Glomerular Disease

Question 1

What is the difference between non- proliferative and proliferative glomerulonephritis?

Answer 1

Proliferative is congested due to excessive numbers of cells in glomeruli.
Non-proliferative is not congested

Question 2

What are the different types of proliferative glomerulonephritis?

Answer 2

Diffuse proliferative
Focal proliferative
Focal necrotising (crescentic)
Membrane-proliferative

Question 3

What is the microbiological cause of diffuse glomerulonephritis?

Answer 3

Lancefield group A streptococci

Question 4

What is the treatment for post-infective glomerulonephritis?

Answer 4

Antibiotics for infection
Loop diuretics for oedema
Vasodilator drugs for hypertension
Possibly immunosuppression in severe cases

Question 5

What is the presentation of acute nephritis?

Answer 5

Fluid retention with oedema 
Normal serum albumin 
Little proteinuria 
Hypertension 
Renal impairment

Question 6

What is the main presentation of IgA nephropathy?

Answer 6

Macroscopic haematuria

Question 7

What causes focal proliferative nephritis?

Answer 7

Mesangial IgA disease

Question 8

What is the treatment for IgA nephropathy?

Answer 8

Ace inhibitors and other hypotensives

Question 9

What are the 3 main settings under which focal narcotising glomerulonephritis can occur?

Answer 9

Presence of anti-glomerular basement membrane antibodies
Associated with systemic vasculitis
Complication of other types of glomerulonephritis

Question 10

How is good pastures disease diagnosed?

Answer 10

Anti-GBM antibodies in serum and kidney

Question 11

What is the management of good pastures disease?

Answer 11

Plasma exchange and immunosuppression

Question 12

How is crescentic glomerulonephritis managed?

Answer 12

Immunosuppression (prednisolone)

Question 13

What are the different types of non proliferative glomerulonephritis?

Answer 13

Minimal change disease
Focal glomerulonephritis
Membranous nephropathy

Question 14

What do all types of non proliferative glomerulonephritis cause?

Answer 14

Nephrotic syndrome

Question 15

What is the clinical triad of nephrotic syndrome?

Answer 15

Pitting oedema
Proteinuria
Hypoalbuminaemia

Question 16

What is the definition of nephrotic syndrome?

Answer 16

Severe oedema caused by hypoalbuminia due to loss of protein in the urine

Question 17

What are the additional features of nephrotic syndrome?

Answer 17

Hyperlipidaemia
Hypercoaguable state
Increased risk of infection, especially pneumococcus

Question 18

What is the differential diagnosis for nephrotic syndrome?

Answer 18

Congestive heart failure

Hepatic disease

Question 19

How is oedema treatment within nephrotic syndrome?

Answer 19

Fluid and sodium restriction
Normal to high protein diet
Loop diuretics
Infusion of albumin with loop diuretics for resistant oedema

Question 20

What prophylaxis is given against complications in nephrotic syndrome?

Answer 20

Penicillin V

Heparin

Question 21

What is minimal change nephrotic syndrome?

Answer 21

Sudden onset of oedema accompanies by complete loss of protein with steroids

Question 22

What is the treatment for minimal change nephrotic syndrome?

Answer 22

Prednisolone

Question 23

What are the complications of steroid responsive nephrotic syndrome?

Answer 23

Bacterial infection, especially with pneumococcus

Thrombosis

Question 24

What are the clinical features of focal gloemrulosclerosis?

Answer 24

Severe nephrotic syndrome

Disabling symptoms

Question 25

What is the treatment for focal glomerulosclerosis?

Answer 25

Initial trial of steroids

Cyclophosphamide or cyclosporin if steroids fail

Question 26

What is the treatment for membranous nephropathy?

Answer 26

Control nephrotic symptoms

Immunosuppression (prednisolone and chrorambucil alternating for 6 months)