2r Ab and C3) in BM with thickened membrane on silver stain (spiky)
management of membranous nephropathy
steroids
alkylating agents
B cell monoclonal Ab
what can membranous nephropathy progress to?
ESRF
which is the commonest type of GN?
IgA nephropathy
presentation of IgA nephropathy
non-nephrotic proteinuria haematuria following resp/GI infection AKI/CKD Coeliac's HSP
diagnosis fo IgA nephropathy
biopsy shows mesangial cell proliferation
LM IgA deposits in mesangium
management of IgA nephropathy
BP control
ACEI/ARB
fish oil
what can IgA nephropathy progress to?
ESRF
causes of membranoproliferative GN
hep C
SLE
malignancy
who gets membranoproliferative GN?
adults and children
presentation of membranoproliferative GN
nephritic
nephrotic
diagnosis of membranoproliferative GN
thick membranes- tram tracks
what is 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
any GN
ANCA +ve and -ve
management of RPGN
immunosuppression
plasmapheresis
dialysis if needed
presentation of nephritic syndrome
renal failure (high K+) oliguria haematuria oedema hypertension
diagnosis of nephritic syndrome
active urinary sediment (RBCs, granular casts)
nephrotic syndrome presentation
proteinuria
can have normal renal function
facial swelling
oedema
diagnosis of nephrotic syndrome
proteinuria >3g/day
hypoalbuminuria (<30)
low complement
hypercholesterolaemia
complications of nephrotic syndrome
infections renal vein thrombosis PE volume depletion (diuretics) vitamin D deficiency hypothyroidism
management of nephrotic syndrome
fluid and salt restriction diuretics ACEI/ARB anticoagulants immunosuppression
