glomerular disease

Question 1

what happens to the glomerulus in nephrotic syndrome

Answer 1

basement membrane becomes very permeable to protein and protein leaks into the urine

Question 2

presentation of nephrotic syndrome

Answer 2

proteinuria
hypoalbuminemia
oedema

can also have hypertension, hypercoagulability, hyperlipidaemia

Question 3

general management of nephrotic syndrome

Answer 3

high dose steroids
low salt diet
diuretics
albumin infusions if needed

Question 4

what is the most common cause of nephrotic syndrome

Answer 4

minimal change disease

Question 5

how does minimal change disease present

Answer 5

usually presents after an illness like gastroenteritis
oedema ascites
small pleural effusions

Question 6

investigations in minimal change disease

Answer 6

bloods for low albumin <12mg/mmol

urine dipstick -

Question 7

what will a urine dipstick in minimal change disease show

Answer 7

protein 3+

blood 2+

Question 8

management of minimal change disease

Answer 8

prednisolone for 8 weeks

Question 9

what should you use if the minimal change disease relapses >4x a year

Answer 9

immunosuppressants

• cyclosporin
• tacrolimus
• rituximab

Question 10

if the minimal change disease is not responding to steroids what other diagnosis should you consider

Answer 10

focal segmental glomerulosclerosis

Question 11

is focal segmental glomerulosclerosis nephritic or nephrotic

Answer 11

nephrotic

Question 12

what age group is most likely to be effected by focal segmental glomerulosclerosis

Answer 12

young adults

Question 13

what can cause FSG

Answer 13

HIV
alport’s syndrome
sickle cell anaemia

Question 14

investigations for FSG

Answer 14

renal biopsy

Question 15

management of FSG

Answer 15

ACEi/BP control
supportive
may need transplant

Question 16

what is Alport syndrome

Answer 16

congenital X linked defect in type IV collagen

Question 17

what group does alports syndrome normally affect

Answer 17

young males

Question 18

pathophysiology of alports syndrome

Answer 18

defect in type IV collagen causes a defective GBM

Question 19

presentation of alport’s syndrome

Answer 19

microscopic haematuria
progressive renal failure
bilateral sensineural deafness

Question 20

management of alports

Answer 20

transplant

Question 21

what is nephritic syndrome

Answer 21

inflammation in nephrons

Question 22

presentation of nephritic syndrome

Answer 22

haematuria
less proteinuria than in nephrotic syndrome
reduced kidney function

Question 23

pathogen in post infectious glomerulosclerosis

Answer 23

usually group A strep

Question 24

pathophysiology of post infectious glomerulosclerosis

Answer 24

strep antigens deposit in glomerulus and antibodies form complexes
initiates immune response in kidney resulting in tissue injury
nephritis

Question 25

investigations in post infectious glomerulonephritis

Answer 25

throat swab for tonsillitis

blood test for antibodies

Question 26

management of post-infectious glomerulonephritis

Answer 26

it is self limiting so most of the time it just needs supportive management
antibiotics if needed
diuretics and anti-hypertensives to stop overload

Question 27

pathophysiology of IgA nephropathy

Answer 27

immune complex formation in circulation

complexes deposit in the kidneys and cause inflammation and injury

Question 28

presentation of IgA nephropathy

Answer 28

nephritic syndrome
1-2 days after UTI
older children

Question 29

biopsy results in IgA nephropathy

Answer 29

IgA deposits and glomerular mesangial proliferation

Question 30

urine dipstick findings in IgA nephropathy

Answer 30

macroscopic haematuria

proteinuria

Question 31

management of IgA nephropathy

Answer 31

ACEi in mild disease
supportive treatment
immunosuppression - cyclophosphamide
steroids

Question 32

what is henoch-schonlein purpura

Answer 32

a variant of IgA nephropathy

Question 33

pathophysiology in HSP

Answer 33

small vessel vasculitis with IgA deposits

Question 34

presentation of HSP

Answer 34

5-15 year olds
1-3 days after a trigger like URTI
purpuric rash with 1 of:
- abdominal pain
- arthritis or arthralgia 
- renal involvement 
- biopsy showing HSP

Question 35

biopsy findings in HSP

Answer 35

IgA deposits

glomerular mesangial proliferation

Question 36

management of HSP

Answer 36

treat symptoms
glucocorticoids for GI involvement
immunosuppression with cyclophosphamide

Question 37

what should be screened for long term in HSP

Answer 37

hypertension

proteinuria