Glomerulonephritis

Question 1

What are the three most common causes of chronic renal failure?

Answer 1

1. Diabetes
2. Glomerulonephritis
3. Hypertension

Question 2

How is acute renal failure defined?

Answer 2

By azoteamia / uraemia.

Azoteamia = Rapid rise in serum creatinine over days to weeks

Uraemia = When it becomes symptomatic

Question 3

How is chronic renal failure defined?

Answer 3

Gradual rise in serum urea/creatitine over months to years.

Question 4

What signs accompy chronic renal failure?

Answer 4

• Lethargy
• Anorexia
• SOB
• Oedema

Question 5

Causes of renail failure can be pre-renal, renal or post-renal. What do these means and give two examples of each.

Answer 5

Pre-renal - impaired renal perfusion

• Hypovolemia
• Heart failure

Renal - damage to glomeruli, tubules.

• Glomerulonephritis
• Vasculitis

Post-renal - obstruction of urinary outflow

• Stones
• Tumour

Question 6

Symptomatic differences between nephrotic syndrome and nephritic syndrome

Answer 6

Nephrotic - 5 core presentations

• Proteinuria >3.5g/24hr
• Hypoalbuminaemia
• Peripheral oedema
• Hyperlipidaemia
• Lipiduria

Nephritic

• Haematuria
• Mild proteinuria
• Azotaemia/Uraemia
• Oliguria
• Hypertension

Question 7

What is the term given to the subset of nephritic syndrome with a rapid and severe rise in serum urea/creatinine?

Answer 7

Rapidly progressive glomerulonephritis (RPGN).

Usually due to crescentic glomerulonephritis.

Question 8

Underlying pathology behind nephrotic syndrome?

Answer 8

Glomerular capillaries become leaky, causing proteins to leak into urine.

Question 9

Two types of pathogenesis of glomerulonephritis

Answer 9

1. Immuno complex mediated GN (ICMGN)
2. Structural - podocytopathy

Question 10

What is the underlying pathology of ICMGN?

Answer 10

Deposition of immune complexes in the glomerulus attracts inflammation.

Question 11

Diagnosis of ICMGN?

Answer 11

Core biopsy

• Light microscopy
• Immunofluorescence
• Electron microscopy

Question 12

What is the underlying pathology of minimal change disease, and how does it present?

Answer 12

Structural abnormality = podocytopathy

Presents with nephrotic syndrome.

Question 13

Underlying pathology of membranous nephropathy and how does it present?

Answer 13

ICMGN

Presents with nephrotic syndrome.

Question 14

Underlying pathology of focal segmental glomeruloscerlsis (FSG) and how does it present?

Answer 14

Structural abnormality - podocytopathy

Presents with nephrotic syndrome.

Question 15

Most common cause of nephrotic syndrome in adults

Answer 15

FSGS - focal segmental glomerulosclerosis.

Question 16

Underlying pathology of post-infectious glomerulonephritis.

Answer 16

Always secondary to infection - Group A beta-haemolytic streptococcus pyogenes immune complexes.

Thus, ICMGN.

Question 17

What is the most common cause of GN worldwide?

WHat is the underlying pathogenesis?

Answer 17

IgA nephropathy

• ICMGN

Question 18

What is the underlying pathology behind rapidly progressive GN?

Answer 18

Cresentic glomerulonephritis - a histological pattern.

Involves rupture of capillaries in the glomerulus, resulting in proliferation of epithelial cells and subsequent occlusion

Prevents urine formation

Question 19

How must RPGN be treated?

Answer 19

Immediately - will progress to chronic renal failure in weeks.

Question 20

Three types of causes of crescentic glomerulonephritis?

Answer 20

Type 1 = Anti-glomerular basement membrane disease (autoantibodies to glomerular basement membrane collagen)

Type 2 = ICMGN

Type 3 = Pauci-immune GN - small vessel vasculities.