glomerulonephritis

Question 1

what is glomerulonephritis (GN)?

Answer 1

Immune-mediated disease of the kidneys
affecting the glomeruli with secondary tubulointerstitial damage

Question 2

what is the pathogenesis of GN?

Answer 2

• humoral (antibody mediated)
• cell-mediated (T-cells)
• inflammatory cells, mediators and complements

Question 3

what happens in damage to endothelial or mesangial cells and what is the presentation?

Answer 3

proliferative lesion with red cells in urine
endothelium damage = vasculitis

Question 4

what happens in damage to podocytes and what is the presentation?

Answer 4

non-proliferative lesion and protein in urine
cells atrophy, loss of size / charge specific barrier

Question 5

how do you diagnose GN?

Answer 5

• clinical presentation
• blood tests
• urine - urinalysis, urine microscopy, urine protein:creatinine ratio
• kidney biopsy

Question 6

how many mg / day is microalbuminuria?

Answer 6

30-300mg

Question 7

what are the complications of nephrotic syndrome?

Answer 7

infections
renal vein thrombosis
pulmonary emboli
volume depletion - may lead to AKI

Question 8

what are some secondary causes of GN?

Answer 8

infections e.g. HIV, drugs e.g. penicillin, NSAIDs, malignancies, vasculitis

Question 9

what are the histological classifications in GN terminology?

Answer 9

• proliferative or non-proliferative
• focal / diffuse (more or less than 50% of glomeruli affected)
• global or segmental (all or part of glomerulus affected)
• crescentic - prescence of crescents

Question 10

what are the principle aims of GN treatment?

Answer 10

Reduce degree of proteinuria
Induce remission of nephrotic syndrome
Preserve longterm renal function

Question 11

what are the non-immunosuppressive treatments of GN?

Answer 11

• anti-hypertensives (target bp 130/80 if proteinuria)
• aceis / arbs
• sglt2i
• diuretics
• statins
• anticoagulants in nephrotic syndrome with profound hypoalbuminaemia

Question 12

what immunosupressive treatments are used in GN?

Answer 12

• Corticosteroids (Prednisolone po/MethylPred IV)
• Alkylating agents (Cyclophosphamide/ Chlorambucil)
• Calcineurin inhibitors (Cyclosporin/Tacrolimus)
• Anti-proliferatives (azathioprine/MMF)

plasmaphoresis (TPE-therapeutic plasma exchange)

antibodies - IV immunoglobulin, monoclonal antibodies

Question 13

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

Answer 13

minimal change nephropathy
(cannot progress to end stage renal disease)

Question 14

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

Answer 14

focal segmental glomerulosclerosis (FSGS)
can progress to end stage renal failure (50% progress after 10 years)

seen in HIV, heroin use, obesity, reflux nephropathy or genetic

Question 15

what can cause membranous nepthropathy?

Answer 15

2nd most common cause of nephrotic syndrome in adults

primary - anti PLA3r antibody

secondary -
infections (hepatitis B/ parasites)
connective tissue diseases (lupus)
malignancies (carcinomas/ lymphoma)
drugs (gold/penicillamine)

Question 16

what are the 2 primary mechanisms of membranoproliferative GN?

Answer 16

• Immune complex deposition and complement activation.
• Dysregulation of the alternative complement pathway.

Question 17

what is the most common cause of GN globally and what is the cause?

Answer 17

IgA nephropathy
IgA deposited in glomerulus and cause local immune activation and injury

Question 18

what us the treatment of rapidly progressive GN (RPGN)?

Answer 18

strong immunosuppression (steroids and cytotoxics or anti B cell antibody as induction therapy, steroids and azathioprine as maintenance)
supportive treatment