Session 8: Glomerular Disease - Glomerulonephritis & Diabetes Mellitus Flashcards
Give the common histological pathological changes found in glomerulonephritis.
Subepithelial immune complexes
Increased number of mesangial cells
Fusion or destruction of podocytes
Narrowed, damaged, or leaky capillaries (endothelial damage)
Four structures of the glomerulus that can be damaged in glomerulonephritis.
Capillary endothelium
Glomerular basement membrane (GBM)
Mesangial cells
Podocytes
What is glomerulonephritis (GN)?
Inflammation of the glomeruli
Clinical presentation of GN (degrees)
Asymptomatic haematuria and/or proteinuria
Chronic GN
Acute GN (Nephritic syndrome)
Rapidly progressive glomerulonephritis (RPGN)
Nephrotic syndrome
Causes of asymptomatic haematuria and/or proteinuria.
IgA
SLE
FSGS
etc…
Causes of chronic GN
IgA
SLE
Any treated GN
Causes of nephritic syndrome
IgA
SLE
ANCA-vasculitis
Anti-GBM
Alport Syndrome
Causes of RPGN
ANCA-Vasculitis
Anti-GBM
Post-infectious
SLE
Causes of nephrotic syndrome
MCG
FSGS
Membranous glomerulonephritis
SLE
Key differences between nephritic syndrome and nephrotic syndrome.
Nephritic:
Inflammation with a triad of haematuria, hypertension and reduced GFR. There is also cola-colored urine and oliguria.
Nephrotic:
Damage to podocytes causing reduction in selectivity of filtration. This leads to a triad of symptoms of proteinuria, hypoalbuminaemia and oedema. You may also see hyperlipidaemia in nephrotic syndrome.
Oedema can occur in both syndromes.
BP and creatinine in nephrotic syndrome.
Usually normal.
What is a proteinuria at above 350 mg/mmol called if it is presented without the triad of symptoms seen in nephrotic syndrome?
Nephrotic range proteinuria.
Primary causes of nephrotic syndrome.
MCG
Membranous glomerulonephritis also called membranous nephropathy also called membranous glomerulonephropathy.
FSGS
Secondary causes of nephrotic syndrome.
Diabetes
SLE
Renal amyloidosis
What is the difference between DM and amyloidosis leading to nephrotic syndrome compared to SLE leading to nephrotic syndrome?
DM and Amyloidosis solely lead to nephrotic syndrome and glomerulonephritis. They are not classed as GNs.
Managment of nephrotic syndrome.
Treating the triad of symptoms.
Oedema by thiazides, loop diuretics (furosemide most commonly) or spironolactone. If this doesn’t work due to the damage of the kidneys salt and fluid restrictions.
ACE-inhibitors
Might give statins for hypercholesterolaemia if there is long-term nephrotic syndrome.
Treating the underlying cause (steroids for MCD e.g.)
Triad of nephritic syndrome.
Haematuria
Reduction in GFR (renal impairment/oliguria)
Hypertension