2. Nephritic And Nephrotic Conditions

Question 1

How can glomerular disease be classified?

Answer 1

Hereditary
Primary (most common)
Secondary to systemic diseases

Question 2

What does glomerular disease result in?

Answer 2

Inflammation of the glomerulus - glomerulonephritis

Question 3

What are the 4 clinical structures within the glomerulus that are prone to damage?

Answer 3

Capillary endothelial cell lining
Glomerular basement membrane
Mesangium supporting the capillaries
Podocytes on the outer surface of the capillary

Question 4

What is nephrotic syndrome characterised by?

Answer 4

Proteinurea (>3g/d)
Hypoabluminaemia
Oedema
Hyperlipidaemia

Question 5

What causes nephrotic syndrome?

Answer 5

Increased permeability of glomerular filter to albumin as a result of glomerular basement membrane damage and increase in pore size

Question 6

What is the management of nephrotic syndrome?

Answer 6

Blood pressure control
Reduction in proteinurea using ACE inhibitors
Control of hyperlipidaemia
Anticoagulation if hypercoaguable
Treatment of underlying cause where possible

Question 7

What happens in diabetic nephropathy?

Answer 7

Excess glucose in blood binds to proteins esp. at efferent arteriole
Hyaline atherosclerosis obstructs blood flow
Initially increased GFR
Over time mesangial cells secrete more structural matrix
Thickening of BM
Decreased GFR

Question 8

What is the treatment for diabetic nephropathy?

Answer 8

Hypertension
Good glycemic control
ACE inhibitors
Angiotensin receptor blockers

Question 9

What is the most common cause of nephrotic syndrome in children under 6?

Answer 9

Minimal change disease

Question 10

What happens in membranous glomerulonephritis?

Answer 10

Subepithelial deposition of immune complexes

Question 11

What are the causes of membranous glomerulonephritis?

Answer 11

Idiopathic
Primary or secondary
Infections
Tumours
Drugs
Systemic illnesses

Question 12

What is the treatment for membranous glomerulonephritis?

Answer 12

Immunosuppressants

Treatment of underlying cause

Question 13

What are the causes of focal segmental glomerulosclerosis?

Answer 13

Primary: idiopathic
Secondary: sickle cell disease, HIV, heroin abuse, kidney hyperperfusion

Question 14

What happens in focal segmental glomerulosclerosis?

Answer 14

Podocytes damaged

Proteins build up in glomerulus - hyalinosis - leading to sclerosis

Question 15

What is the treatment for focal segmental glomerulosclerosis?

Answer 15

Steroids

Inconsistent results can lead to chronic renal failure

Question 16

What are the signs and symptoms of acute nephritic syndrome?

Answer 16

*Oliguria/anuria
*Hypertension
*Hematuria - microscopic or macroscopic
Fluid retention
Uraemia
Proteinuria

Question 17

What is the treatment of acute nephritic syndrome?

Answer 17

Steroids

Question 18

What is IgA nephropathy?

Answer 18

Causes recurrent hematuria

Hypertension and IgA levels raised, deposited in mesangium, sclerosis of damaged segment

Question 19

What is the treatment for IgA nephropathy?

Answer 19

Steroids
Control BP
Antihypertensives

Question 20

What is rapidly progressive glomerulonephritis?

Answer 20

Severe glomerular injury, leakage of fibrin, macrophages and epithelial cells proliferate
Crescent shape masses form, reducing glomerular blood supply
Loss of renal function within days to weeks

Question 21

What is the treatment for rapidly progressive glomerulonephritis?

Answer 21

High dose steroids

Immunosuppressants and plasma exchange

Question 22

What is post-streptococcal glomerulonephritis?

Answer 22

Presents 1-3 weeks following group A beta-hemolytic streptococcal infection of tonsils, pharynx or skin

Question 23

What is the treatment for post-streptococcal glomerulonephritis?

Answer 23

Antibiotics to treat remaining infection

Question 24

What is Goodpastures syndrome?

Answer 24

Antibodies o type IV collagen in glomerular BM develop, causing inflammation
Results in rapidly progressive glomerulonephritis, acute renal failure and lung haemorrhage

Question 25

What is the treatment for goodpastures syndrome?

Answer 25

Plasma exchange, corticosteroids

Question 26

What is acute nephritic syndrome?

Answer 26

Some proteinuria, mostly hematuria, oliguria and hypertension