Renal SOH > Glomerulonephritis > Flashcards

Glomerulonephritis Flashcards

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1
Q

Definition

A

Immune mediated disease which affects the glomeruli.

Disruption of the glomerular capillary wall

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2
Q

Which 3 parts of the glomerulus can be affected?

A

Endothelium
Basement membrane
Podocytes

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3
Q

Causes

A 
Idiopathic
Infections
Drugs 
Malignancies 
Small vessel vasculitis 
Lupus 
Goodpastures
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4
Q

Pathology

A

Depends on site of injury

Depends on type of injury

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5
Q

Proliferative or non proliferative refers to…

A

Presence or absence of proliferation of mesangial cells

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6
Q

Focal or diffuse refers to…

A

How much of the glomeruli are affected

  • focal = less than 50% affected
  • diffuse = more than 50% affected
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7
Q

Global or segmental refers to…

A

Global - all glomerulus affected

Segmental - parts of glomerulus affected

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8
Q

Cresenteric refers to…

A

Presence of a crescent of cells

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9
Q

Crescents is a manifestation of mild/severe glomerular damage

A

Severe

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10
Q

Damage to mesangial cells leads to proliferative/non-proliferative lesion

A

Proliferative

- mesangial cells proliferate and release angiotensin II

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11
Q

Damage to mesangial cells - urine

A

Leakage occurs through the glomerular wall resulting in

  • haematuria
  • proteinuria
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12
Q

Damage to mesangial cells - inflammatory or non inflammatory process?

A

Inflammatory

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13
Q

Can damage to mesangial cells result in renal failure?

A

Yes

- gradual progression of renal failure

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14
Q

Damage to endothelial cells - proliferative or non-proliferative lesion?

A

Proliferative

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15
Q

Damage to endothelial cells - inflammatory or non inflammatory process?

A

Inflammatory

- inflammation of the endothelium

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16
Q

Which condition does damage to the endothelial cells result in?

A

Vasculitis

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17
Q

Damage to endothelial cells - urine

A

Leakage occurs through the glomerular wall resulting in

- haematuria

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18
Q

Can damage to endothelial cells result in renal failure?

A

Yes

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19
Q

Damage to endothelial cells results in a very rapid decline in the patient. True or false?

A

True

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20
Q

Damage to podocytes leads to a proliferative or non proliferative lesion?

A

Non-proliferative

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21
Q

Damage to podocytes involves an inflammatory or non-inflammatory process?

A

Non-inflammatory process

- podocytes shrink back and they are no longer an effective barrier

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22
Q

Damage to podocytes - urine

A

Leakage occurs through the exposed glomerular wall resulting in

  • haematuria
  • proteinuria
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23
Q

