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Nephrology > Glomerulonephritis > Flashcards

Glomerulonephritis Flashcards

1
Q

What is the definition of nephrotic syndrome?

A

Proteinuria >3.5g/24 hours
Hypoalbuminaemia <30g/L
Peripheral oedema

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2
Q

What is the definition of nephritis syndrome?

A

Haematuria
Hypertension
Oliguria

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3
Q

What are the potential causes of nephrotic syndrome?

A 
Minimal change disease
Focal segmental glomerulonephropathy
Membranous glomerulonephropathy
Thin basement membrane disease
Fibronectin glomerulonephropathy
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4
Q

What are the potential causes of nephritic disease?

A 
IgA nephropathy
Goodpastures syndrome
Membranoproliferative glomerulonephropathy
Post-infectious glomerulonephropathy
Granulomatosis with polyangiitis
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5
Q

What are the specific complications associated with nephrotic syndrome?

A

Thromboembolism

Risk of infection

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6
Q

What are the potential complications of glomerulonephropathy?

A 
Risk of infection
Hypervolaemia
Hypertension
Hypercholesterikaemia
Hypercoagulability
CV disease
AKI
CKD
End stage renal disease
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7
Q

What is Rapidly progressive glomerulonephritis?

A

Acute nephritic syndrome alongside formation of crescents (due to the thrombosis and rupture of glomerular capillaries compressing surrounding glomerular structures)

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8
Q

What age group of patients is most likely to have rapidly progressing glomerulonephritis?

A

20 - 50 years

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9
Q

What investigations should be conducted for glomerulonephritis?

A

Bloods - U&Es, glucose, ANA, anti-dsDNA, ANCA, complement, Hep B/C, HIV, paraprotein, anti-GBM antibodies, anti-steptolysin O antibody,

Urinalysis - protein, blood
Urine protein creatinine ratio
Urine microscopy
Renal ultrasound

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10
Q

What management strategies form part of the basic treatment of glomerulonephritis?

A

ACEi/ARB
VTE prophylaxis
Fluid / salt restriction or sometimes diuretics
Treatment of the underlying cause

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11
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal change disease

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12
Q

What findings will be seen on immunofluorescence, light microscopy and electron microscopy in minimal change disease?

A

Immunofluoresence and light microscopy - unremarkable

Electron microscopy - fusion of podocyte foot processes

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13
Q

How is minimal change disease managed?

A

Nutritional support
Salt and fluid restriction
Corticosteroids
If steroids fail, rituximab

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14
Q

What findings will be seen on immunofluorescence, light microscopy and electron microscopy in focal segmental glomerulosclerosis?

A

Immunofluoresence and light microscopy - unremarkable

Electron microscopy - segmental scarring of certain glomeruli and fusion of podocyte fusion processes

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15
Q

What is the management official segmental glomerulosclerosis?

A

Generally supportive

Steroids in some patients

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16
Q

What are the potential causes of focal segmental glomerulosclerosis?

A

Primary - genetic mutations

Secondary - HIV, lupus, reflux nephropathy

17
Q

What is the most common cause of nephrotic syndrome in adults?

A

Focal segmental glomerulosclerosis

18
Q

What age group of patients are most commonly affected by membranous glomerulonephritis?

A

Age 30-50 years

19
Q

What are the potential causes of membranous glomerulonephritis?

A

Idiopathic
Hep B
Malaria
Lupus

20
Q

What findings will be seen on immunofluorescence, light microscopy and electron microscopy in membranous glomerulonephritis?

A

Microscopy - thickening glomerular basement membrane

Immunofluorescence - diffuse uptake of IgG

21
Q

How is membranous glomerulonephritis managed?

A

Steroids for progressive disease

Supportive care

22
Q

What is the most common type of nephritic syndrome in adults?

A

IgA nephropathy

23
Q

How long after an upper respiratory tract infection does IgA nephropathy usually present?

A

24-48 hours

24
Q

What findings will be seen on immunofluorescence, light microscopy and electron microscopy in IgA nephropathy?

A

Microscopy - increase numbers of mesangial cells

Immunohistochemistry - IgA deposition within mesangial cells

25
Q

What is the management of IgA nephroapthy?

A

Supportive care
Steroids
Immunosuppressants in some cases

26
Q

How long after upper respiratory tract infection does post-strep glomerulonephritis usually present?

A

2 weeks later

27
Q

What investigations findings are typically seen in post-strep glomerulonephritis?

A

Diffuse proliferative and exudative glomerular histology
Dominant C3 staining and subepithelial humps
Raised serum strep titres

28
Q

What is the management of post-strep glomerulonephritis?

A

Mostly supportive (it is usually self-limiting)

29
Q

What conditions are associated with membranoproliferazive glomerulonephritis?

A

Hep C

Autoimmune disease e.g. SLE

30
Q

What investigations findings are typically seen in membranoproliferative glomerulonephritis?

A

Thickening basement membrane and mesangium
Tram tracking appearance
Subendothelial deposition of IgG

31
Q

How is membranoproliferative glomerulonephritis managed?

A

Steroids in children

Antiplatelets in adults

32
Q

What respiratory complications can occur in Goodpasture’s syndrome?

A

Pulmonary haemorrhage

33
Q

What investigations findings are typically seen in goodpastures syndrome?

A

Serum anti-GBM antibodies

IgG deposits along basement membrane on immunohistochemistry

34
Q

How is good pastures syndrome managed?

A

High dose immunosuppression - steroids and cyclophosphamide +/- plasmapheresis

35
Q

What investigations findings are typically seen in granulomatosis with polyangiitis?

A

Positive c-ANCA

Leukocytoclastic vasculitis with necrosis and granulomatous inflammation

36
Q

How is granulomatosis with polyangiitis managed?

A

Immunosupression induction with high dose steroids and Rituximab / cyclophosphamide
Maintenance therapy - steroids, methotrexate

37
Q

What investigations findings are typically seen in microscopic polyangiitis?

A

Positive p-ANCA antibodies

Anaemia

38
Q

How is microscopic polyangiitis managed?

A

Long term steroids / cyclophosphamide

Nephrology (5 decks)

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