Glomerulonephritis Overview Flashcards
What is glomerulonephritis?
Inflammation of the glomerulus
What is often required for a diagnosis of glomerulonephritis?
Kidney biopsy
Which type of vessels make up the glomerulus?
Capillaries
What are the three layers of the triple filtration barrier of the glomerulus?
Endothelium cells on the inner side
Glomerular basement membrane in the middle
Podocytes on outer side
What is meant by active urine sediment?
If you look at a urine sample under the microscope, there would be haematuria, dysmorphic RBC’s and cellular casts seen
What are the three features of nephritic state?
Active urine sediment
Hypertension
Renal impairment
What are the four features of nephritic syndrome?
Oedema
Nephrotic range of proteinuria (>3.5g/day pr 350mg/mmol of creatinine)
Hypoalbuminemia (serum albumin <35g/L)
Dyslipidaemia
What happens in nephritic state?
Invasion of the glomerulus by inflammatory cells
Attacks endothelium and damages glomerular basement membrane and podocytes
Disruption of these filter layers means leak of blood cells
What happens in nephrotic state?
Thickening of glomerular basemen membrane
Shrinking of podocytes meaning the foot processes come apart leading to the spillage of albumin
Glomerulonephritis can be classified as proliferative or non-proliferative.
When is glomerulonephritis known to be proliferative?
When there is excessive number of cells in the glomeruli, including infiltrating leucocytes
Glomerulonephritis can be classified as proliferative or non-proliferative.
When is glomerulonephritis known to be non-proliferative?
Glomeruli look normal or have areas or scarring but a normal number of cells
Which techniques can be used to asses glomerulonephritis ?
Immunofluorescence or electron microscopy
In terms of pathology description, what is meant if it is said there is diffuse glomerulonephritis ?
> 50% of the glomeruli are affected
In terms of pathology description, what is meant if it is said there is focal glomerulonephritis ?
<50% of the glomeruli are affected
In terms of pathology description, what is meant if it is said there is global glomerulonephritis ?
All the glomerulus is affected
->global = whole world
In terms of pathology description, what is meant if it is said there is segmental glomerulonephritis ?
Only part of the glomerulus is affected
Okay, what is the difference between nephrotic syndrome and nephritic syndrome?
Nephrotic- loss of significant volumes of protein, resulting in hypoalbuminemia
Nephritic- involves haematuria, mild to moderate proteinuria, hypertension.
What is the commonest cause of glomerulonephritis ?
IgA nephropathy
What is IgA nephropathy characterised by?
Deposition of IgA in the mesagium
Mesangial proliferation
In which decades of life is IgA nephropathy more common?
2nd and 3rd decades of life
What are the different way that IgA nephropathy can present?
-Microscopic haematuria
-Microscopic haematuria and proteinuria
-Nephrotic syndrome
-IgA crescentic glomerulonephritis
What is the best way to deal with end stage kidney disease?
Kidney transplant
Post-infectious glomerulonephritis ?
Disease of the kidney occurring after an infection of a different part of the body
When does post-streptococcal glomerulonephritis occur?
Follows 10-21 days after infection of typically throat or skin
What type of streptococcus is post-streptococcal glomerulonephritis most commonly associated with?
Lancefield group A Streptococci
How is post infectious glomerulonephritis treated?
Antibiotics for infection in some cases
Loop diuretics e.g. frusemide for oedema
Anti-hypertensive drugs
What is the most severe form of proliferative glomerulonephritis ?
Crescentic glomerulonephritis
What is the commonest type of crescentic glomerulonephritis?
ANCA associated glomerulonephritis
->recap- ANCA = anti-neutrophil cytoplasmic antibodies
So- crescentic glomerulonephritis is bad and ANCA associated crescentic glomerulonephritis is the most common.
There are three types of ANCA associated crescentic glomerulonephritis. Name them
Microscopic polyangiitis
Granulomatosis with polyangiitis
Eosinophilic granulomatosis with polyangiitis
Okay got told this in clinical skills today! What is the triad for nephrotic syndrome?
The three O’s apparently :)
Oedema
HypOalbuminemia
PrOteinuria
Does proliferative glomerulonephritis usually present with a nephritic or nephrotic state?
Nephritic
Name the three non-proliferative glomerulonephritis conditions.
Minimal Change Disease
Focal and segmental glomerulonephritis
Membranous Nephropathy
What are the general measures taken in any kind of nephrotic syndrome based condition?
Treat oedema- salt and fluid restriction and loop diuretics
Hypertension management
Reduce risks of thrombosis using heparin or warfarin
Reduce risk of infection e.g. pneumococcal vaccine
Treat dyslipidaemia using statins
->after these measures have been taken, there can be specific therapy towards the non-proliferative glomerulonephritis
Does minimal change disease present with nephritic or nephrotic state?
Nephrotic state
Which type of nephrotic state is most common in children?
MCD
Minimal Chnage Disease
->mentioned in urinary comms if that rings any bells?
How does MCD treated?
Steroids e.g. prednisolone
MCD can relapse. What proportion of patients get a relaspe?
2/3
What can subsequent relapses of MCD be treated with?
Cyclophosphamide
Cyclosporine
Tacrolimus
Does MCD have a high chance of progressing into end stage renal disease?
No prognosis is good
Does focal and segmental glomerulonephritis present with neprhitic or nephrotic syndrome?
Nephrotic syndrome
How is focal and segmnetal glomerulonephritis treated?
General measures for nephrotic syndrome e.g. diuretics, hypertension control etc.
Trial of steroids but generally steroid resitsant ut good to try
If steroids don’t work = cyclosporine, cyclophosphamide, rituximab
What is the commonest cause of nephrotic state in adults?
Membranous nephropathy
The majority of membranous nephropathy cases occur in isolation but what can be some secondary causes?
Malignancies
Rheumatoid arthritis
NSAIDs, gold, penicillamine
What is the treatment of membranous nephropathy?
General measures for nephrotic syndrome for at least six months
Cyclophosphamide and steroids, alternative months for 6 months
Tacrolimus
Rituximab
