glomerulonephritis

Question 1

what is glomerulonephritis?

Answer 1

immune mediated disease of the kidneys affecting the glomeruli (with secondary tubulointerstitial damage)

Question 2

what is the pathogenesis of Glomerulonephritis?

Answer 2

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

Question 3

what is the impact of distruption to the capillary wall in glomerulonephritis?

Answer 3

haematuria and/or proteinuria

Question 4

what happens when endothelial or mesangial cells are damaged in glomerulonephritis?

Answer 4

there is a proliferative lesion and red cells in the urine

Question 5

what happens when podocytes are damaged in glomerulonephritis?

Answer 5

a non-proliferative lesion and protein in the urine

Question 6

how do podocytes respond to injury?

Answer 6

atrophies
loss of size/charge specific barrier

Question 7

what happens when mesangium cells are injured?

Answer 7

they proliferate and release angiotensin II
there is a release of chemokines and it attracks inflammatory cells

Question 8

what happens in endothelial cell injury?

Answer 8

vasculitis

Question 9

how is glomerulonephritis diagnosed?

Answer 9

clinical pres
blood tests
urine examination
-urinalysis: haematuria, proteinuria
- microscopy: RBC
- urine protein: creatinine ratio/24hr urine
kidney biopsy

Question 10

what are the albuminuria indications of glomerulonephritis?

Answer 10

Microalbuminuria (30-300mg albuminuria/day)

Question 11

what are the presenting features of glomerulonephritis?

Answer 11

impaired renal function
hypertension

Question 12

what does nephritic syndrome in glomerulonephritis indicate?

Answer 12

a proliferative process affecting endothelial cells

Question 13

what does nephrotic syndrome in glomerulonephritis indicate?

Answer 13

a non proliferative process affecting podocytes

Question 14

what are the complications of nephrotic syndrome?

Answer 14

infections
renal vein thrombosis
pulmonary emboli
volume depletion

Question 15

what are some causes of glomerulonephritis?

Answer 15

majority are primary disease
some are caused by infections/drugs like penicillin or NSAIDs
some are part of systemic disease eg lupus

Question 16

what are some non-immunosuppressive treatments of glomerulonephritis?

Answer 16

anti hypertensives (target BP<130/80 if proteinuria)
ACEi/ARB
SGLT2i
diuretics
statins
anti coagulants in nephrotic syndrome with profound hypoalbuminaemia

Question 17

what are the immunosuppressive treatments of glomerulonephritis?

Answer 17

corticosteroids
alkylating agents (cyclophophamide)
calcineurin inhibitors (cyclosporin/tacrolimus)
antiproliferatives (azathioprine)
plasmapheresis
antibodies

Question 18

how are nephrotic patients treated?

Answer 18

fluid restriction
salt restriction
diuretics
ACEi/ARB

Question 19

what is the threshold for nephrotic remission?

Answer 19

proteinuria < 300mg/day

Question 20

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

Answer 20

minimal change nephropathy

Question 21

how is minimal change nephropathy treated?

Answer 21

oral steroids
cyclophosphamide 2nd line

Question 22

what is the commonest cause of nephrotic syndrome in adults?

Answer 22

FSGS- focal segmental glomerulosclerosis

Question 23

what is the 2nd commonest cause of nephrotic syndrome in adults?

Answer 23

membranous nephropathy

Question 24

what causes membranous nephropathy?

Answer 24

infections
connective tissue disease
malignancies
drugs (gold/penicillamine)

Question 25

how is membranous nephropathy treated?

Answer 25

steroids/alkylating agents/ B cell monoclonal antibodies

Question 26

what antibody is present in >70% of primary membranous nephropathy?

Answer 26

anti PLA2r antibody

Question 27

what cause membranoproliferative GN?

Answer 27

immune complex deposition and complement activation dysregulation of the alternative complement pathway

Question 28

what is the most common glomerulonephritis worldwide?

Answer 28

IgA nephropathy

Question 29

what are some signs of IgA nephropathy?

Answer 29

asymptomatic microhaematuria macroscopic haematuria after resp/GI infection AKI/CKD associated with HSP

Question 30

how is IgA nephropathy treated?

Answer 30

BP control/ ACEi/fish oil

Question 31

what is rapidly progressing glomerulonephritis?

Answer 31

a treatable immune mediated cause of acute kidney injury

Question 32

what are the signs of rapidly progressive glomerulonephritis?

Answer 32

rapid deterioration active urinary sediment may be part of systemic disease associated with glomerular crescents on biopsy

Question 33

what conditions are associated with rapidly progressive glomerulonephritis?

Answer 33

ANCA assocaited vasculitis

Question 34

how is rapidly progressive glomerulonephritis treated?

Answer 34

start treatment ASAP steroids and cytotoxics (cyclophosphamide) or anti B cell antibody (rituximab) as induction therapy steroids and azathioprine as maintenance for years to prevent relapse