1. Glomerulonephritis

Question 1

nephrotic syndrome is characterised by

Answer 1

proteinuria - typically >3g/24hr
hypoalbuminaemia - typically serum album <25g/L
oedema
hyperlipidaemia

Question 2

what happens in the kidney in nephrotic syndrome

Answer 2

glomerular basement membrane damage and increased pore size leads to increased permeability of glomerular filter to albumin
capillary walls become permeable to proteins of higher molecular weights, as severity of injury continues
loss of albumin

Question 3

what happens in hypoalbuminaemia

Answer 3

heavy proteinuria leads to low plasma albumin
colloid osmotic pressure is not maintained. so less fluid moves back into capillaries
stimulates RAAS- leads to further water and Na+ retention

Question 4

complications from nephrotic syndrome

Answer 4

immunosuppression - immunoglobulins lost in urine
hypercoagulable - controlling proteins lost in urine – increases risk of DVT, PE, renal vein thrombosis
hyperlipidaemia - increases risk of vascular disease, IHD

Question 5

management options in nephrotic syndrome

Answer 5

BP control 
ACE inhibitors to reduce proteinuria 
control hyperlipdaemia 
if hypercoagulable - anticoagulation 
treat underlying condition if possible

Question 6

primary causes of nephrotic syndrome

Answer 6

minimal change disease
membranous glomerulonephropathy
membranoproliferative GN
focal segmental glomerulosclerosis

Question 7

secondary causes of nephrotic syndrome

Answer 7

HSP (Henoch-Schlönlein purpura)
SLE 
tumour amyloid 
diabetes mellitus drugs, e.g. penicillamine
bacterial endocarditis 
congenital nephrotic syndrome

Question 8

minimal change disease causes/associations

Answer 8

cause unknown 
associated with:
- NSAIDs
- lithium/gold 
- post allergy 
- Hodgkin's

Question 9

minimal change disease histology

Answer 9

no significant change under light microscopy

under electron microscopy: podocyte fusion (foot process effacement)

Question 10

minimal change disease presentation

Answer 10

frothy urine
low albumin
preserved renal function
= nephrotic syndrome

Question 11

minimal change disease treatment

Answer 11

corticosteroids 
calcineurin inhibitors (tacrolimus)

Question 12

membranous glomerulonephropathy histology

Answer 12

sub-epithelial deposition of immune complexes
basement membrane thickening, widespread (caused by immunoglobulin deposition)
abnormal mesangial matrix causes hyalinisation of glomerulus and death of individual nephrons

Question 13

membranous glomerulonephropathy causes

Answer 13

• idiopathic (85%)
• autoimmune disease: SLE, RA, ankylosing spondylitis, post transplant
• infection: hep B, syphilis, hep C, malaria
• drugs: mercury, captopril, gold, heroin

Question 14

membranous glomerulonephropathy presentation

Answer 14

nephrotic syndrome

AKI / CKD

Question 15

membranous glomerulonephropathy treatment

Answer 15

underlying cause
steroids
calcineurin inhibitors

Question 16

focal segmental glomerulosclerosis presentation

Answer 16

proteinuria or nephrotic syndrome
later develop: haematuria and hypertension
most develop CKD within 10 years

Question 17

focal segmental glomerulosclerosis causes

Answer 17

primary
- idiopathic
secondary
- familial - reoccurs after transplantation
- virus - HIV
- drugs - heroin, pamidronate
- obesity, HTN, atheroemboli, sickle cell anaemia

Question 18

focal segmental glomerulosclerosis treatment

Answer 18

primary and familial: immunosuppression and BP control

treat secondary underlying cause

Question 19

symptoms and signs of nephritic syndrome

Answer 19

oliguria/anuria
hypertension 
fludi retention - seen as facial oedema 
haematuria - microscopic or macroscopic
uraemia 
proteinuria 

patients may also complain of: loin pain, headache, general malaise

Question 20

nephrotic vs nephritic syndrome

Answer 20

nephrotic: characterised by massive loss of protein causing various complications
nephritic: may be some proteinuria, more importantly there is haematuria, oliguria and hypertension

Question 21

primary causes of nephritic syndrome

Answer 21

mesangial proliferative GN
diffuse proliferative GN
crescentic (rapidly progressive) GN
membranoproliferative / mesangial capillary GN

Question 22

secondary causes fo nephritic syndrome

Answer 22

SLE
Wegner’s granulomatosis
microscopic polyangiitis

Question 23

mesangial proliferative GN causes

Answer 23

can occur in several diseases: IgA nephropathy, IgM nephropathy, lupus

Question 24

mesangial proliferative GN presentation

Answer 24

variable
haematuria
nephrotic syndrome?
AKI / CKD

Question 25

mesangial proliferative GN treatment

Answer 25

depends on cause
steroids
mycophenolate mofetil
cyclophosphamide

Question 26

diffuse proliferative GN

Answer 26

IgG, IgM, C3 deposition

presents with AKI, haematuria

Question 27

diffuse proliferative GN causes + treatment

Answer 27

endocarditis
post-streptococcal GN
treat underlying infection

Question 28

crescentic GN (rapidly progressive) histology

Answer 28

fibirin leaks, stimulating endothelial cells and macrophages in Bowman’s capsule to proliferate and create crescent shaped masses
reduces glomerular blood glow
seen as a part os systemic illness

Question 29

crescentic GN causes

Answer 29

ANCA-associated - related to small vessel vasculitis
- granulomatosis with polyangiitis, Wegner/s granulomatosis
- GDM disease (Goodpasteurs)
aggressive IgA nephropathy

Question 30

crescentic GN treatment

Answer 30

strict BP control 
ACE inhibitors for proteinuria >1g/day 
immunosuppression:
- steroids
- cyclophosphamide 
- mycophenolate mofetil 
- rituximab

Question 31

membranoproliferative / mesangial capillary GN histology

Answer 31

diffuse global membrane thickening and mesangial proliferation

Question 32

membranoproliferative GN presentation

Answer 32

asymptomatic haematuria or combined with nephrotic/nephritic syndrome

Question 33

membranoproliferative GN causes

Answer 33

primary (mostly)

secondary: hep C, endocarditis, viral infections, malaria, sickle cell disease

Question 34

membranoproliferative GN treatment

Answer 34

strict BP control 
ACE inhibitors for proteinuria >1g/day 
immunosuppression:
- steroids 
- calcineurin inhibitors 
- mycophenolate mofetil 
- rituximab