23. ZTF glomerulonephritis

Question 1

what does the term nephritis mean

Answer 1

Nephritis is a very generic term that means inflammation of the kidneys. It is a very non-specific descriptive term and is not a diagnosis or syndrome that has any criteria

Question 2

what does nephritic syndrome or acute nephritic syndrome mean

Answer 2

refers to a group of symptoms, not a diagnosis. When we say a patient has “nephritic syndrome” it simply means they fit a clinical picture of having inflammation of their kidney and it does not represent a specific diagnosis or give the underlying cause

Question 3

unlike nephrotic syndrome, there are no set criteria for nephritic syndrome however there are the what features in nephritic syndrome

Answer 3

• Haematuria means blood in the urine. This can be microscopic (not visible) or macroscopic (visible).
• Oliguria means there is a significantly reduced urine output.
• Proteinuria is protein in the urine. In nephritic syndrome, there is less than 3g / 24 hours. Any more and it starts being classified as nephrotic syndrome.
• Fluid retention

Question 4

what is the criteria for a patient to have nephrotic syndrome

Answer 4

• Peripheral oedema
• Proteinuria more than 3g / 24 hours
• Serum albumin less than 25g / L
• Hypercholesterolaemia

Question 5

what is glomerulonephritis

Answer 5

umbrella term applied to conditions that cause inflammation of or around the glomerulus and nephron. There are many conditions that can be described as glomerulonephritis
- there are specific diseases and diagnosis that have their own pathophysiology

Question 6

what is interstitial nephritis

Answer 6

term to describe a situation where there is inflammation of the space between cells and tubules (the interstitium) within the kidney.

• acute interstitial nephritis
• chronic tubulointerstitial nephritis

Question 7

what is glomerulosclerosis

Answer 7

a term to describe the pathological process of scarring of the tissue in the glomerulus. It is not a diagnosis in itself and is more a term used to describe the damage and scarring done by other diagnose

• can be caused by any type of glomerulonephritis or obstructive uropathy and by specific disease called focal segmental glomerulosclerosis

Question 8

Name the specific types of glomerulonephritis

Answer 8

• Minimal change disease
• Focal segmental glomerulosclerosis
• Membranous glomerulonephritis
• IgA nephropathy (AKA mesangioproliferative glomerulonephritis or Berger’s disease)
• Post streptococcal glomerulonephritis (AKA diffuse proliferative glomerulonephritis)
• Mesangiocapillary glomerulonephritis
• Rapidly progressive glomerulonephritis
• Goodpasture Syndrome

Question 9

what are most types of glomerulonephritis treated with

Answer 9

immunosuppression (eg steroids)

blood pressure control with ACEi or ARB

Question 10

what does nephrotic syndrome predispose a patient to

Answer 10

thrombosis, HTN and high cholesterol

Question 11

what is the most common cause of nephrotic syndrome in children

• Minimal change disease
• Focal segmental glomerulosclerosis
• Membranous glomerulonephritis

Answer 11

minimal change disease

it is usually idiopathic and treated successfully with steroids

Question 12

what is the most common cause of nephrotic syndrome in adults

• Minimal change disease
• Focal segmental glomerulosclerosis
• Membranous glomerulonephritis

Answer 12

focal segmental glomerulosclerosis

Question 13

What is the most common cause of primary glomerulonephritis (not caused by another disease)

IgA nephropathy (AKA mesangioproliferative glomerulonephritis or Berger’s disease)
• Post streptococcal glomerulonephritis (AKA diffuse proliferative glomerulonephritis)
• Mesangiocapillary glomerulonephritis
• Rapidly progressive glomerulonephritis
• Goodpasture Syndrome

Answer 13

IgA nephropathy aka burgers disease

Question 14

what is the peak age of presentation of IgA nephropathy ie bergers disease

Answer 14

20

Question 15

what does histology show for IgA nephropathy ie Berger’s disease

Answer 15

IgA deposits and glomerular mesangial proliferation

Question 16

what is the most common type of Glomerulonephritis overall

• Minimal change disease
• Focal segmental glomerulosclerosis
• Membranous glomerulonephritis
• IgA nephropathy (AKA mesangioproliferative glomerulonephritis or Berger’s disease)
• Post streptococcal glomerulonephritis (AKA diffuse proliferative glomerulonephritis)
• Mesangiocapillary glomerulonephritis
• Rapidly progressive glomerulonephritis
• Goodpasture Syndrome

Answer 16

membranous Glomerulonephritis

bimodal peak in age in 20s and 60s

histology shows IgG and compliment deposits on the basement membrane

can be secondary to malignancy, rheumatoid disorders and drugs eg NSIADs

Question 17

how does Post streptococcal glomerulonephritis (AKA diffuse proliferative glomerulonephritis) usually present

Answer 17

typically under 30 and
1-3 weeks after a streptococcal infection (eg tonsillitis or impetigo
they develop nephritic syndrome
is usually a full recovery

Question 18

what is good pasture syndrome

Answer 18

Anti-GBM (glomerular basement membrane) antibodies attack glomerulus and pulmonary basement membranes. This causes glomerulonephritis and pulmonary haemorrhage

Question 19

in an exam, if a patient presents with acute kidney failure and haemoptysis what are you thinking of

Answer 19

good pastures syndrome

or granulomatosis with polyangitis (aka wagerers granulomatosis)

Question 20

what is good pastures syndrome associated with

Answer 20

anti GBM antibodies

Question 21

what is wagerers granulomatosis (a type of vasculitis|) associated with

Answer 21

anti neutrophil cytoplasmic antibodies (ANCA)

these patients may also have a wheeze, sinusitis and a saddle shaped nose

Question 22

in rapidly progressive Glomerulonephritis what does histology show
and what is it often secondary to

Answer 22

Histology shows “crescentic glomerulonephritis”

Often secondary to Goodpasture syndrome