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Stage 2 Year 2 > Nephritic Glomerulonephritis > Flashcards

Nephritic Glomerulonephritis Flashcards

1
Q

What is the most common primary glomerulonephritis?

A

IgA nephropathy

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2
Q

How does IgA nephropathy present?

A

Young patient (male)

  • Asymptomatic non-visible haematuria
  • OR Episodic visible haematuria which may be synpharyngitic aka within 12-72h of infection
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3
Q

What conditions is IgA nephropathy associated with?

A
  • Alcoholic cirrhosis
  • Coeliac disease/dermatitis herpetiformis
  • Henoch-Schonlein purpura
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4
Q

What are symptoms of IgA nephropathy?

A

Asymptomatic or increased BP ± increased creatinine, proteinuria (usually < 1g)

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5
Q

What % of patients progress to renal failure?

A

20-50% (minority)

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6
Q

How do you diagnose IgA nephropathy?

A

Renal biopsy

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7
Q

What would you see on renal biopsy in IgA nephropathy?

A
  • IgA deposition in mesangium
  • Mesangial hypercellularity
  • Positive immunofluorescence for IgA & C3
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8
Q

How do you treat IgA nephropathy and Henoch-Schonlein purpura?

A
  • ACE-i/ARB (reduce proteinuria and protect renal function)
  • Corticosteroids (good for gut involvement in HSP) + fish oil if proteinuria > 1g despite 3-6 months of ACE-i/ARB and GFR > 50
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9
Q

What happens in Henoch-Schonlein purpura?

A
  • Small vessel vasculitis (systemic variant of IgA nephropathy)
  • IgA deposition in kidney, skin, joints, gut
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10
Q

How do you diagnose Henoch-Schonlein purpura?

A
  • Usually clinical diagnosis
  • Confirm with positive immunofluorescence for IgA & C3 in skin
  • Renal biopsy identical to IgA nephropathy
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11
Q

What is symptoms of Henoch-Schonlein purpura?

A
  • Purpuric rash on extensor surface, typically legs
  • Flitting polyarthritis
  • Abdominal pain (GI bleeding)
  • Nephritis
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12
Q

What is nephritis?

A

Haematuria due to inflammatory damage

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13
Q

What is nephrosis?

A

Proteinuria due to podocyte pathology

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14
Q

What investigations do you want to do in all glomerulonephritis?

A
  • Bloods
  • Immunoglobulins
  • Electrophoresis
  • C3 & C4
  • ANA, ANCA, ds-DNA, anti-GBM (autoantibodies)
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15
Q

What imaging/further investigations do you want to do in all glomerulonephritis?

A
  • CXR - pulmonary haemorrhage

- Renal US + biopsy

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16
Q

What happens in post-streptococcal glomerulonephritis?

A

Following throat (2 weeks) or skin infection (3-6 weeks), strep antigen deposits in glomerulus causing immune complex formation and inflammation

17
Q

How does post-streptococcal glomerulonephritis present?

A
  • Varies - haematuria or acute nephritis
  • Oedema
  • Raised BP
  • Oliguria
18
Q

How do you diagnose post-streptococcal glomerulonephritis?

A
  • Evidence of streptococcal infection
  • Increased ASOT (antistreptolysin O titre) - blood test that looks for antibodies to the streptococcus A bacteria
  • Anti-DNAase B - antibody produced by the immune system in response to a strep infection
  • Reduced serum levels of C3
19
Q

How do you treat post-streptococcal glomerulonephritis?

A
  • Supportive

- Antibiotics - to clear the nephritogenic bacteria

20
Q

What is goodpasture’s syndrome now called?

A

Anti-GBM disease

21
Q

What happens in anti-GBM disease?

A

Autoantibodies to type IV collagen present in glomerular and alveolar basement membranes

22
Q

How does anti-GBM disease present?

A
  • Renal disease (oligouria/anuria, haematuria, AKI, renal failure)
  • Lung disease (pulmonary haemorrhage - SOB, haemoptysis)
23
Q

How do you diagnose anti-GBM disease?

A

Anti-GBM in circulation/kidney (immunofluorescence for IgG)

24
Q

How do you treat anti-GBM disease?

A
  • Plasma exchange
  • Corticosteroids
  • Cyclophosphamide
25
Q

What is rapidly progressive glomerulonephritis (crescentic GN)?

A

Any aggressive glomerulonephritis, rapidly progressing to renal failure in days or weeks

26
Q

What are causes of rapidly progressive glomerulonephritis?

A
  • Small vessel/ANCA vasculitis
  • Lupus nephritis
  • Anti-GBM disease
  • Other GNs may transform to become rapid progressive incl. IgA, membranous
27
Q

How do you diagnose rapidly progressive glomerulonephritis?

A

Crescents seen on renal biopsy (due to breaks in the GBM allowing an influx of inflammatory cells)

28
Q

How do you treat rapidly progressive glomerulonephritis?

A
  • Corticosteroids
  • Cyclophosphamide
  • Plasma exchange for anti-GBM/ANCA vasculitis
  • ?Mabs in lupus nephritis
29
Q

What indicates worse prognosis in anti-GBM disease?

A
  • Dialysis dependence at presentation

- Increased crescents seen on biopsy

Stage 2 Year 2 (13 decks)

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