Lecture 14: Glomerulonephritis Flashcards
glomerulonephritis clinical features
- haematuria (non-visible or visible)
- proteinuria (low grade or nephrotic)
- hypertension
- renal impairment
nephrotic syndrome definition
- a clinical syndrome that arises secondary to increased permeability of serum proteins through a damaged basement membrane in the renal glomerulus.
nephrotic disease is characterised by which signs and symptoms?
- proteinuria (> 3.5g/day or 350mg/mmol creatinine)
- oedema (particularly periorbital and peripheral)
- hypoalbuminaemia: < 35g/L
- hyperlipidaemia
- lipiduria
nephritic syndrome definition
- A group of kidney disorders that result in the presence of red blood cells in urine (haematuria), non-nephrotic range proteinuria, and often hypertension.
- typically characterised by inflammation and damage to the glomeruli.
nephritic syndrome typically presents with:
- haematuria, often microscopic but can be macroscopic
- hypertension
- non-nephrotic range proteinuria
- oedema (less severe than in nephrotic syndrome
- in severe cases, symptoms of AKI like oliguria and anuria.
describe the two types of glomerulonephritis
Proliferative:
- excessive numbers of cells in glomeruli, including infiltrating leucocytes.
Non-proliferative:
- glomeruli look normal or have areas of scarring, they have normal numbers of cells.
what is the most common cause of glomerulonephritis world-wide?
IgA nephropathy
IgA nephropathy presentation
- Recurrent gross or microscopic haematuria, generally occurring 12–72 hours after an upper respiratory tract or gastrointestinal infection.
- Mild proteinuria.
- Hypertension.
- Less commonly, presentations can include nephrotic syndrome or a rapidly progressive GN, resulting in acute renal failure.
- Associations with Henoch-Schönlein purpura (HSP)/IgA vasculitis, chronic liver disease, inflammatory bowel disease (IBD), and skin and joint disorders, such as psoriasis, have been observed.
features of post-streptococcal (infectious) glomerulonephritis
incubation period, genetic predisposition
- follows 10-21 days after infection typically of throat or skin
- most commonly with lancefield group A streptococci
- genetic predispostion: HLA-DR,-DP.
how can IgA nephropathy be differentiated from post-streptococcal glomerulonephritis?
- IgAN occurs 1-2 days post-infection vs 1-3 weeks post infection in PSGN.
- renal biopsy in IgAN shows IgA immune-complec deposits vs IgG immune complex deposits in PSGN.
clinical features of anti-GBM glomerulonephritis
used to be known as goodpasture syndrome
- haemoptysis and pulmonary haemorrhage
- AKI, often severe and rapidly progressive, leading to renal failure.
- more common in males
- two peaks in age of presentation: 20-30 years and 60-70 years
anti-GBM disease treatment
aggressive immunosuppression:
- steroid
- plasma exchange and cyclophosphamide
nephrotic syndrome non-specific management
- treat oedema: salt and fluid restriction and loop diuretics
- hypertension: use renin-angiotensin-aldosterone blockade
- reduce risk of thrombosis: heparin or warfarin
- reduce risk of infection e.g. pneumococcal vaccine
- treat dyslipidaemia e.g. statins
- specific therapy towards cause of the non-proliferative glomerulonephritis
minimal change disease features
- commonest cause of GN in children.
- sudden onset of oedema - days
- remission with steroids (often)
- relapse occurs in 2/3 patients
minimal change disease treatment
- prednisolone 1mg/kg for up to 16 weeks
- once remission achieved, slow taper over 6 months
- initial relapse treated with further steroid course
- subsequent relapses treated with: cyclophosphamide, cyclosporin, tacrolimus, mycophenolate mofetil, rituximab
