Glomerulonephritis

Question 1

Specific types of glomerulonephritis:

Answer 1

• Minimal change disease
• Focal segmental glomerulosclerosis
• Membranous glomerulonephritis
• IgA nephropathy (AKA mesangioproliferative glomerulonephritis or Berger’s disease)
• Post streptococcal glomerulonephritis (AKA diffuse proliferative glomerulonephritis)
• Mesangiocapillary glomerulonephritis
• Rapidly progressive glomerulonephritis
• Goodpasture Syndrome

Question 2

General treatments for patients with glomerulonephritis:

Answer 2

Most types of glomerulonephritis treated with:
- Immunosuppression (e.g. steroids)

• Blood pressure control by blocking the renin-angiotensin system (i.e. ACE inhibitors or angiotensin-II receptor blockers)

Question 3

Most common cause of nephrotic syndrome in children: - +treatment

Answer 3

Minimal change disease (idiopathic - no identifiable cause)

Treated successfully with steroids

Question 4

Most common cause of nephrotic syndrome in adults:

Answer 4

focal segmental glomerulosclerosis

Question 5

IgA nephropathy:

Answer 5

AKA Berger’s disease

• Most common cause of primary glomerulonephritis (not caused by another disease)
• Peak age at presentation is 20s

Question 6

Histology finding in Berger’s disease:

Answer 6

AKA - IgA nephropathy

‘IgA deposits and glomerular mesangial proliferation’

Question 7

Most common type of glomerulonephritis overall:

Answer 7

Membranous glomerulonephritis

Question 8

Membranous glomerulonephritis age of presentation

Answer 8

There is a bimodal peak in age in the 20s and 60s

Question 9

Membranous glomerulonephritis histology findings:

Answer 9

Histology shows “IgG and complement deposits on the basement membrane”

Question 10

Membranous glomerulonephritis - causes:

Answer 10

The majority (~70%) are idiopathic

Can be secondary to malignancy, rheumatoid disorders and drugs (e.g. NSAIDS)

Question 11

Post streptococcal glomerulonephritis

Answer 11

(AKA diffuse proliferative glomerulonephritis)

Patients are typically under 30

Presents as:

• 1-3 weeks after a streptococcal infection (e.g. tonsillitis or impetigo)
• They develop a nephritic syndrome
• There is usually a full recovery

Question 12

Goodpastures syndrome:

Answer 12

Anti-GBM (glomerular basement membrane) antibodies attack glomerulus and pulmonary basement membranes.

This causes glomerulonephritis and pulmonary haemorrhage.

In your exam, there may be a patient that presents with acute kidney failure and haemoptysis (coughing up blood).

Question 13

What to think in patient with acute renal failure and haemoptysis:

Answer 13

think of two conditions: Goodpasture syndrome and granulomatosis with polyangiitis (AKA Wegener’s granulomatosis).

• Goodpasture syndrome is associated with anti-GBM antibodies,
• whereas Wegener’s granulomatosis is a type of vasculitis associated with anti-neutrophil cytoplasmic antibodies (ANCA).

Patients with Wegener’s granulomatosis may also have a wheeze, sinusitis and a saddle-shaped nose.

Question 14

Polyangiitis (Wegener’s granulomatosis)

Answer 14

type of vasculitis associated with anti-neutrophil cytoplasmic antibodies (ANCA).

Patients with Wegener’s granulomatosis may also have a wheeze, sinusitis and a saddle-shaped nose.

Question 15

Rapidly progressive glomerulonephritis - finding on histology

Answer 15

“crescentic glomerulonephritis”

Question 16

Presentation of Rapidly Progressive Glomerulonephritis:

Answer 16

It presents with a very acute illness with sick patients but it responds well to treatment

Often secondary to Goodpasture syndrome