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302 Scientific basis of medicine > Renal 1) Nephrotic / nephritic syndrome > Flashcards

Renal 1) Nephrotic / nephritic syndrome Flashcards

1
Q

What might be present in the urine of glomerulonephritis?

A

Protein
Blood
WBC
Casts (made of WBC, RBC, kidney cells, proteins or fat)

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2
Q

What is the presentation of nephrotic syndrome?

A

Proteinuria >3g/day
Decreased serum albumin
Oedema

Preserved renal function
Decreased total protein

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3
Q

What histological changes can occur in glomerulonephritis?

A

Focal vs diffuse, segmental vs global
Crescents
Minimal changes
Parts affected - mesanguim, basement membrane, epithelial, endothelial

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4
Q

What can cause glomerulonephritis?

A

Autoimmune
Haematological disorder
Toxins
Infection

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5
Q

What is the presentation of nephritic syndrome?

A

Impaired renal function - rapid or chronic
Proteinuria, haematuria, leucosuria
Low urine volume

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6
Q

What are the symptoms of glomerulonephritis?

A

Systemic, flu-like symptoms
Rash
Arthralgia
Swelling

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7
Q

What does a urine analysis show in nephrotic syndrome?

A

± Blood
Lots of protein
± leucocytes
No nitrites

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8
Q

What does a urine analysis show in nephritic syndrome?

A

Blood
Protein
Leucocytes
No nitrites

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9
Q

What blood tests are done for glomerulonephritis?

A

Serum albumin, protein
Renal function
Autoimmune screen

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10
Q

How are renal biopsies analysed?

A

Light microscopy
Immune-histology
Electron microscopy

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11
Q

Describe a renal biopsy in minimal change nephrotic syndrome

A

Minimal change in light microscopy
Immunofluorescence showing IgM in mesanguim
ECM showing effacement of podocyte foot processes

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12
Q

What is minimal change associated with?

A

NSAIDs
Lithium / gold
Allergy
Hodgkins

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13
Q

What is the presentation of minimal change disease?

A

Frothy urine
Oedema
Low albumin, preserved function

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14
Q

What is the treatment of minimal change disease?

A 
Steroids
Calcineurin inhibitors (tacrolimus)
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15
Q

Describe a renal biopsy in membranous nephrotic syndrome

A

LM - mesangial expansion, capillary wall thickening
Immunofluoresence - IgG and C3 protein
ECM - glomerular basement thickening

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16
Q

What are the causes of membranous nephrotic syndrome?

A

Autoimmune disease - lupus, Sjogren’s, rheumatoid arthritis, ankylosing spondylitis, post-transplant
Infection - hep B and C
Drugs - mercury, captopril, gold, penicillamine
Paraneoplastic
Idiopathic

17
Q

How can membranous nephrotic syndrome present?

A

Nephrotic syndrome

AKI / CKD

18
Q

What is the treatment of membranous nephrotic syndrome?

A

Treat underlying cause
Steroids
Calcineurin inhibitors
BP management

19
Q

Describe mesangial proliferative glomerulonephritis

A

IgA deposition - malaria, typhoid, IgA nephropathy

Variable presentation - haematuria, AKI, CKJ, hypertensive crisis

20
Q

Describe diffuse proliferative glomerulonephritis

A

IgG, IgM, C3 deposition
Causes: endocarditis, post-streptococcal GN
AKI, haematuria

21
Q

Describe a renal biopsy in focal segmental glomerulosclerosis

A

LM - focal segmental sclerosis of glomerulus
Immunofluorescence - nothing
ECM - glomerular basement membrane thickening

22
Q

What are the causes of focal segmental glomerulosclerosis?

A 
Primary - idiopathic
Secondary 
 - familial
 - virus e.g. HIV
 - drugs (heroin, pamidronate)
 - obesity, hypertension, atheroembolic, sickle cell
23
Q

Describe crescentic GN

A

ANCA associated - related to small vessel vasculitis
Granulomatosis with polyangiitis, Wegener granulomatosis
Microscopic polyangitis
GBM disease
Aggressive IgA nephropathy

24
Q

What is the treatment for crescentic GN?

A

Strict BP control
ACEi for proteinuria
Immunosuppression - steroids, cyclophosphamide, azathioprine, mycophenolate mofetil, rituximab

25
Q

What are the causes of membranoproliferative / mesangial capillary GN?

A

Primary

Secondary - hep C, endocarditis, viral infections, malaria, sickle cell disease

302 Scientific basis of medicine (28 decks)

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