Z Year3 Urology > Glomerulonephritis > Flashcards

Glomerulonephritis Flashcards

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1
Q

What are the 2 types of glomerulonephritis?

A
  1. Nonproliferative (cells do not multiply): nephrotic

2. Proliferative (cells multiple): nephritic

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2
Q

What are features of nephrotic syndrome?

A
  1. Massive proteinuria (>3.5g/d) – foamy urine
  2. Hypoalbuminaemia (<25g/L)
  3. Oedema (peripheries, eyes)
  4. Hyperlipidaemia + lipiduria – fatty casts on microscopy
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3
Q

What are features of nephritic syndrome?

A
  1. Haematuria - red cell casts (dmage is enough to let RBC through)
  2. Proteinuria (1-3.5g/d)
  3. Oedema
  4. Progressive renal impairment
  5. HTN
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4
Q

How do you remember nephrotic syndrome?

A
  • Protein COAL
    1. Proteinuria
    2. Cholesterol up
    3. Oedema
    4. Albumin down
    5. Lipids up
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5
Q

How do you remember nephritic syndrome?

A
  • Protein HOB
    1. Proteinuria
    2. Haematuria
    3. Oedema
    4. Blood pressure up
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6
Q

What are the primary causes of nephrotic syndrome?

A
  1. Minimal changes disease
  2. Membranous GN
  3. FSGS
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7
Q

What are the secondary causes of nephrotic syndrome?

A
  1. Diabetic nephropathy

2. Amyloid nephropathy

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8
Q

What is minimal changes disease?

A

most common form of nephrotic syndrome in children

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9
Q

What is the cause of minimal changes disease?

A
  1. Idiopathic

2. often triggered by immunological insult

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10
Q

What are minimal changes disease associated with?

A

non-hodgkins lymphoma

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11
Q

What are symptoms of minimal changes disease?

A
  1. FULLY NEPHROTIC PICTURE

2. facial or generalized oedema

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12
Q

What are two investigations for minimal changes disease?

A
  1. Light microscopy

2. Electron microscopy

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13
Q

What would light microscopy show on minimal changes disease?

A

minimal histological changes on biopsy (only reserved to patients not responding to treatment/ frequent relapses)

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14
Q

What would electron microscopy show on minimal changes disease?

A
  1. Podocyte effacement

2. Negative immunofluorescence (no IC deposition)

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15
Q

What is the management for minimal changes disease?

A

corticosteroids (complete recovery)

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16
Q

What is the epid for membranous GN?

A

commonest form of nephrotic syndrome in adults

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17
Q

What is the aetiology for membranous GN?

A

SUBEPITHELIAL Deposition of immune complexes on BM

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18
Q

What are RF for membranous GN?

A
  1. autoimmune disease
  2. hep B/C
  3. syphilis
  4. malignancy
  5. certain medications (NSAIDs, gold, lithium)
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19
Q

What are symptoms for membranous GN?

A
  1. Often asymptomatic
  2. Oedema
  3. Xanthelasma
  4. foamy urine
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20
Q

How do you diagnosis membranous GN?

A

Diagnosis by exclusion, renal biopsy for definite diagnosis

  1. Light microscopy
  2. Electron microscopy
  3. Immunofluroscence
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21
Q

What do you see for light microscopy in membranous GN?

A

BM thickening

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22
Q

What do you see for electron microscopy in membranous GN?

A

spike & dome appearance (glomerular matrix on top of IC deposits); podocyte effacement

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23
Q

What would imunofluresnece show in membranous GN?

A

granular immunofluorescence; IgG4 antibodies against phospholipase A2 receptors

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24
Q

What is the management for membranous gN?

