Nephrotic Syndromes/non-proliferative glomerulonephritis Flashcards
What is non-proliferative glomerulonephritis?
When the glomeruli don’t have an excess of cells, they can either look normal or can have scarring.
What are diseases that present as nephrotic syndromes?
1 - minimal change disease
2 - focal segmental glomerulosclerosis
3 - membranous nephropathy
What is common in any nephrotic disease?
- oedema
- hypoalbuminia = <3.5g/dL
- proteinuria = >3.5g/24hrs (frothy urine)
- hyperlipidaemia
- hypercoagulable
- immune compromised
What are common complications of nephrotic syndromes?
- Thrombosis
- Infection
- high cholesterol
- hypertension
What is the most common cause of nephrotic syndrome in children?
Minimal change disease
How is minimal change disease treated?
Steroids - only one that responds to steroids fully.
What is the most common cause of nephrotic syndrome in adults?
Focal segmental glomerulosclerosis.
Which non-proliferative glomerulonephritis has selective proteinuria?
Minimal change disease - it only lets albumin through.
what is the cause of minimal change disease?
Idiopathic - often triggered by vaccines, immune response, or infection.
Caused by T cells in the blood
What are the 3 main investigations used in glomerulonephritis?
Light microscopy
electron microscopy
immunofluoresence
What is the investigation findings of minimal change disease?
Light microscopy - normal glomerulus
Electron microscopy - effacement of foot processes of podocytes.
How is minimal change disease treated?
With steroids
What is the relapse rate of minimal change disease?
2/3rds will relapse.
What is the risk factors for focal segmental glomerulosclerosis?
African-American, heroin, HIV, congenital malformations.
What happens to the cells in FSGS?
there’s effacement of the podocytes and hyaline deposits - leading to sclerosis and scar tissue.
What are the investigation findings of FSGS?
Light microscopy - hyalinosis/sclerosis/scar tissue
immunofluorescence - mostly negative, can be positive to C1, C3, IgM
which 2 non-proliferative diseases are most likely to progress to chronic kidney disease?
Membranous nephropathy + focal segmental glomerulosclerosis.
What are the risk factors of membranous nephropathy?
Hep B, Hep C, adults, SLE, tumours, NSAIDs.
what causes the damage in membranous nephropathy?
Immune complex deposition. between the podocytes and glomerular basement membrane.
theres damage to the podocytes and mesangial cells,
Which Ig antibodies are positive in membranous nephropathy?
IgG against PLA2R
What are the investigation findings in membranous nephropathy?
Light microscopy - capillary + GBM thickening.
immunofluorescence - IgG, C3
electron misroscopy - podocyte effacement + sub epithelial immune complexes (SPIKE AND DOME PATTERN)
What is the most common cause of end stage renal disease and chronic kidney disease?
Diabetic glomerulonephritis.
what is diabetic glomerulosclerosis?
when the high levels of glucose cause glomerular scarring.
What is the main treatment for diabetic nephropathy?
optimising blood glucose levels, ACE inhibitors
What lesions are seen in light microscopy of diabetic nephropathy?
Kimmelsteil-Wilson lesions.
