ICC3 > glomerulonephritis > Flashcards

glomerulonephritis Flashcards

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1
Q

what is the hallmark of glomerulonephritis ?

A

excretion of protein in the urine

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2
Q

what are the clinical presentation of glomerular disease ?

A 
.asymptomatic 
.macroscopic heamturia 
.nephrotic syndrome 
.nephritic syndrome 
.rapidly progressive glomerulonephritis 
.chronic glomerulonephritis
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3
Q

what is the pathophysiological classification of glomerular disease ?

A
  1. immune mediated
  2. protein deposition
  3. Miscellaneous ( drug induced, inherited)
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4
Q

when do we consider glomerular disease in aetiology ?

A 
presenting with hypertension 
edema 
proteinuria 
hematuria 
AKI 
CKD
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5
Q

what are the primary nephritic syndrome glomerular pathologies ?

A
  • immunoglobulin A Nephropathy
  • anti-glomerular basement membrane disease
  • thin basement membrane nephropathy ( Alport Syndrome )
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6
Q

what is nephritic syndrome ?

A

presence of hematuria, accompanied by RBC casts

oliguria

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7
Q

what are the secondary nephritic syndrome glomerular pathologies ?

A
  • Lupus nephritis
  • membrenoproliferative GN
  • post infectious GN
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8
Q

what is the onset of nephritic syndrome in children with PIGN ? and what is the most common causative organism ?

A

onset is after infection

and is predominantly streptococcal

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9
Q

what is the onset of nephritic syndrome in adults with PIGN and the most common causative organism ?

A

onset is during the ongoing infection and it is more likely to be staphylococcal

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10
Q

where id the site of infection in children with PIGN ?

A

pharyngitis

skin as with impetigo

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11
Q

what is the other name for Immunoglobulin A nephropathy?

A

Berger’s disease

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12
Q

what is the most common cause of glomerulonephritis ?

A

IgA nephropathy

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13
Q

what is the diagnostic measure taken for IgA nephropathy ?

A

immunofluorescence

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14
Q

what do patients with IgA present with ?

A

usually macroscopic hematuria in v late stages the disease can shift to nephrotic

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15
Q

How can IgAN happen ?

A

can occur with upper respiratory tract infections as a site of entry
may also be associated with alcoholic liver cirrohsis

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16
Q

which causative organism can cause severe IgAN ?

A

s.aureus

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17
Q

when can nephrotic proteinuria occur in IgAN ?

A
  • early in the disease course if IgAN + minimal change disease
  • late if it is 2ry too glomerular scarring
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18
Q

what are the secondary causes of IgAN ?

A

rheumatic/autoimmune disease
GIT/liver disease
Infections

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19
Q

what is the treatment approach for IgAN

A

give ARBs
immunosuppression
corticosteroids - predinsolone

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20
Q

what are the criteria for diagnosing Lupus nephritis ?

A 
mala rash 
discoid rashes 
photosensitivity 
oral ulcers 
arthritis
serositis 
kidney disorder
Anti-dsDNA 
ANA
neurological, haematological or immunological disorder
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21
Q

what are the treatment options for lupus nephritis ?

A

IV steroids

RAAS blockade

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22
Q

what are the most common causes of membrenoproliferative GN

A

hepatits C virus

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23
Q

what is the old classification for MBP GN?

A

type I : IC deposits in the mesangium and sub endothelial space
type II : continuous, dense ribbon-like deposits in GBM
dense deposit disease
type III : sub endothelial and sub epithelial IC deposits

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24
Q

what is the new classification of MPGN?