What is the range of microalbuminuria

A

30-300mg albuminuria/day

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24
Q

Asymptomatic proteinuria range

A

<1g/day

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25
Heavy proteinuria range
1-3g/day
26
Nephrotic range of proteinuria
>3g/day
27
Glomerulonephritis causes a decreased production of urine. True or false?
True
28
AKI due to glomerulonephritis is most commonly due to - damage to mesangial cells - damage to endothelial cells - damage to podocytes
Damage to endothelial cells
29
Investigations
``` Blood tests Urinalysis Urine microscopy Renal biopsy Immunofluoresence Electron microscopy ```
30
Investigations - urine microscopy findings
Dysmorphic RBCs - since they are squeezed through damaged glomerulus RBC and granular casts - small tubule shaped prticles which get washed into the urine
31
What do the presence of granular casts suggest?
There is an active inflammatory process - damage to mesangial cells - damage to endothelial cells
32
If urinalysis reveals proteinuria, what is the next investigation to do?
24 hour urine collection to quantify the proteinuria
33
Investigations - What is the purpose of immunofluoresence?
Look for circulating immune complexes
34
Investigations - what is the purpose of electron microscopy?
Shows how cells are affected
35
Proteinuria impacts on how quickly the disease progresses - true or false?
True
36
Management - aims
Reduce degree of proteinuria | Preserve long term renal function
37
Target BP in a patient with proteinuria?
Less than 130/80
38
Management - medications
``` ACE inhibitors ARBs Diuretics Statins Anticoagulants/antiplatelets ```
39
Management - immunosuppressive therapy
Corticosteroids Azathioprine Cyclophosphamides
40
Is plasmaphoresis of use in GN?
Yes | - rapidly removes the antibody whilst the drugs start to work
41
Rapidly progressive glomerulonephritis (RPGN) is a treatable cause of AKI. True or false?
True
42
What is likely to be seen on renal biopsy of RPGN patient?
Granular casts
43
Management of RPGN
``` Treat ASAP Strong steroids Cyclophosphamide Plasmapheresis Supportive care ```
44
Nephrotic syndrome
Disorder of glomerular filtration allowing protein to appear in filtrate, resulting in proteinuria
45
Nephrotic syndrome - clinical features
Oedema (everywhere) Proteinuria HypoalbuminAEMIA HypercholesterolAEMIA
46
Why does oedema occur in nephrotic syndrome
Patients are loosing protein faster than they can make it | Fluid leaks out into the interstitium
47
Renal function is usually normal in nephrotic syndrome. True or false?
True | - normal creatinine level
48
Nephrotic syndrome is most likely due to a proliferative or non-proliferative process?
Non proliferative | - affecting the podocytes
49
Nephrotic syndrome - management
``` Fluid restriction Salt restriction Diuretics ACE inhibitor or ARBs Anticoagulation ```
50
Patients with nephrotic syndrome are more or less susceptible to infection?
More | - peeing out proteins (Ig)
51
Nephritic syndrome is most likely due to a proliferative or non-proliferative process?
Proliferative - damage to the mesangial cells - damage to the endothelial cells
52
Nephritic syndrome - clinical features
``` AKI Oliguria Oedema Haematuria Hypertension ```
53
What is the commonest cause of nephrotic syndrome in children?
Minimal change nephropathy
54
Minimal change nephropathy is due to damage of... ? - mesangial cells - endothelial cells - podocytes
Podocytes
55
Who gets minimal change nephropathy?
Children
56
Minimal change nephropathy - Renal biopsy appearance?
Looks normal
57
Electron microcopy is a good way to visualise podocytes?
True
58
Minimal change nephropathy - management
Oral steroids | Cyclophosphamide
59
Focal segmental glomerulosclerosis nephropathy (FSGS) is due to damage of ? - mesangial cells - endothelial cells - podocytes
Podocytes
60
FSGS is more common in adults or children?
Adults
61
What is the most common cause of nephrotic syndrome in adults?
FSGS
62
FSGS - pathology
Patches of focal sclerosis
63
FSGS - causes
HIV Heroin use Obesity Reflux nephropathy
64
FSGS renal biopsy appearance
Focal segmental glomerulosclerosis - only some glomeruli are affected - only some parts are affected
65
FSGS - management
Prolonged steroids
66
What is the most common cause of nephrotic syndrome in the UK?
Membranous nephropathy
67
Membranous nephropathy - definition
Thickening of the glomerular BM
68
Membranous nephropathy - causes
Infections CTD (lupus) Malignancy
69
Membranous nephropathy - immunology
IgG attaaches to podocytes and causes podocyte damage
70
Membranous nephropathy renal biopsy appearance
Thickening of the glomerular BM (silver stain) | Immune complex deposition between podocytes
71
Membranous nephropathy - management
Steroids Immunosuppression (if steroids don't work) MABs
72
Patients with membranous nephropathy can progress to ESRF?
True
73
What is the commonest GN in the world?
IgA nephropathy
74
IgA nephropathy - immunopathogenesis
Wonky IgA
75
IgA nephropathy - cause
Infection | - More IgA production and therefore more kidney inflammation
76
Patient develops macroscopic haematuria after a resp infection. What is the most likely diagnosis?
IgA nephropathy
77
IgA nephropathy - associated condition
HSP (small vessel vasculitis)
78
IgA nephropathy - renal biopsy appearance
Mesangial cell proliferation and expansion
79
IgA nephropathy - management
BP control
Renal SOH
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