Glomerulonephritis

Question 1

Chronic glomerulonephritis is the most common cause of end-stage renal failure (chronic kidney disease). True/False?

Answer 1

False

2nd most common, after diabetic nephropathy

Question 2

Glomerulonephritis is caused by infection. True/False?

Answer 2

False

Immune-mediated destruction with secondary tubulointerstitial damage

Question 3

Which aspects of the immune system cause glomerulonephritis?

Answer 3

Antibodies
T-cell mediated
Inflammatory cells, mediators, complement

Question 4

Which part of the glomerulus is disrupted in glomerulonephritis?

Answer 4

Disruption of glomerular basement membrane and/or podocytes, leading to leakage of protein/blood

Question 5

The site and type of injury determines the clinical presentation of glomerulonephritis. Damage to endothelial/mesangial cells leads to what?

Answer 5

Proliferative lesion, causing haematuria

Question 6

The site and type of injury determines the clinical presentation of glomerulonephritis. Damage to podocytes leads to what?

Answer 6

Non-proliferative lesion, causing proteinuria

Question 7

What might be found on urinalysis in glomerulonephritis?

Answer 7

Proteinuria

Haematuria

Question 8

What might be found on urine microscopy in glomerulonephritis?

Answer 8

Dysmorphic RBCs
RBC casts
Lipiduria

Question 9

What ratio is measured over 24 hours to quantify proteinuria?

Answer 9

Urine protein : creatinine ratio

Question 10

What is the definitive investigation for glomerulonephritis?

Answer 10

Kidney biopsy

Question 11

Microalbuminuria is low amounts of albumin in the urine and is an early sign of what?

Answer 11

Diabetic nephropathy

Question 12

How much protein is classed as heavy proteinuria?

Answer 12

1-3 g/day

Question 13

What is meant by “red cell casts”?

Answer 13

Red cells stuck with other cells in a matrix formed by Tamm-Horsfall protein

Question 14

List the components that define nephrotic syndrome

Answer 14

Proteinuria over 3 g/day
Hypoalbuminaemia
Oedema
Hypercholesterolaemia

Question 15

Renal function is usually normal in nephrotic syndrome. True/False?

Answer 15

True

Question 16

List the components that define nephritic syndrome

Answer 16

Acute renal failure
Oliguria
Oedema
Haematuria

Question 17

List the main complications of nephrotic syndrome

Answer 17

Pulmonary emboli
Infection
Renal vein thrombosis
Hypovolaemia

Question 18

The majority of glomerulonephritis is idiopathic. True/False?

Answer 18

True

Question 19

List non-idiopathic causes of glomerulonephritis

Answer 19

Drugs
Malignancy
ANCA-vasculitis
SLE
Goodpasture's syndrome

Question 20

Once renal biopsy is taken, what histological investigations may be done on the biopsy?

Answer 20

Light microscopy
Immunofluorescence
Electron microscopy

Question 21

What is meant by focal and diffuse glomerulonephritis?

Answer 21

Focal = less than 50% glomeruli affected
Diffuse = more than 50% glomeruli affected

Question 22

What is meant by crescentic glomerulonephritis?

Answer 22

Presence of crescents - epithelial cell extra-capillary proliferation

Question 23

What are the principal aims of glomerulonephritis treatment? (RRP)

Answer 23

Reduce proteinuria
Reverse nephrotic syndrome
Preserve renal function

Question 24

What is the target BP for glomerulonephritis with and without proteinuria?

Answer 24

Less than 130/80 if no proteinuria

Less than 120/75 if proteinuria

Question 25

Which class of drug may help control BP in glomerulonephritis?

Answer 25

ACE inhibitors | Also consider diuretics/statins

Question 26

Outline medical management of glomerulonephritis

Answer 26

``` Corticosteroid (prednisolone oral/methylprednisolone IV) Azathioprine Cyclophosphamide Cyclosporin IV immunoglobulin Plasmapharesis ```

Question 27

Outline management of nephrotic syndrome

Answer 27

Fluid + salt restriction Diuretic ACE inhibitor IV albumin if hypovolaemia

Question 28

What is the commonest type of idiopathic glomerulonephritis in children?

Answer 28

Minimal-change nephropathy | normal renal biopsy

Question 29

Which interleukin might be associated with minimal-change nephropathy?

Answer 29

IL-13

Question 30

What is the commonest glomerulonephritic cause of nephrotic syndrome in adults?

Answer 30

Focal segmental glomerulonephritis

Question 31

What is focal segmental glomerulonephritis associated with?

Answer 31

``` HIV Heroin use Obesity Reflux Nephropathy ```

Question 32

What is the 2nd commonest glomerulonephritic cause of nephrotic syndrome in adults?

Answer 32

Membranous nephropathy, involving immune-complex deposition at basement membrane

Question 33

What is membranous nephropathy associated with?

Answer 33

Infection (hep B) CTDs Malignancy Drugs - gold, penicillamine

Question 34

Which antibody is present in over 70% of primary membranous nephropathy?

Answer 34

Anti-PLA2r antibody

Question 35

What is the commonest type of glomerulonephritis in the world?

Answer 35

IgA nephropathy involving mesangial proliferation with IgA deposits

Question 36

Which skin condition is associated with IgA nephropathy?

Answer 36

Henoch-Schonlein Purpura

Question 37

Rapidly progressive glomerulonephritis involves rapid deterioration in renal function over days/weeks. What are the 2 main classifications and their causes?

Answer 37

ANCA-positive (vasculitis - GPA/MPA) | ANCA-negative (Goodpasture's, Henoch-Schonlein, SLE)

Question 38

Which antibody is associated with Goodpasture's disease?

Answer 38

Anti-GBM (anti-glomerular-basement-membrane)