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Med 2 > Glomerulonephritis - Nephrotic and Nephritic > Flashcards

Glomerulonephritis - Nephrotic and Nephritic Flashcards

1
Q

What is the quadrad of nephrotic syndrome?

A
  1. Proteinuria (>3g/24hr)
  2. Hypoalbuminemia (<30g/L)
  3. Oedema
  4. Dyslipidemia/ hypercholesterolemia
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2
Q

What is the basic process underpinning nephrotic syndrome?

A
  1. Inflammation and damage to the glomerulus -> more permeable but dec GFR (can lead to HTN)
  2. Proteins filtered into urine (may be followed with haematuria depending on extent of damage) - includes antibody loss so increased risk of infection
  3. Hypoproteinemia (low albumin) cause water and electrolyte loss into interstittium -> odemea -> low cardiac output = low eGFR = activating RAAS which worsens oedema
  4. Liver inc protein and cholesterol production to compensate -> dyslipidemia -> may also increase coagulation proteins -> inc risk of thromboembolic events
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3
Q

What are the different primary causes of glomerulonephritis?

A
  1. Minimal change GN = children
  2. Membranous GN
  3. Focal segmentation glomerulosclerosis = adults
  4. Membranoproliferative GN
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4
Q

What are some secondary causes of nephrotic syndrome?

A

Diabetes mellitus
SLE
Amyloidosis

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5
Q

What are some outlier causes of nephrotic syndrome?

A

Gold (sodium aurohtimalate), penicillamine
Congenital
Neoplasia = carcinoma, lymphoma, leukaemia, myeloma
Infection = bacterial endocarditis, hepatitis B, malaria

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6
Q

What is the relationship between glomerulonephritis, nephrotic syndrome and nephritic syndrome?

A

GN = inflammation of glomeruli
Can result in nephrotic (protein uria and oedema) or nephritic (haematuria, HTN and less proteinuria) syndrome

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7
Q

How might nephrotic syndrome present?

A

Proteinuria = frothy urine
Hypoalbuminemia = fatigue, leukonychia
Odema = peripheral, periorbital, pulmonary or pleural effusions (breathlessness) or ascities
Dyslipidemia = xanthelasma and xanthomata

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8
Q

What are some key investigations for nephrotic syndrome?

A

Bedside - urine dip (frothy, protein uria >3.5g/24hr), urine immunoglobulins, protein: creatinine ratio.
Bloods - U&Es, ()(), lipid profile (dysplipemia), FBC, LFTs, Ca2+, CRP, Glucose, Serum immunoglobulins, autoimmune screen (Hep B/C, HIV)
Imaging - ultrasound, kidney biopsy, CXR (pulmonary oedema/effusion)

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9
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal change disease

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10
Q

What is the most common cause of nephrotic syndrome in adults?

A

Membranous nephropathy

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11
Q

What are the suspected blood test results in nephrotic syndrome?

A

LFTs = hypoalbuminemia
U&Es = renal function
FBC = anaemia
Vitamin D = low
Bone profile = hypoCa2+
Coagulation screen = hyper
HbA1c or fasting glucose = diabetes
Lipid profile = dyslipidemia
CRP and ESR = rasied
Myeloma screen (just in case)
Autoimmune screen (SLE)
Infection screen (Hep B/C, HIV)

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12
Q

What is the golden standard investigation for the diagnosis of nephrotic syndrome?

A

Renal biopsy

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13
Q

What is the typical conservative management for nephrotic syndrome?

A

Restrict salt intake <2g/day
Fluid restriction <1.5g/day
Weight monitoring
Diet - avoid high protein
Mechanical thromboprophylaxis

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14
Q

What is the medical management for nephrotic syndrome?

A

Corticosteroids - until remission
Immunosuppressive drugs - if severe or refractory
Diuretics - for sig perph oedema norm LOOP
Consider need for: prophylactic anti-coag, anti-hypertensives, vaccination (NOT live), statins, PPI (if on steroids).

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15
Q

What is the damage to the glomerulus in nephrotic syndrome?

A

Typically main damage to podocytes but all layers may be affected due to close proximity
Damaged by immune complexes or complement

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16
Q

What is the key process in minimal change disease?

A

Childhood
Light microscopy - low/no change
Immunology = occasional IgM in mesangium
Electron microscopy = podocyte effacement (loss fo feet) = allows for protein to filter out

17
Q

What are the key features of membranous glomerulus nephritis?

A

Adulthood
Light microscope = capillary wall thickening, mesangial expansion
IF = IgG and C3
Electron microscope = GBM thickening
Subepithelial deposits of immune components are termed spikes -> this damages podocytes

18
Q

What are the key features of focal segmental glomerulosclerosis?

