Renal 1) Nephrotic / nephritic syndrome Flashcards
What might be present in the urine of glomerulonephritis?
Protein
Blood
WBC
Casts (made of WBC, RBC, kidney cells, proteins or fat)
What is the presentation of nephrotic syndrome?
Proteinuria >3g/day
Decreased serum albumin
Oedema
Preserved renal function
Decreased total protein
What histological changes can occur in glomerulonephritis?
Focal vs diffuse, segmental vs global
Crescents
Minimal changes
Parts affected - mesanguim, basement membrane, epithelial, endothelial
What can cause glomerulonephritis?
Autoimmune
Haematological disorder
Toxins
Infection
What is the presentation of nephritic syndrome?
Impaired renal function - rapid or chronic
Proteinuria, haematuria, leucosuria
Low urine volume
What are the symptoms of glomerulonephritis?
Systemic, flu-like symptoms
Rash
Arthralgia
Swelling
What does a urine analysis show in nephrotic syndrome?
± Blood
Lots of protein
± leucocytes
No nitrites
What does a urine analysis show in nephritic syndrome?
Blood
Protein
Leucocytes
No nitrites
What blood tests are done for glomerulonephritis?
Serum albumin, protein
Renal function
Autoimmune screen
How are renal biopsies analysed?
Light microscopy
Immune-histology
Electron microscopy
Describe a renal biopsy in minimal change nephrotic syndrome
Minimal change in light microscopy
Immunofluorescence showing IgM in mesanguim
ECM showing effacement of podocyte foot processes
What is minimal change associated with?
NSAIDs
Lithium / gold
Allergy
Hodgkins
What is the presentation of minimal change disease?
Frothy urine
Oedema
Low albumin, preserved function
What is the treatment of minimal change disease?
Steroids Calcineurin inhibitors (tacrolimus)
Describe a renal biopsy in membranous nephrotic syndrome
LM - mesangial expansion, capillary wall thickening
Immunofluoresence - IgG and C3 protein
ECM - glomerular basement thickening
What are the causes of membranous nephrotic syndrome?
Autoimmune disease - lupus, Sjogren’s, rheumatoid arthritis, ankylosing spondylitis, post-transplant
Infection - hep B and C
Drugs - mercury, captopril, gold, penicillamine
Paraneoplastic
Idiopathic
How can membranous nephrotic syndrome present?
Nephrotic syndrome
AKI / CKD
What is the treatment of membranous nephrotic syndrome?
Treat underlying cause
Steroids
Calcineurin inhibitors
BP management
Describe mesangial proliferative glomerulonephritis
IgA deposition - malaria, typhoid, IgA nephropathy
Variable presentation - haematuria, AKI, CKJ, hypertensive crisis
Describe diffuse proliferative glomerulonephritis
IgG, IgM, C3 deposition
Causes: endocarditis, post-streptococcal GN
AKI, haematuria
Describe a renal biopsy in focal segmental glomerulosclerosis
LM - focal segmental sclerosis of glomerulus
Immunofluorescence - nothing
ECM - glomerular basement membrane thickening
What are the causes of focal segmental glomerulosclerosis?
Primary - idiopathic Secondary - familial - virus e.g. HIV - drugs (heroin, pamidronate) - obesity, hypertension, atheroembolic, sickle cell
Describe crescentic GN
ANCA associated - related to small vessel vasculitis
Granulomatosis with polyangiitis, Wegener granulomatosis
Microscopic polyangitis
GBM disease
Aggressive IgA nephropathy
What is the treatment for crescentic GN?
Strict BP control
ACEi for proteinuria
Immunosuppression - steroids, cyclophosphamide, azathioprine, mycophenolate mofetil, rituximab
What are the causes of membranoproliferative / mesangial capillary GN?
Primary
Secondary - hep C, endocarditis, viral infections, malaria, sickle cell disease
