updated glomerulonephritis Flashcards
in hematuria associated with glomerulonephritis what is special about the RBCs ?
abnormal shape and can show acanthocytes ( RBC budding) due to gglomerular cause
what is seen on macroscopic examination of urine that indicated proteinuria ?
frothy urine
if there is injury to the podocytes what is the presentation ?
proteinuria ( nephrotic )
if there is injury to the mesangial or endothelial cells what is the presentation ?
hematuria - nephritic
if there are breaks in the GBMM what is the presentation ?
hematuria - neephritic
what are the glomerular diseases generally divided into ?
asymptomatic proteinuria
asymptomatic hematuria
nephritic syndrome
nephrotic syndrome
macroscopic hematuria
rapidly progressive glomerulonephritis
chronic glomerulonephritis
what are the different etiologies for glomerular injury ?
antigen antibody complex
complement activation
t-lymphocytes
genetics
what is the difference between nephritic and nephrotic syndrome ?
nephritis - associated with hematuria, mild proteinuria
nephrotic - proteinuria above 3.5 mg/dl , hypoalbuminemia , oedema and ascites
hypertension is associated with nephritic or nephrotic ?
nephritic more commonly
what are the main characteristics of nephrotic syndrome ?
proteinuria above 3.5 mg/dll
hyperlipidemia
lipiduria
hypercoagulability - due. to loss of anticoagulants
ascites
generalized oedema - ascites , pleural effusion
how can nephrotic syndrome cause acute kidney injury ?
1- drugs that are used to treat nephrotic can cause AKI
2- renal vein thrombosis
3- no osmotic pressure due to lack of albumin, which causes pre renal AK if left for too long can cause ATN
what is rapidly progressive glomerulonephritis ?
similar to nephritic but kidney function loss happens over a week
what is the treatment for glomerular disease from a general supportive aspect ?
adequate dietary protein intake
ACE inhibitors or ARBS
loop diuretics
dietary sodium restriction
what is the goal for blood pressure in patients with glomerular disease ?
below 130/80
what is rapidly progressive glomerulonephritis characterized by ?
formation of crescents and hematuria with red cell casts ( which is also seen in nephritic)
what are the diseases that fall under the band off nephrotic syndrome ?
minimal change disease
focal segmental glomerulosclerosis
membranous nephropathy
amyloidosis
diabeticc nephropathy
what are the diseases that fall under the band off nephritic syndrome ?
acute diffuse proliferative glomerulonephritis ( Acute post-streptococcal glomerulonephritis
Lupus proliferative glomerulonephritis )
IgA nephropathy
Alport syndrome
what are the types of rapidly progressive glomerulonephritis ?
type 1 : goodpasture syndrome
type 2 : immune complex mediated glomerulonephritis
type 3: ANCA associated vasculitis
what disease falls under mixed nephritic and nephrotic syndrome ?
membranoproliferative glomerulonephritis
what is the cause of post streptococcal glomerulonephritis ?
chest or skin infection ( group b hemolytic streptococcal infection ) , affecting the sub epithelials area
what is the clinical presentation for acute post streptococcal GN ?
nephritic syndrome which present 1-4 weeks after a streptococcal infection ( sore throat or skin infection )
what age group is commonly associated with post strep GN ?
young children
what are the specific investigations for post strep GN ?
antistreptolysin O titre
ASOT
what is the clinical presentation of SLE proliferative GN ?
if the patient presents with :
nephrotic - membranous nephropathy
nephritic - lupus proliferative GN
mixed - MPGN
what are the specific investigations for SLE proliferative GN ?
detection of autoantibodies :
anti-dsDNA
Anti-smith
ANA
what is the cause of IgA nephropathy ?
after a respiratory tract or GIT infection
abnormal Ig formation occurs
which then acts as the antigen
what is the CP of IgA nephropathy ?
recurrent attacks of nephritic syndrome or macroscopic haematuria 1-2 days after thee infection and usually occurs in older patients
what disease is IgA nephropathy associated with ?
