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Year 2- Urinary > Glomerulonephritis Overview > Flashcards

Glomerulonephritis Overview Flashcards

1
Q

What is glomerulonephritis?

A

Inflammation of the glomerulus

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2
Q

What is often required for a diagnosis of glomerulonephritis?

A

Kidney biopsy

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3
Q

Which type of vessels make up the glomerulus?

A

Capillaries

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4
Q

What are the three layers of the triple filtration barrier of the glomerulus?

A

Endothelium cells on the inner side
Glomerular basement membrane in the middle
Podocytes on outer side

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5
Q

What is meant by active urine sediment?

A

If you look at a urine sample under the microscope, there would be haematuria, dysmorphic RBC’s and cellular casts seen

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6
Q

What are the three features of nephritic state?

A

Active urine sediment
Hypertension
Renal impairment

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7
Q

What are the four features of nephritic syndrome?

A

Oedema
Nephrotic range of proteinuria (>3.5g/day pr 350mg/mmol of creatinine)
Hypoalbuminemia (serum albumin <35g/L)
Dyslipidaemia

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8
Q

What happens in nephritic state?

A

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

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9
Q

What happens in nephrotic state?

A

Thickening of glomerular basemen membrane
Shrinking of podocytes meaning the foot processes come apart leading to the spillage of albumin

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10
Q

Glomerulonephritis can be classified as proliferative or non-proliferative.
When is glomerulonephritis known to be proliferative?

A

When there is excessive number of cells in the glomeruli, including infiltrating leucocytes

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11
Q

Glomerulonephritis can be classified as proliferative or non-proliferative.
When is glomerulonephritis known to be non-proliferative?

A

Glomeruli look normal or have areas or scarring but a normal number of cells

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12
Q

Which techniques can be used to asses glomerulonephritis ?

A

Immunofluorescence or electron microscopy

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13
Q

In terms of pathology description, what is meant if it is said there is diffuse glomerulonephritis ?

A

> 50% of the glomeruli are affected

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14
Q

In terms of pathology description, what is meant if it is said there is focal glomerulonephritis ?

A

<50% of the glomeruli are affected

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15
Q

In terms of pathology description, what is meant if it is said there is global glomerulonephritis ?

A

All the glomerulus is affected

->global = whole world

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16
Q

In terms of pathology description, what is meant if it is said there is segmental glomerulonephritis ?

A

Only part of the glomerulus is affected

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17
Q

Okay, what is the difference between nephrotic syndrome and nephritic syndrome?

A

Nephrotic- loss of significant volumes of protein, resulting in hypoalbuminemia

Nephritic- involves haematuria, mild to moderate proteinuria, hypertension.

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18
Q

What is the commonest cause of glomerulonephritis ?

A

IgA nephropathy

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19
Q

What is IgA nephropathy characterised by?

A

Deposition of IgA in the mesagium
Mesangial proliferation

20
Q

In which decades of life is IgA nephropathy more common?

A

2nd and 3rd decades of life

21
Q

What are the different way that IgA nephropathy can present?

A

-Microscopic haematuria
-Microscopic haematuria and proteinuria
-Nephrotic syndrome
-IgA crescentic glomerulonephritis

22
Q

What is the best way to deal with end stage kidney disease?

A

Kidney transplant

23
Q

Post-infectious glomerulonephritis ?

A

Disease of the kidney occurring after an infection of a different part of the body

24
Q

When does post-streptococcal glomerulonephritis occur?

A

Follows 10-21 days after infection of typically throat or skin

25
Q

What type of streptococcus is post-streptococcal glomerulonephritis most commonly associated with?

A

Lancefield group A Streptococci

26
Q

How is post infectious glomerulonephritis treated?

A

Antibiotics for infection in some cases
Loop diuretics e.g. frusemide for oedema
Anti-hypertensive drugs

27
Q

What is the most severe form of proliferative glomerulonephritis ?

A

Crescentic glomerulonephritis

28
Q

What is the commonest type of crescentic glomerulonephritis?

A

ANCA associated glomerulonephritis

->recap- ANCA = anti-neutrophil cytoplasmic antibodies

29
Q

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

A

Microscopic polyangiitis
Granulomatosis with polyangiitis
Eosinophilic granulomatosis with polyangiitis

30
Q

Okay got told this in clinical skills today! What is the triad for nephrotic syndrome?

A

The three O’s apparently :)

Oedema
HypOalbuminemia
PrOteinuria

31
Q

Does proliferative glomerulonephritis usually present with a nephritic or nephrotic state?

A

Nephritic

32
Q

Name the three non-proliferative glomerulonephritis conditions.

A

Minimal Change Disease
Focal and segmental glomerulonephritis
Membranous Nephropathy

33
Q

What are the general measures taken in any kind of nephrotic syndrome based condition?

A

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

34
Q

Does minimal change disease present with nephritic or nephrotic state?

A

Nephrotic state

35
Q

Which type of nephrotic state is most common in children?

A

MCD

Minimal Chnage Disease

->mentioned in urinary comms if that rings any bells?

36
Q

How does MCD treated?

A

Steroids e.g. prednisolone

37
Q

MCD can relapse. What proportion of patients get a relaspe?

A

2/3

38
Q

What can subsequent relapses of MCD be treated with?

A

Cyclophosphamide
Cyclosporine
Tacrolimus

39
Q

Does MCD have a high chance of progressing into end stage renal disease?

A

No prognosis is good

40
Q

Does focal and segmental glomerulonephritis present with neprhitic or nephrotic syndrome?

A

Nephrotic syndrome

41
Q

How is focal and segmnetal glomerulonephritis treated?

A

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

42
Q

What is the commonest cause of nephrotic state in adults?

A

Membranous nephropathy

43
Q

The majority of membranous nephropathy cases occur in isolation but what can be some secondary causes?

A

Malignancies
Rheumatoid arthritis
NSAIDs, gold, penicillamine

44
Q

What is the treatment of membranous nephropathy?

A

General measures for nephrotic syndrome for at least six months
Cyclophosphamide and steroids, alternative months for 6 months
Tacrolimus
Rituximab

45
Q
A

Year 2- Urinary (22 decks)

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