Glomerular disease clinical

Question 1

What is the most common glomerular disease in children?

Answer 1

Minimal change disease

Question 2

Describe a nephritic state

Answer 2

Inflammatory infiltration by mesangial cells.
Haematuria
Hypertension
Excess numbers of cells in golmeruli will be seen under microscope.

e.g IgA nephropathy

Question 3

Describe a nephrotic syndrome

Answer 3

Non-poliferative, destruction/damage of podocytes
Proteinuria >3.5g/day or 350mg/mmol creatinine
Low serum albumin (<35g/l)
Oedema
Under microscope glomeruli will look normal but with some scarring

Can have IgG involvement

Question 4

How do you investigate glomerular disease?

Answer 4

Blood test

Renal biopsy

Question 5

How does glomerular disease present?

Answer 5

Haematuria - visable, microscopic or dipstick positive
Discoloured or frothy urine
oedema
Tiredness

Question 6

What organism commonly causes post-infectious glomerulonephritis?

Answer 6

Lancefield group A sterptococci

Question 7

What can cause crescentic glomerulonephritis?

Answer 7

This is when a crescent forms in the glomerulus due to mass poliferation which squashes the glomerulus.
Can be caused by:
Anti- neutrophil cytoplasmis antibody (ANCA) associated conditions (microscopoc polyangitis, granulomatosis with polyangitis, eosinophilic granulomatosis with polyangitis.
IgA
SLE
anti-glomerular basement membrane (GBM)

Question 8

How does Goodpasture’s syndrome present?

Answer 8

Nephritis + lung haemorrhage
anti-GBM positive
Haematuria and haemoptysis
Peaks on 3rd, 6th and 7th decade
Treat with aggressive immune suppression, steroids, plasma exchange and cyclophosphamide

Question 9

What are the 3 main non-poliferative glomerulonephritis conditons?

Answer 9

Minimal change disease
Focal and segmental glomerulonephritis
Membranous nephropathy

Question 10

What are the 3 main non-poliferative glomerulonephritis conditons?

Answer 10

Minimal change disease
Focal and segmental glomerulosclerosis
Membranous nephropathy

Question 11

What is the general treatment for nephrotic syndromes?

Answer 11

Treat oedema- salt+fluid restrictions and loop diuretics
hypertension- renin-angiotensin-aldosterone blockade
Risk of thrombosis- heparin or warfarin
Risk of infection-pneumococcal vaccine
Treat dyslipidemia- statins

Question 12

How is minimal change disease treated?

Answer 12

Prednisolone for 16 weeks
Taper over 6 months once in remission
Initial relapse treat with steroids
Then subsequent relapses treat with: cyclophosphamide, cyclosporin, tacrrolimus, rituximab
Despite relapse prognosis is good

Question 13

How does focal and segmental glomerulosclerosis get treated?

Answer 13

General measures (diruetics, warfarin,statins ect), with trail of steroids, but often is steroid resistant.
Alternative options: cyclosporin, cyclophosphamide, rituximab.

Question 14

How does membranous nephropathy present?

Answer 14

This is the commonest nephrotic syndrome in adults.
Proteinuria, high urine creatinine
Low serum albumin
May be secondarily caused by:
malignancy, SLE, rheumatoid arthritis, drugs (e.g. NSAIDs)
May be anti-phospholipase A2 receptor (PLA2R) positive

Question 15

How is membranous nephropathy treated?

Answer 15

Immune suppression.
Cyclophosphamide and steroids alternated for 6 months
Tacrolimus
Rituxmiab
General measures (warfarin, diuretics, statins ect)

Question 16

How is membranous nephropathy treated?

Answer 16

Immune suppression.
Cyclophosphamide and steroids alternated for 6 months
Tacrolimus
Rituxmiab
General measures (warfarin, diuretics, statins ect)

Prognosis is good for those whose proteinuria resolves. 25% will be on dialysis at 10 years though.