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ICC3 > updated glomerulonephritis > Flashcards

updated glomerulonephritis Flashcards

1
Q

in hematuria associated with glomerulonephritis what is special about the RBCs ?

A

abnormal shape and can show acanthocytes ( RBC budding) due to gglomerular cause

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2
Q

what is seen on macroscopic examination of urine that indicated proteinuria ?

A

frothy urine

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3
Q

if there is injury to the podocytes what is the presentation ?

A

proteinuria ( nephrotic )

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4
Q

if there is injury to the mesangial or endothelial cells what is the presentation ?

A

hematuria - nephritic

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5
Q

if there are breaks in the GBMM what is the presentation ?

A

hematuria - neephritic

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6
Q

what are the glomerular diseases generally divided into ?

A

asymptomatic proteinuria
asymptomatic hematuria
nephritic syndrome
nephrotic syndrome
macroscopic hematuria
rapidly progressive glomerulonephritis
chronic glomerulonephritis

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7
Q

what are the different etiologies for glomerular injury ?

A

antigen antibody complex
complement activation
t-lymphocytes
genetics

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8
Q

what is the difference between nephritic and nephrotic syndrome ?

A

nephritis - associated with hematuria, mild proteinuria
nephrotic - proteinuria above 3.5 mg/dl , hypoalbuminemia , oedema and ascites

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9
Q

hypertension is associated with nephritic or nephrotic ?

A

nephritic more commonly

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10
Q

what are the main characteristics of nephrotic syndrome ?

A

proteinuria above 3.5 mg/dll
hyperlipidemia
lipiduria
hypercoagulability - due. to loss of anticoagulants
ascites
generalized oedema - ascites , pleural effusion

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11
Q

how can nephrotic syndrome cause acute kidney injury ?

A

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

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12
Q

what is rapidly progressive glomerulonephritis ?

A

similar to nephritic but kidney function loss happens over a week

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13
Q

what is the treatment for glomerular disease from a general supportive aspect ?

A

adequate dietary protein intake
ACE inhibitors or ARBS
loop diuretics
dietary sodium restriction

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14
Q

what is the goal for blood pressure in patients with glomerular disease ?

A

below 130/80

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15
Q

what is rapidly progressive glomerulonephritis characterized by ?

A

formation of crescents and hematuria with red cell casts ( which is also seen in nephritic)

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16
Q

what are the diseases that fall under the band off nephrotic syndrome ?

A

minimal change disease
focal segmental glomerulosclerosis
membranous nephropathy
amyloidosis
diabeticc nephropathy

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17
Q

what are the diseases that fall under the band off nephritic syndrome ?

A

acute diffuse proliferative glomerulonephritis ( Acute post-streptococcal glomerulonephritis
Lupus proliferative glomerulonephritis )
IgA nephropathy
Alport syndrome

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18
Q

what are the types of rapidly progressive glomerulonephritis ?

A

type 1 : goodpasture syndrome
type 2 : immune complex mediated glomerulonephritis
type 3: ANCA associated vasculitis

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19
Q

what disease falls under mixed nephritic and nephrotic syndrome ?

A

membranoproliferative glomerulonephritis

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20
Q

what is the cause of post streptococcal glomerulonephritis ?

A

chest or skin infection ( group b hemolytic streptococcal infection ) , affecting the sub epithelials area

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21
Q

what is the clinical presentation for acute post streptococcal GN ?

A

nephritic syndrome which present 1-4 weeks after a streptococcal infection ( sore throat or skin infection )

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22
Q

what age group is commonly associated with post strep GN ?

A

young children

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23
Q

what are the specific investigations for post strep GN ?

A

antistreptolysin O titre
ASOT

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24
Q

what is the clinical presentation of SLE proliferative GN ?

A

if the patient presents with :
nephrotic - membranous nephropathy
nephritic - lupus proliferative GN
mixed - MPGN

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25
Q

what are the specific investigations for SLE proliferative GN ?

A

detection of autoantibodies :
anti-dsDNA
Anti-smith
ANA

26
Q

what is the cause of IgA nephropathy ?

A

after a respiratory tract or GIT infection
abnormal Ig formation occurs
which then acts as the antigen

27
Q

what is the CP of IgA nephropathy ?

A

recurrent attacks of nephritic syndrome or macroscopic haematuria 1-2 days after thee infection and usually occurs in older patients

28
Q

what disease is IgA nephropathy associated with ?

