Nephropathy Flashcards
What are the common primary causes of nephritic syndrome?
Mesangiocapillary glomerulonephritis
IgA Nephropathy
What are the primary causes of nephrOtic syndrome?
Mesangiocapillary glomerulonephritis Focal Segmental Glomerulosclerosis Minimal change nephropathy membranous nephropathy Amyloidosis
What are the secondary causes of nephrOtic syndrome?
Diabetic nephropathy
Vaculitis
SLE
Hepatitis B/C
What are the secondary causes of nephritic syndrome?
Anti glomerular basement membrane disease (goodpasture’s syndrome)
Vasculitis
SLE
Post streptoccal glomerulonephritis
What are the common causes of acute kidney injury
Rapidly progressive glomerulonephritis (GPA, eGPA, MPA)
Acute interstital disease
Acute necrotic tubular disease
Which disease causes 90% of NEPHROTIC syndrome in children?
Minimal change nephropathy
What are the three key features of minimal change nephropathy?
- fusion of podocytes can be seen on electron microscopy
- light microscopy and immunostaining is normal
- associated with atopy
Ten year old presents with nephrotic syndrome. Past medical history includes asthma and eczema. Nephrotic syndrome preceded by an episode of coryza three weeks previously, for which she was given over the counter Iburoprofen. What is the cause of the nephrotic syndrome?
Minimal change
Can be precipitated by NSAIDs, preceded by URTI
often assoc with atopy, 90% of nephrotic syndrome in children.
What is the prognosis for minimal change nephropathy?
Spontaneous remission can occur, but most require steroids for this.
The majority of patients will experience a relapse of this condition, but getting end stage renal failure is extremely rare.
How can you treat minimal change nephropathy?
Steroids, ciclophosphamide for people who relapse frequently.
What is the most common cause of nephrotic syndrome in elderly patients?
Membranous nephropathy
What is the most common glomerular disease in the world?
IgA nephropathy
Which glomerulonephritis is very rare and when it does occur it occurs mostly in young adults and children?
Mesangiocapillary glomerulonephritis
Which three nephropathies account for around 20% of nephropathies in adults each?
Minimal change nephropathy (20%) Membranous nephropathy (20-30%) Focal Segmental glomerulosclerosis (15%)
What is the name of the variant of IgA nephropathy that mainly affects children under the age of ten?
Henoch - Schonlein purpura
What are the recognised causes of focal segmental glomerulosclerosis?
Idiopathic
HIV
Obesity
What are the four key features of FSGS?
- segments of sclerotic tissue in glomeruli. Sclerotic tissue will be formed by complement and immunoglobulins.
- Electron microscopy shows fusion of podocytes
- Nephrotic syndrome
- Hypertension
(Can cause haematuria but usually only nephrotic syndrome)
Can FSGS recure after transplant?
yes - 20% of transplanted kidneys
What is the prognosis for FSGS?
Many patients eventually develop end stage renal failure.
<10% have spontaneous remission
What are the three features of membranous nephropathy?
- Diffuse thickened glomerular basement membrane
- Nephrotic syndrome secondary to the thickened basement membrane (this increases permeability at the glomerulus)
- Subepithelial deposits of complement and antigen-antibody complexes
What can cause membranous nephropathy?
Usually idiopathic but can be secondary to hepatitis B infection, drugs such as NSAIDs or gold and malignancy.
What is the prognosis of membranous nephropathy?
Mixed, a third undergo spontanous remission, a third undergo partial remission, a third will require dialysis due to ESRF.
Can result in end stage renal failure.
What is the treatment for membrnous nephropathy?
Treat underlying cause.
General measures such as diuretics and ACEs or ARBs can help with proteinuria by dilating arterioles and lowering intraglomerular pressure.
Steroids and immunosupressive drugs.
What is the suspected pathogenesis of membraous nephropathy?
Antibody against phospholipase A2 receptor in the basement membrane generated by idiopathically by the body or other disease processes attacks the glomerulus.
(These antibodies are found in 80% of patients)
What are the two subtypes of mesangiocapillary glomerulonephritis?
Type 1 is antibody complex mediated glomerular damage (associated with hepatitis C and SLE)
Type 2 is complement mediated glomerular damage
Which subtype of mesangiocapillary glomerulonephritis is most common?
Type 1 (antibody complex mediated)
What are the key features of mesangiocapillary glomerulonephritis?
- Mixed nephrotic and nephritic syndrome
- Mesangial cell and endocapillary proliferation (hyperplasia), and mesangial matrix expansion
- Thickened glomerular basement membrane
- Immune deposits of antibody complexes or complement
Mesangiocapillary glomerulonephritis is also known as?
Membranoproliferative glomerulonephritis
What is the prognosis like for mesangiocapillary GM?
Poor
Can mesangiocapillary GM recur in transplants?
Yes
Treatment for mesangiocapillary GM?
Treat underlying cause.
General measures such as diuretics and ACEs or ARBs can help with proteinuria by dilating arterioles and lowering intraglomerular pressure.
Steroids and immunosupressive drugs.
What is rhabdomyolsis?
Breakdown of skeletal muscle - can be secondary to a fall or a traumatic incident.
How does rhabdomyolsis lead to kidney injury?
Breakdown of skeletal muscle releases myoglobin which is nephrotoxic.
