updated GN Flashcards
How do you differentiate between glomerulonephritis-associated hematuria and other causes of hematuria?
GN hematuria is associated with an abnormally shaped RBC
normal morphology in non-GN hematuria
What are the different presentations associated with glomerular disease?
asymptomaticc proteinuria
asymmptommatic hematuria
nephrotic syndrome
nephritic syndrome
RPGN
chronic GN
What type of injury is associated with nephritic vs. nephrotic?
nephrotic is associated with podocyte injury
nephritic is associated with sub-endothelial cell injury and GBM injury
What is characteristically found in RPGN?
crescent formation
what is the difference in urinary protein levels between nephritic and nephrotic ?
more than 3.5g in nephrotic
less than 3g in nephritic
what are the associated presentations/complications of nephrotic syndrome ?
hyperlipidemia
lipiduria
negative nitrogen balance ( muscle wasting )
hypercoagulability
infection
AKI
when are oval fat bodies found in the urine ?
in nephrotic syndrome
what type of AKI is associated with nephrotic ?
pre renal or ATN
what are the diseases that fall under nephrotic syndrome ?
MAD MF
Minimal change disease
Amyloidosis
Diabetic nephropathy
Membranous nephropathy
Focal segmental glomerulosclerosis
what are the diseases associated with nephritic syndrome ?
1- Acute diffuse proliferative GN :
acute post strept GN
lupus proliferative GN
2- IgA nephropathy
3- Alport Syndrome
which disease may present with both nephritic and nephrotic ?
membranoproliferative GN
what are the diseases associated with RPGN ?
Type 1 - good pastures syndrome
Type 2 - immune complex mediated GN
Type 3 - ANCA associated vasclitis
what is the other name for good pastures disease ?
anti glomerular basement membrane disease
what are the general supportive measures for each of these symptoms :
hypoproteinemia
proteinuria
edema
hypertension
hyperlipidemia
hypercoagulability
infection
hypoproteinemia - adequate protein intake
proteinuria - ACE or ARB
edema - loop diuretics and thiazide diuretics
hypertension- dietary salt restriction
hyperlipidemia - statins ezetimibe
hypercoagulability - prophylactic anticoag
infection - parental ab
what is the target blood pressure in patients with glomerular disease ?
below 130/80
what is the cause of post streptococcal GN ?
a type of acute nephritis
due to group A beta hemolytic streptococcal infection of the pharynx or the skin
which part of the glomeruli is affected in post streptococcal GN ?
subendothelial cells hence the hematuria
what is the presentation of acute post streptococcal GN ?
nephritic syndrome 1-4 weeks after a throat or skin streptococcal infection
usually occcurs in childhood
what is the specific investigation for post strep GN ?
ASOT ( anti streptolysin )
what is the treatment for post strep GN ?
general supportive treatment
if there is an ongoing infection give ab
what are the specific investigations associated with systemic lupus GN ?
anti dsDNA
anti smith
ANA
what is the treatment for SLE GN ?
immunosuppressive treatment
what is the presentation of IgA nephropathy ?
recurrrent attacks of nephritic syndrome or macroscopicc hematuria 1-2 days after an URT or GIT infection
what disease is associated with IgA nephropathy ?
celiac disease
what is the specific investigation associated with IgA nephropathy ?
elevated serum IgA
what is the treatment for IggA nephropathy ?
supportive +
immunosuppressive and ab if there is an ongoing infection
what is the cause of alport syndrome ?
x linked hereditary glomerular disease
what type of collagen is deficient in alports syndrome ?
type 4
what is the clinical presentation of alports syndrome ?
nephritic syndrome
recurrent attacks of macroscopic hematuria
sensorineural deafness
ocular abnormalities
what is the presentation of minimal change disease ?
nephrotic syndrome
more common in children
what is the treatment of minimal change disease ?
1ry : corticosteroids
2ry : treat the cause
what are the different causes associated with secondary FSGS ?
HIV
heroin
Obesity
what is thee presentation of membranoproliferative GN ?
mixed nephritic and nephrotic
what is the other namme for goood pastures disease ?
type 1 RPGN
or
Anti GBM membrane
what is the clinical presentation associated with Goodpasture’s disease ?
pulmonary hge and hemoptysis
what are the specificc antibodies associated with anti-GBM ?
anti GBM antibodies
what is the treatment for goodpasteurs disease ?
immunosuppressive agents
plasma exchange
what is the prognosis of acute poost streptococcal GN ?
self limmitng associated with full renal recovery
what is thee prrognosis of minimal change disease ?
corticosteroids are usually useful in inducing remission but relapse is common
what is the prognosis of alports syndrome ?
almost all cases prrogress to CCKD
what is the prognosis of FSGS ?
almost all cases progress to CKD
what is the prognosis of membranous nephropathy ?
1- 25% of cases are resistant to therapy and progress to CKD
2- 75% of cases enter remission
what is the prognosis of lupus diffuse proliferative GN ?
outcomes are variable it depends
what are the glomerular diseases associated with SLE ?
1- acute proliferative GN
2- membranous nephropathy
3- MPGN
what are the glomerular diseases associated with HBV ?
membranous nephropathy
MPGN
what aree the glomerular diseases associated with HCV ?
membranous nephropathy
MPGN
what are the glomerular diseases associated with HIV ?
membranous nephropathy
FSGS
what are the glomerular diseases associated with malignancy ?
membranous nephropathy
what are the systemic diseases associated with minimal change disease ?
respiratory tract infection
Atopy
Hodgkin’s disease
what are the drugs associated with causing secondary gloomerrular disease ?
NSAIDs
immunizations
Penicillamine
Pamidronate
Interferon
Heroin
how can you differentiate between acute post streptococcal GN vs IgA nephropathy ?
post strep happens 1-4 weeks after a throat or skin infection whilst IgA nephropathy happens 1-2 days after an URT or GIT infection
what are the diseases associated with membranoproliferative ?
HIV
HCV
HBV
SLE
plasma cell dyscrasias
what is the prognosis of membranoproliferative ?
50% progress to CKD
what is the prognosis of RPGN ?
renal function is rapidly lost