A

Celiac disease

29
Q

what is the specific investigation for IgA nephropathy ?

A

elevated serum IgA

30
Q

what is the cause of Alports syndrome ?

A

x linked hereditary disease
mutation in type 4 collagen of the basement membrane

31
Q

what is the clinical picture of alports syndrome ?

A

nephritic syndrome
recurrent attacks of macroscopic hematuria
sensorineural deafness
ocular abnormalities

32
Q

what are the different causes of minimal change disease ?

A

primary : abnormal T lymphocyte activity

secondary : respiratory tract infections
atopy
immunizations
hodgkin’s lymphoma
NSAID therapy in adults

33
Q

what is the clinical presentation of MCD ?

A

nephrotic syndrome , and primary is more commonly seen in children

34
Q

what is thee treatment for 1ry and 2ry MCD ?

A

1ry MCD : immunosuppressive drugs , first line corticosteroids
2rry MCD : treat the cause - no immunosuppressive

35
Q

what is the cause of primary focal segmental glomerulosclerosis ?

A

abnormal T lymphocyte activation
may also be hereditary

36
Q

what are the causes of secondary FSGS ?

A

HIV
Heroin
pamidronate - drugs for osteoporosis
interferon

37
Q

what is the effect of circulating permeability factors ?

A

damage to the podocytes , causing effacement and hence nephrotic syndrome

38
Q

what are the causes of primary membranous nephropathy ?

A

immune complex formation

39
Q

what are the causes of secondary membranous nephropathy ?

A

malignancy
HBV , HCV , HIV
SLEE
drugs : NSAIDs, penicillamine

40
Q

what is the clinical picture of membranous nephropathy ?

A

nephrotic syndrome

41
Q

what is different about the presentation of membranoproliferative GN ?

A

present with nephrotic and nephritic
proteinuria of more than 3.5 , edeema, hematuria and hypertension

42
Q

what are the secondary causes of secondary membranoproliferative GN ?

A

HCV, HBV
SLE
plasma cell dyscrasias - like multiple myelomas

43
Q

what is the cause of goodpasture disease ?

A

auto antibodies against alpha 3 chain of type 4 collagen off thee GBM and alveolus BM

44
Q

what is the clinical presentation of goodpasture syndrome ?

A

rapidly progressive GN ( crescent formation )
pulmonary hge and hemoptysis

45
Q

what is the other name for good pasture’s disease ?

A

anti GBM disease

46
Q

what is the treatment for good pastures disease ?

A

immunosuppressive and plasma exchange

47
Q

what is the specific investigation for goodpasture’s disease ?

A

anti-GBM antibodies

48
Q

what are the three different types of RPGN ?

A

type I : good pasture
type II : immune complex mediated GN
type III : ANCA associated vasculitis

49
Q

what is the prognosis for acute post strep GN ?

A

self-limiting , associated with full renal recovery

50
Q

what is the prognosis of minimal change disease ?

A

corticosteroids are effective in remission
relapse is common

51
Q

what is the prognosis for alport and FSGS ?

A

almost all cases progress to chronic kidney failure

52
Q

what is the prognosis of RPGN ?

A

renal function deteriorates rapidly and is often irreversible

53
Q

what is the prognosis for IgA and MPGN ?

A

50% will progress to CKD over time

54
Q

what is the prognosis for membranous nephropathy ?

A

25% of cases are resistant to therapy and progress to CKD
75 % off cases enter remission

55
Q

what is the prognosis of lupus diffuse proliferative GN ?

A

outcomes are variable

56
Q

generally do nephrotoxic drugs cause nephritic or nephrotic ?

A

nephrotic

57
Q

what is the difference between acute post strep glomerulonephritis and IgA nephropathy ?

A

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

58
Q

what is the treatment for post strep GN ?

A

treat with antibiotics

59
Q

what specific investigation can be ordered for a patient with alports ?

A

genetic testing

60
Q

Is there any role for testing or investigating other family members? If yes, what investigations would you request for patients with alport’s ?

A

family members should be screened for hematuria

61
Q

what is the most common nephrotic disease in children ?

A

minimal change nephropathy

62
Q

why are patients with nephrotic syndrome more prone for thromboembolic events ?

A
  • 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.

ICC3 (66 decks)

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