Celiac disease
what is the specific investigation for IgA nephropathy ?
elevated serum IgA
what is the cause of Alports syndrome ?
x linked hereditary disease
mutation in type 4 collagen of the basement membrane
what is the clinical picture of alports syndrome ?
nephritic syndrome
recurrent attacks of macroscopic hematuria
sensorineural deafness
ocular abnormalities
what are the different causes of minimal change disease ?
primary : abnormal T lymphocyte activity
secondary : respiratory tract infections
atopy
immunizations
hodgkin’s lymphoma
NSAID therapy in adults
what is the clinical presentation of MCD ?
nephrotic syndrome , and primary is more commonly seen in children
what is thee treatment for 1ry and 2ry MCD ?
1ry MCD : immunosuppressive drugs , first line corticosteroids
2rry MCD : treat the cause - no immunosuppressive
what is the cause of primary focal segmental glomerulosclerosis ?
abnormal T lymphocyte activation
may also be hereditary
what are the causes of secondary FSGS ?
HIV
Heroin
pamidronate - drugs for osteoporosis
interferon
what is the effect of circulating permeability factors ?
damage to the podocytes , causing effacement and hence nephrotic syndrome
what are the causes of primary membranous nephropathy ?
immune complex formation
what are the causes of secondary membranous nephropathy ?
malignancy
HBV , HCV , HIV
SLEE
drugs : NSAIDs, penicillamine
what is the clinical picture of membranous nephropathy ?
nephrotic syndrome
what is different about the presentation of membranoproliferative GN ?
present with nephrotic and nephritic
proteinuria of more than 3.5 , edeema, hematuria and hypertension
what are the secondary causes of secondary membranoproliferative GN ?
HCV, HBV
SLE
plasma cell dyscrasias - like multiple myelomas
what is the cause of goodpasture disease ?
auto antibodies against alpha 3 chain of type 4 collagen off thee GBM and alveolus BM
what is the clinical presentation of goodpasture syndrome ?
rapidly progressive GN ( crescent formation )
pulmonary hge and hemoptysis
what is the other name for good pasture’s disease ?
anti GBM disease
what is the treatment for good pastures disease ?
immunosuppressive and plasma exchange
what is the specific investigation for goodpasture’s disease ?
anti-GBM antibodies
what are the three different types of RPGN ?
type I : good pasture
type II : immune complex mediated GN
type III : ANCA associated vasculitis
what is the prognosis for acute post strep GN ?
self-limiting , associated with full renal recovery
what is the prognosis of minimal change disease ?
corticosteroids are effective in remission
relapse is common
what is the prognosis for alport and FSGS ?
almost all cases progress to chronic kidney failure
what is the prognosis of RPGN ?
renal function deteriorates rapidly and is often irreversible
what is the prognosis for IgA and MPGN ?
50% will progress to CKD over time
what is the prognosis for membranous nephropathy ?
25% of cases are resistant to therapy and progress to CKD
75 % off cases enter remission
what is the prognosis of lupus diffuse proliferative GN ?
outcomes are variable
generally do nephrotoxic drugs cause nephritic or nephrotic ?
nephrotic
what is the difference between acute post strep glomerulonephritis and IgA nephropathy ?
post strep - presents with nephritic
present 1-4 weeks after infection of the skin or throat and usually occurs in children
IgA nephropathy - recurrent attacks of nephritic syndrome or macroscopic hematuria
presents 1-2 days after GIT or resp tract infection and is seen in older patients
what is the treatment for post strep GN ?
treat with antibiotics
what specific investigation can be ordered for a patient with alports ?
genetic testing
Is there any role for testing or investigating other family members? If yes, what investigations would you request for patients with alport’s ?
family members should be screened for hematuria
what is the most common nephrotic disease in children ?
minimal change nephropathy
why are patients with nephrotic syndrome more prone for thromboembolic events ?
- Risk of thromboembolic events due to decreased levels of natural anticoagulants (due to urinary losses) such as:
a. anti-thrombin III
b. Plasminogen
c. protein C and S - Avoid thromboembolic events by using prophylactic anticoagulation with heparin, warfarin.
