Nephritic syndrome Flashcards
Which diseases cause nephritic syndrome?
Post infectious (mumps, legionella, streptococcal, malaria) glomerulonephritis Subacute bacterial endocarditis Cryoglobulinemia with Hep C IgA nephropathy (Berger's) Membranoproliferative glomerulonephritis Wegener's granulomatosis Goodpasture's SLE Henoch-schonlein pura pura
What causes membranoproliferazive glomerulonephritis?
Chronic infection (abscesses, IE,) Cfyloglobuminaemia secondary to hep C
What is nephritic syndrome?
When it occurs in glomerulus it’s glomerulonephritis
Kidney disease involving inflammation
What are the clinical features of nephritic syndrome?
Hematuria Proteinuria Hypertension Blurred vision Azotemia Oliguria
What are the features of rapidly progressive glomerulonephritis?
Acute nephritis, crescent shape GBM breaks 50's-60's- poor prognosis Focal necrosis with or without crescents and rapidly progressive renal failure over weeks to months Caused by: Anti-GBM antibody (good pastures) Immune complexes (SLE, IgA nephropathy) Idiopathic
What is tubulointerstitial nephritis?
Primary injury to the renal tubules and interstitium that results in decreased renal function
Acute- due to allergic drug reaction (penicillin/NSAIDs) and infections
Chronic- analgesic nephropathy, diabetes, toxins (lead)
What are the clinical features of tubulointerstitial nephritis?
Acute- fever, eosinophilia and eosinophiluria, AKI
Chronic- Polyuria, proteinuria uraemia
What is Goodpasture’s syndrome?
Autoimmune disease that affects lungs and kidneys
hemoptysis ans hematuria
Environmental factors: infection, smoking, oxidative stress
What are secondary factors causing deposition of antigens causing glomerulonephritis?
NSAID HSP Neoplasm SLE Amyloid Infection Diabetes Henoch Schonlein Purpura
What is chronic interstitial nephritis pathology?
Chronic pyelonephritis, irregular areas of scarring, chronic inflammatory infiltrate
Reflux associated chronic interstitial nephritis: incompetent vesicoureteric valves, predisposing inflammation + scarring. Presents in early adulthood
Obstructive chronic interstitial nephritis: anatomic abnormality leads to recurrent infections (prostate, retroperitoneal fibrosis), stones
How can diabetes damage the kidney?
Direct glomerular damage: basement membrane thickening, increased permeability of capillary wall + proteinuria, eventual glomerular hyalinisation —> CKD
Ischaemia due to arterial disease: atherosclerosis causes reduced eGFR and glomerular ischaemia
Ascending infection
What is nephritic syndrome pathology?
TETRAD: haematuria + red cell casts, oliguria, proteinuria, hypertension
Proliferative (increased cell numbers) + damage to basement membrane –> casts form from blood and protein
Primary causes: IgA nephropathy, Goodpastures
Secondary causes: SLE, HSP
What are the differences between IgA nephropathy and post-streptococcal glomerulonephritis?
IgA- 1-2 days after URTI. post-s- 1-2 weeks
IgA- young males, macroscopic haematuria
Post-s- proteinuria, low complement
What is acute tubular necrosis associated with?
Granular muddy brown urinary casts
Normal urea:creatinine ratio
What are the features of Henoch-Schonlein purpura?
IgA mediated small vessel vasculitis
Palpable purpuric rash (localised oedema) over buttocks and extensor surfaces of arms and legs
Polyarthritis
Haematuria, renal failure
