glomerular disease

Question 1

focal

Answer 1

some but not all the glomeruli contain the lesion

Question 2

diffuse (global)

Answer 2

most of the glomeruli contain the lesion

Question 3

segmental

Answer 3

only a part of the glomerulus is affected (most focal lesions are also segmental)

Question 4

the presence of some form of glomerular disease, as opposed to tubulointerstitial or vascular disease is usually suspected from the hx and from one or more of the following findings:

Answer 4

urinary: haematuria, red cell casts, proteinuria

pt will likely have inc BP

Question 5

symptoms nephrotic syndrome

Answer 5

massive proteinuria
hypoalbuminaemia
oedema
lipiduria
hyperlipidaemia

Question 6

symptoms acute glomerulonephritis (acute nephritic syndrome)

Answer 6

abrupt onset of haematuria with casts or dysmorphic red cells
non nephrotic range proteinuria
oedema
HTN
transient renal impairment

Question 7

symptoms rapidly progressive glomerulonephritis

Answer 7

features of acute nephritis
focal necrosis with or without crescents
rapidly progressive renal failure over weeks

Question 8

what happens in nephrotic syndrome

Answer 8

there is massively increased filtration of macromolecules across the glomerular capillary wall due to structural and functional abnormalities of the glomerular podocytes

Question 9

signs nephrotic syndrome

Answer 9

Loss of protein through the kidneys (proteinuria) leads to low protein levels in the blood (hypoalbuminemia), which causes water to be drawn into soft tissues (oedema).

Question 10

investigations nephrotic syndrome

Answer 10

to monitor progress: eGFR, urinary protein, U+E, serum albumin
diagnosis: urine microscopy - red cell casts = glomerulonephritis
culture swan from throat/skin = diagnosis of recent strep infec
renal biopsy

Question 11

management nephrotic syndrome - general

Answer 11

oedema - dietary salt restriction & thiazide diuretic e.g. bendroflumethiazide followed by furosemide
proteinuria - ACEi / angiotensin II receptor antagonists
prolonged bed rest avoided & LT prophylactiv anticoag due to thrombotic tendency

Question 12

management nephrotic syndrome - specific

Answer 12

rx of underlying disease eg SLE
only severe cases receive specific rx as high rate of spontaneous recovery
rx is w cyclophosphamide - immunosuppressive therapy or chlorambicil w prednisolone

Question 13

complications nephrotic syndrome

Answer 13

venous thrombosis - loss of clotting factors in the urine
sepsis - loss of immunoglobulin in the urine
AKI due to hypovolaemia (rather than the underlying renal disease)

(SAT- sepsis, AKI, thrombosis)

Question 14

Aetiology acute glomerulonephritis (acute nephritic syndrome)

Answer 14

often caused by an immune response triggered by an infection or other disease. Diseases commonly associated:
post strep 
staphylococcus, mumps, hep b/c
infective endocarditis
oliguria 
uraemia
SLE

Question 15

symptoms nephritic syndrome

Answer 15

AKI
acute and rapid deterioration in kidney function & an active dipstick - haematuria/proteinuria
HTN and fluid overload

Question 16

investigations nephritic syndrome

Answer 16

As for nephrotic syndrome
to monitor progress: eGFR, urinary protein, U+E, serum albumin
diagnosis: urine microscopy - red cell casts = glomerulonephritis
culture swan from throat/skin = diagnosis of recent strep infec
renal biopsy

Question 17

management nephritic syndrome

Answer 17

post strep glomerulonephritis = gd prog, just supportive rx
HTN rx w salt restriction & loop diuretics / vasodilators
in glomerulonephritis complicating SLE or the systemic vasculitides immunosuppression with prednisolone improved renal func

Question 18

causes of rapidly progressive glomerulonephritis

Answer 18

acute nephritic syndrome
antiglomerular basement membrane disease
antineutrophilic cytoplasmic antibody associated vasculitis

(triple AAA!!!)

Question 19

big difference nephrotic and nephritic syndrome

Answer 19

nephrotic syndrome involves the loss of a lot of protein, whereas nephritic syndrome involves the loss of a lot of blood.

Question 20

IgA nephropathy

Answer 20

Abnormality in IgA glycosylation = mesangial deposition
can present as nephritic, nephrotic, asymptomatic or as progressive CKD
rx = supportive and immunosuppression if aggressive