A
  • positive for both IG and complement
  • positive for complement
  • no immunofluroscense (negative for both)
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25
what is another name for granulomatosis with polyangitis ?
wegner's granulomatosis
26
what are the presenting symptoms of GPA ?
history of recurrent sinusitis hemoptysis heamturia severe AKI
27
what are the lab findings in GPA ?
cANCA +ve | crescents found in renal biopsy
28
what is the treatment for Wegner's granulomatosis ?
Steroids cyclosporine plasmapheresis may be required
29
what is churg-strauss syndrome ?
a type of vasculitis
30
what is the other name for churg-stauss syndrome ?
eosinophilic granulomatosis with polyangitis
31
what is the clinical presentation of Churg-stauss syndrome | eosinophilic granulomatosis with polyangitis ?
-similar presentation to GPA/Wegner's disease -significant allergic/asthmatic features the triad consists of : hypereosinophilia asthma pulmonary infiltrates
32
what is a crucial symptom for diagnosis of Churg-stauss syndrome ?
Asthma is a must for diagnosis
33
what are the lab findings in Churg-strauss syndrome ?
pANCA positive | renal biopsy shows granuloma and eosinophils
34
what is the treatment for Churg-strauss ?
steroids cyclosporine
35
what is the pathogenesis of anti glomerular basement membrane disease ?
antibodies are found for type 4 collagen , and is limited to the lungs and kidney
36
what other syndrome is associated with Anti-GBM GN ?
Good Pastures disease
37
what is the clinical presentation of Anti-glomerular basement membrane disease
- alveolar haemorrhages and severe anuric AKI | - No skin or GIT involvement
38
what are the lab investigations for anti-glomerular disease?
* Check Anti-GBM Abs’ levels. | * Bx: Immunofluroscense : +ve Anti-GBM Abs
39
what is the treatment for anti-glomerular disease ?
pulse steroids +cyclosporine plasmapheresis relapses are rare
40
what is polyarteritis noda PAN ?
- medium vessel vasculitis - multi system involvement except the lungs - more common in hepatitis B virus patients
41
what is the common presentation of PAN ?
- hepatits B patient complaining of abdominal pain, fatigue and weight loss - postprandial abdominal pain - livedo reticularis
42
what are the lab findings in PAN ?
anemia raised ESR raised CRP
43
what is the treatment for PAN?
steroids | cyclosporine
44
what are examples of thrombotic microangiopathies?
- thrombotic thrombocytopenia purpura (TTP) | - Hemolytic uremic syndrome (HUS)
45
what is the characteristic triad of HUS ?
hemolytic anemia Uremia Thrombocytopenia
46
what is the characteristic pentad of TTP?
``` hemolytic anemia thrombocytopenia uremia fever CNS changes ```
47
what type of cells would we find in a peripheral blood smear of TTP/HUS ?
schistocytosis
48
what are the biopsy findings in TTP/HUS?
small thrombi within glomerular capillary loops
49
what is important to take into consideration when treating TTP/HUS ?
- DO NOT give PLATELET transfusion. | - DO NOT give Antibiotics.
50
what are the types of cryoglobulinemia ?
type I: Multiple myeloma type II: HCV Type III: SLE , rheumatoid arth
51
what is the common clinical presentation of cryoglobulinemia ?
HCV patient with joint pain and rash
52
what would the lab finding of cryoglobulinemia be ?
serum cryoglobulins rheumatoid factor low complements
53
what is Henoch-Schonlein Purpura
a type of vasculitis commonly found in children
54
what are the findings in Henoch-Schonlein Purpura ?
purpura of the extremities arthritis colicky abdominal pain
55
what is nephrotic syndrome ?
- protein excretion of more than 3.5mg - hypoalbuminemia - hypercholesterolemia - peripheral edema
56
what is classified under secondary nephrotic syndrome?
diabetic nephropathy | renal amyloidosis
57
what are the diagnostic workup for glomerular disease?
determine patients GFR urinalysis quantify proteinuria Renal US
58
what are some additional lab investigations to consider ?
``` hepatitis panel HIV testing complement levels RF cryoglobulins ANA ANCA Anti-GBM ```
59
what are the complications of nephrotic syndrome ?
1. Negative Nitrogen Balance 2. Hypercoaguability 3. Lipid Abnormalities 4. Infections 5. AKI 6. CKD 7. Peripheral edema 8. Hypercholesteremia 9. Anemia
60
what is classified under primary nephrotic syndrome glomerular pathology ?
- Minimal change nephrotic syndrome - membranous nephropathy - focal segmental glomerulosclerosis
61
what is the main cause of nephrotic syndrome?
minimal change disease
62
response of MCD to therapy ?
almost always steroid sensitive
63
what does the renal biopsy show in kids with steroid resistant NS?
focal segmental glomerulosclerosis
64
what are the causes of focal segmental glomerulosclerosis?
-familial/genetic -virus associated ( HIV patient , parvovirus ) -drug induced
65
what is the most common cause of nephrotic syndrome in noon DM adults ?
Membranous glomerulopathy
66
what is alport's syndrome?
a rare x-linked dominant disease with a type 4 collagen abnormality
67
what is the typical presentation ?
a young patient who is deaf or has some form of ocular defects
68
what is the prognosis of alports syndrome ?
no cure , ultimate progression to end stage renal disease
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