glomerulonephritis

Question 1

glomerulus

Answer 1

capillary network in the renal corpuscle that filters blood across capillary walls to Bowman’s capsule

Question 2

nephritic syndrome

Answer 2

active glomerular inflammation with the presence of:
RBCs and RBC casts
protein in urine <3.5 
HTN 
decline in kidney function

Question 3

nephritic syndrome urinalysis findings

Answer 3

hematuria
acanthocytes
RBC casts
Proteinuria <3.5g/day

Question 4

what are acanthocytes? why do they form?

Answer 4

dysmorphic RBC that looks like Mickey Mouse

form because of osmotic stress in the tubules

Question 5

what does the presence of dysmorphic RBCs in urine mean?

Answer 5

indicate glomerular bleeding due to damage of the basement membrane

Question 6

nephritic syndrome general pathophys

Answer 6

inflammatory response in glomeruli leads to basement membrane damage
=leakage of proteins and RBCs through porous membrane and decreased GFR

Question 7

ANCA

Answer 7

anti-neutrophil cytoplasmic antibodies

Question 8

what would make ANCA positive on blood work?

Answer 8

glomerulonephritis due to vasculitis

Question 9

C-ANCA

Answer 9

autoantibody against proteinase 3

Question 10

P-ANCA

Answer 10

autoantibody again myeloperoxidase

Question 11

what is RPGN

Answer 11

rapidly progressive glomerulonephritis

• rapidly declining kidney function due to rapid destruction of glomeruli
• will rapidly progress to end stage renal disease

Question 12

glomerular disease can either present as ____ or ____

Answer 12

nephritic or nephrotic syndrome

“itis” of the glomerulus

Question 13

podocytes

Answer 13

cells that form the epithelial layer of Bowmans capsule, they have foot processes to help with filtration

Question 14

most important initial test to diagnose glomerular disease

Answer 14

urinalysis

Question 15

in the glomerulus blood enters via the ____ and exits via the ______

Answer 15

afferent arteriole

efferent arteriole

Question 16

disease that shows crescent formation on biopsy

Answer 16

RPGN

Question 17

what causes crescent formation

Answer 17

fibrin and plasma protein depositions cause Bowmans capsule to collapse and look like a crescent

Question 18

gold standard to definitively diagnose glomerular disease

Answer 18

kidney biopsy

Question 19

most common cause of acute glomerulonephritis

Answer 19

IgA nephropathy (Berger disease)

Question 20

IgA nephropathy (Berger disease) commonly affects who

Answer 20

young males

Question 21

IgA nephropathy (Berger disease) is triggered by

Answer 21

URI or GI infection (mucosal infections)

Question 22

IgA nephropathy (Berger disease) pathophys

Answer 22

increased number of defective IgA antibodies are made and form immune complexes that are deposited in the glomerulus and lead to inflammation

Question 23

post infectious GN is most common after___

Answer 23

10-14 days post group A Streptococcus infection

skin or pharyngeal strep

Question 24

IgA nephropathy diagnosis

Answer 24

kidney biopsy showing IgA mesangial deposits on immunostaining

Question 25

poststreptococcal diagnosis

Answer 25

kidney biopsy showing granular sub epithelial immune complex depositions of IgG, IgM, C3 along the GBM "starry sky" appearance

Question 26

Membranoproliferative GN (MPGN) usually occurs due to

Answer 26

SLE, HCV, HBV forming immune complexes that damage glomeruli

Question 27

type 1 Membranoproliferative GN (MPGN) what is it and what does it show on kidney biopsy?

Answer 27

immunoglobulin mediated MPGN | sub endothelial IgG immune complexes on GBM

Question 28

Type II Membranoproliferative GN (MPGN) what is it and what does it show on kidney biopsy?

Answer 28

Complement-mediated MPGN | intra-membranous C3 deposits on GBM

Question 29

immune complex GN that presents as a mixed nephritic-nephrotic picture

Answer 29

MPGN, lupus nephritis too

Question 30

mutation in gene encoding type IV collagen

Answer 30

Alport Syndrome

Question 31

X-linked dominant autosomal recessive immune complex GN

Answer 31

alport syndrome

Question 32

MPGN has ____ C3 serum levels and ____ C4

Answer 32

low | normal

Question 33

3 main categories of RPGN

Answer 33

Immune Complex GN Pauci-immune GN Goodpasture's (AntiGBM disease)

Question 34

lupus nephritis pathophys

Answer 34

immune complexes deposit in glomeruli and cause damage | very dangerous and can lead to death in lupus pts

Question 35

anti-GBM antibody disease (Goodpasture syndrome) pathophys

Answer 35

A type of RPGN that forms autoantibodies directly against collagen type IV in the GBM of the kidney and lung alveoli

Question 36

presents with AGN and hemoptysis

Answer 36

goodpasture syndrome

Question 37

IgA nephropathy/proteinuria treatment

Answer 37

ACE inhibitors +/- corticosteroids

Question 38

lupus nephritis treatment

Answer 38

immunosuppression with cyclophosphamide | +/- corticosteroids

Question 39

anti-GBM treatment (Goodpasture)

Answer 39

plasmapheresis

Question 40

renal biopsy findings for Goodpasture

Answer 40

IgG deposits in GBM (also in lungs)

Question 41

types of Pauci immune GN

Answer 41

Granulomatosis with polyangiitis Microscopic Polyangiitis Churg-Strauss

Question 42

Pauci-immune GN features

Answer 42

no immune complexes deposited | + ANCA antibodies

Question 43

has a + P-ANCA

Answer 43

microscopic polyangiitis | P like puny, like microscopic

Question 44

has a positive C-ANCA

Answer 44

granulomatosis with polyangiitis (Wegener's) (C like cheesy granuloma)

Question 45

what makes a nephritic/nephrotic picture?

Answer 45

hematuria and proteinuria >3.5 g / day

Question 46

Alport has ___ C3 and ___ C4

Answer 46

normal normal

Question 47

Anti-GBM has ___ C3 and ___ C4

Answer 47

normal | normal

Question 48

lupus nephritis has ___ C3 and ___ C4

Answer 48

low | low

Question 49

acute presentation, often have pulmonary renal syndrome

Answer 49

RPGN pts