A
  1. LOW RESPONSE TO STEROIDS
  2. Conservative management (low salt low protein diet)
  3. Symptomatic management: corticosteroids + cytotoxic/immunosup therapy
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25
What is FSGS?
FOCAL SEGMENTAL GLOMERULOSCLEROSIS
26
What is the aetiology of FSGS?
Injury to podocytes
27
What are RF for FSGS?
1. HIV 2. heroin abuse 3. congenital malformations 4. INF treatment
28
What are symptoms for FSGS?
Asymptomatic or nephrotic syndrome
29
What investigations are done for FSGS?
1. Renal biopsy | 2. Electron miscrospy
30
What does Renal Biopsy show in FSGS?
focal segmental areas of mesangial collapse and sclerosis
31
What does electron microscopy show in FSGS?
effacement of foot processes of podocytes
32
What is the management of FSGS?
corticosteroids, symptomatic management
33
What is the aeitology of diabetic nephropathy?
Kidney damage caused by type I or type II diabetes
34
What is the patho of diabetic nephropathy?
1. Excess glucose in urine 2. So Glycation of proteins 3. Then BM thickening of efferent arteriole 4. So high pressure state 5. Then Matrix deposition & mesangial expansion 6. Forms Kimmelstiel-Wilson nodules + Glomerular damage
35
What are symptoms for diabetic nephropathy?
mostly asymptomatic
36
What is needed for diagnosis of diabetic nephropathy?
1. Microalbuminuria | 2. Light microscopy
37
What can be seen on light microscopy for diabetic nephropathy?
1. Mesangial expansion 2. GBM thicjening 3. Kimmelstiel-Wilson nodules
38
What is the management of diabetic nephropathy?
1. Diabetic control | 2. ACEi/ARBs (lower pressure in glomerulus)
39
What is amyloid nephropathy caused by?
secondary to amyloidosis
40
What is the patho of amyloid nephropathy?
Abnormal amyloid protein deposits leads to Tissue damage (if in kidneys: nodular glomerulosclerosis)
41
What investigation is used for amyloid nephropathy?
Biopsy showing nodular glomerulosclerosis
42
What stain and result is used to diagnose amyloid nephropathy?
Congo red stain + polarizing light leads to apple green birefringence
43
What are the 2 causes for nephritic syndrome?
1. MPGN | 2. RPGN/Crescenteric GN
44
What is MPGN?
MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS
45
What is the aetiology of MPGN?
1. Subendothelial Immune deposits 2. lead to Inflammation 3. amking structural damage of glomerulus
46
What are the two types of MOGN?
1. Type 1: immune complex deposits | 2. Type 2: Complement deposits
47
What is Type 1 MPGN caused by?
resulting from chronic infection, i.e.: hep B or C – complexes
48
What is Type 2 MPGN caused by?
inappropriate activation of alternative complement pathway aka. C3 breakdown
49
What are symptoms for MPGN?
Mixed picture | Both nephritic and nephrotic like haematuria and high protein
50
What investigation is done and what does it show for MPGN?
``` Light microscopy showing BM double contour (Tram tracking) ```
51
What is the management of MPGN?
steroids
52
What is RPGN?
RAPIDLY PROLIFERATIVE GLOMERULONEPHRITIS
53
What is the aetiology of RPGN?
Proliferation of cells in the Bowman’s space leads to Crescent shape
54
What investigations are done for RPGN?
1. BIOPSY 2. light microcopy 3. electron microscopy 4. immunofluorescence
55
What is the management of RPGN?
1. Anticoagulants might be used to reduce fibrin buildup in crescent formation 2. Plasmapheresis is usually used in combination with immunosuppressants (i.e.: corticosteroids)
56
What are the 3 types of FPGN?
TYPE 1: Goodpasture syndrome TYPE 2: Immune-complex mediated TYPE 3: Pauci-immune
57
What is the patho of good pastures syndrome?
Anti-glomerular membrane (GBM) antibodies trigger a TII hypersensitivity reaction
58
What are symptoms of goodpasture syndrome?
1. Damage to BM in lungs (initial presentation: haemoptysis, SOB) 2. and kidneys (nephritic syndrome)
59
How do you investigate goodpastures syndrome?
1. Light microscopy: Crescent | 2. Immunofluorescence: Linear deposition
60
What are the types of immune complex mediated FPGN nephritic syndrome?
1. Poststreptococcal GN 2. SLE 3. IgA nephropahy/ Berger’s disease 4. Henoch-Schonlein purpura
61
What is Poststreptococcal GN?
1. Several weeks after group A beta-hemolytic streptococcus infection (6w after impetigo; 1-2w post throat infection) 2. IC formation and subepithelial depositions 3. Sx: fever, smokey urine
62
What is invesitgations and management for poststrep GN?
1. Dx: Antibodies anti strep (Anti-sptreptolysin O antibody) | 2. Mx: supportive
63
What is SLE?
Diffuse (all nephrons in both kidneys) or focal (some nephrons in one kidney) Nuclear antigen + Anti-nuclear antibodies = IC deposits trigger Type III hypersensitivity reaction
64
What is IgA nephropahy/ Berger’s disease?
1. 1-2 days post-GI/resp infections: Formation of IgA ICs which deposit in mesangium 2. Sx: Episodic macroscopic haematuria
65
What investigations and results are done for IgA nephropahy/ Berger’s disease?
1. Mesangial proliferation on LM 2. EM & Immunofluorescence showing 3. IC deposition in mensagium
66
What is Henoch-Schonlein purpura?
1. IgA vasculitis: IgA deposition in small vessels 2. Sx: Ig A nephropathy + Arthralgia + purpura
67
What is the aetiology of Type 2 Pauci-Immune nephritic syndrome FPGN?
no immune deposits, associated with anti-neutrophilic cytoplasmic antibodies (ANCA)
68
What investigations are done for Pacui-immune?
Immnofluorescence is negative (no immune deposits); +ve ANCA
69
What is cANCA pauci-immune?
1. Wegener’s granulomatosis | 2. Associated symptoms: Saddle nose shape, sinusitis
70
What is pANCAs pauci-immune?
1. Microscopic polyangiitis (Associated symptoms: purpuric rash) 2. Churg Strauss (Associated symptoms: granulomatous inflammation, asthma and eosinophilia)
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