B5.042 Prework 2: Glomerulonephritis

Question 1

what is glomerulonephritis

Answer 1

any condition associated with inflammation of the glomerular tuft

Question 2

what are 4 categories of classification of glomerulonephritis

Answer 2

causative disease
clinical syndrome
pattern of injury
pathology

Question 3

causative diseases

Answer 3

renal

systemic

Question 4

clinical syndromes

Answer 4

nephritic

nephrotic

Question 5

patterns of injury

Answer 5

diffuse- more than 50% of glomeruli
focal- involve less than 50% of glomeruli
segmental- portions of the glomerulus
global- all glomerulus affected

Question 6

pathology

Answer 6

membranous- thickening of glomerular capillary wall
proliferative- hypercellularity in glomerulus, mesangial expansion
membranoproliferative- combination of the above
glomerulosclerosis- sclerosis with capillary collapse

Question 7

types of glomerulonephritis that lead to nephrotic syndrome

Answer 7

minimal change glomerulonephritis
focal segmental glomerulosclerosis
membranous glomerulonephritis
diabetes nephropathy
amyloidosis

Question 8

types of glomerulonephritis that lead to nephritic syndrome

Answer 8

post-streptococcal glomerulonephritis
ANCA-associated
Alport syndrome
Goodpasture syndrome

Question 9

characterize post-streptococcal glomerulonephritis

Answer 9

occurs after a Group A strep infection
reduced C3-4 in first 6-8 weeks
good prognosis, particularly in children
hypercellular inflamed glomeruli
immunocomplex deposition (sub-epi humps)

Question 10

characterize ANCA associated glomerulonephritis/vasculitis

Answer 10

progresses in weeks to renal failure
can present as acute
serologic marker is ANCA
LM: crescent

Question 11

characterize Alport syndrome

Answer 11

inherited alteration of type IV collagen

LM: thinning and splitting of BM

Question 12

characterize Goodpasture syndrome

Answer 12

rare disease cause by anti-GMB antibodies
IgG: deposition along glomerular capillary loops
LM: fibrin in crescents
IF: linear or diffuse IgG staining
treat w steroids

Question 13

glomerulonephritis that can lead to both nephrotic and nephritic syndrome

Answer 13

membrane proliferative glomerulonephritis
IgA nephropathy
lupus

Question 14

characterize membrane proliferative glomerulonephritis

Answer 14

2 types: Ig+ with chronic antigenemia, and Ig- with alternative complement abnormalities
LM: double contours and lobular hypercellularity
EM: sub endothelial deposits

Question 15

characterize the types of lupus nephropathy

Answer 15

I: no renal involvement
II: mesangial
III and IV: proliferative lupus, nephritic syndrome
v: membranous lupus present with nephrotic syndrome
EM: deposits everywhere, GBM may show dense deposits

Question 16

epidemiology of IgA nephropathy

Answer 16

one of most common forms of glomerulonephritis worldwide
more common in adolescents and young adults
male to female 2-3:1
common in asians

Question 17

signs and symptoms of IgA nephropathy

Answer 17

episodic hematuria after nonspecific URTI or GI or GU infection
henoch schonlein purpura, vasculitis
proteinuria and nephritis syndrome OR heavy proteinuria and nephrotic syndrome

Question 18

pathology of IgA nephropathy

Answer 18

mesangial expansion
deposits of IgA
healing may lead to scerosis

Question 19

pathogenesis of IgA nephropathy

Answer 19

increased polymeric IgA in blood
IgA abnormally glycosylated
IgA trapped in mesangium, causing it to proliferate

Question 20

diagnosis of IgA nephropathy

Answer 20

urine test for blood/urine/casts
blood tests show kidney insufficiency
kidney biopsy to confirm diagnosis

Question 21

treatment of IgA nephropathy

Answer 21

high BP meds
immunosuppressive drugs
omega 3s