A

Light microscope = focal, sgemental glomerular sclerosis
IF = no
Electron microscopy = GBM thickenining from sclerosis -> dec urine output and damage surrounding podocytes.

19
Q

What is the surgical treatment for nephrotic syndrome?

A

Renal Replacement Therapy - dialysis or renal transplantation.
If nephrotic syndrome results in end-stage renal failure.

20
Q

What are some common complications of nephrotic syndrome?

A

Infection risk inc
Thrombembolism risk
AKI - due to excessive diuresis or renal vein thrombosis
CKD - secondary
Hypothyroidism - due to urinary loss of T4 and T3 with their binding proteins
VitD loss
Anaemia - iron bound to transferrin and EPO are lost in urine

21
Q

What are the key urinary features of nephritis syndrome?

A

Micro/macroscopic haematuria
Proteinuria
Sterile pyruia (wbcs with no infection)
HTN (due to dec GFR)

22
Q

What is the key damage and process within the nephron in nephritic syndrome?

A
  1. Inflammation and damage to glomerulus -> particularly BM (rbcs),
  2. Leakage of rbcs into filtrate - clump to form clasts or become dysmorphic = acanthocyte
  3. Leakage of wbcs into filtrate
  4. Damage to podocytes = some proteinuria (less than nephrotic)
  5. Dec GFR = oliguria, AKI (inc creatinine), azotemia (retained uria)
  6. RAAS stimulated = HTN.
23
Q

What are some specific causes of glomerulonephritis?

A

Rapidly progressive GN
Anti-GBM antibody GN (goodpastures)
ANCA associated GN
Immune complex mediated GN
Membranoproliferative GN
Post-streptococcal GN

24
Q

What is the overview of rapidly progressive GN?

A

Caused by other glomerulonephric disease
Loss of GFR >50%
Extensive glomerular cresents (rupture of glomerular capillary wall with macro and fibro accumulation)

25
Q

What is Anti-GBM or goodpastures disease?

A

Antibodies directed against intrinsic antigen in BM.
Leads to cresent formation
90% - present with RPGN
Can also target BM in alveoli in the lungs - present with co-cominant pulmonary haemorrhage (hemoptysis)

26
Q

Give an overview of ANCA glomerulonephritis?

A

No immune deposits on immunofluorescence
Causes renal vasculitis
Prodrome of malaise, arthalgia, myalgia, flu like and AKI

27
Q

What are the key signs and symptoms of nephritic syndrome?

A

Haematuria - coal coloured brown urine
Hypertension (headache and blurred vision)
Peripheral and pulmonary oedema
Oliguria
Ureamic symptoms - anorexia, nausea, fatigue, pruritis, lethargy

Alopecia - SLE
Haemoptyisis and dyspnoea = anti-GBM
Purpuric rash, arthirits and abdominal pain = Henoch-schonlein purpura

28
Q

What bed side investigations should be done for nephritic syndrome?

A

Urine dip - haematuria + proteinuria
Urine microscopy and culture - dysmorphic rbcs and casts, culture neg
Urine protein:creatinine ratio - <3.5g/day protein
Blood gas - acid base status and hyperkalaemia

29
Q

What blood tests should be done for nephritic syndrome?

A

FBC - cytopaenia SLE
U&Es - renal impairement and hyperkalemia
LFTs - post infection GN HepB
CRP and ESR - vasculitis
Coagulation screen
Anti-GBM antibodies
ANCA
Complement - SLE
ANA
RF
Serology - HIV, Hep B/C
Blood cultures if infective endocarditis suspected

30
Q

What imaging should be done for nephritic syndrome?

A

Renal ultrasound - obstructive AKI, plan biospy
CXR - renal-pulmonary syndrome
Echocardiogram - if infective endocarditis suspected

31
Q

What is the gold standard diagnostic test for nephritic syndrome?
What is a key sign on this?

A

Renal biopsy
Starry sky - IgG and complement subepithelial deposits indicates post-strep GN

32
Q

What are the typical consertvative managements for nephritic syndrome?

A

Stop causative medication
Fluid and salt restriction
Low potassium diet

33
Q

What is the medical treatment for nephritic syndrome?

A

Treat underlying disease
Immunosuppression - must rule out infective causes first
Anti-hypertensives
Diuretics - often loops - for oedema
Renal replacement therapy
Plasmapheresis

34
Q

What are some common complications of nephritic syndrome?

A

Acute renal failure
Hypertension cause HF or encephalopathy
Hyperkalaemia = arryhtmias
Uraemia = pericarditis, encephalopathy

35
Q
A

Med 2 (22 decks)

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