Glomerulonephritis

Question 1

Does focal segmental glomerulonephritis (FSGS) cause nephrotic or nephritic syndrome?

Answer 1

Nephrotic

Question 2

What age does focal segmental glomerulosclerosis most commonly present?

Answer 2

Young adults (20-30)

Question 3

What are the causes of focal segmental glomerulosclerosis?

Answer 3

Idiopathic
Secondary to other renal pathology e.g. IgA Nephropathy, reflux nephropathy
HIV
Heroin
Alport’s syndrome
Sickle-cell

Question 4

What happens in renal transplants in patients with FSGS?

Answer 4

Commonly recurrs

Question 5

What is seen on light microscopy in FSGS?

Answer 5

Focal and segmental sclerosis and hyalinosis on light microscopy

Question 6

What is seen on electron microscopy in FSGS?

Answer 6

Effacement of foot processes

Question 7

What is the management for FSGS?

Answer 7

Steroids and immunosuppressants

Question 8

What is the commonest form of nephrotic syndrome in adults?

Answer 8

FSGS (unsure might be membranous)

Question 9

How can you tell the difference between IgA nephropathy and post-streptococcal glomerulonephritis (AKA diffuse proliferative glomerulonephritis)?

Answer 9

IgA starts a day or two after URTI, whereas post-streptococcal is weeks after infection

Question 10

What are the 4 main features of nephritic syndrome?

Answer 10

Haematuria (microscopic or macroscopic)
Oliguria
Proteinuria (less than 3g/day)
Fluid retention

Question 11

What are the 4 main features of nephrotic syndrome?

Answer 11

Peripheral oedema
Proteinuria >3g/day
Serum albumin <25g/l
Hypercholesterolaemia (due to increased production and decreased metabolism)

Question 12

What is the commonest form of glomerulonephritis in children?

Answer 12

Minimal change disease

Question 13

What is the cause of minimal change disease?

Answer 13

Idiopathic

Question 14

What is the management and prognosis of minimal change disease?

Answer 14

Steroids
Good prognosis

Question 15

What syndromes do post-streptococcal and IgA nephropathy cause?

Answer 15

Nephritic

Question 16

What is the commonest overall glomerulonephritis in adults?

Answer 16

Membranous glomerulonephritis

Question 17

Is membranous glomerulonephritis nephrotic or nephritic?

Answer 17

Nephrotic most common

Question 18

What is the peak incidence of membranous glomerulonephritis?

Answer 18

50-60 years

Question 19

What are the causes of membranous glomerulonephritis?

Answer 19

idiopathic
infections: hepatitis B, malaria, syphilis
malignancy: lung cancer, lymphoma, leukaemia
drugs: gold, penicillamine, NSAIDs
autoimmune diseases: systemic lupus erythematosus (class V disease), thyroiditis, rheumatoid

Question 20

What antibodies are involved in idiopathic membranous glomerulonephritis?

Answer 20

anti-phospholipase A2 antibodies

Question 21

What does membranous glomerulonephritis look like on electron microscopy?

Answer 21

the basement membrane is thickened with subepithelial electron dense deposits. This creates a ‘spike and dome’ appearance

Question 22

What is the management of membranous glomerulonephritis?

Answer 22

ACEI or ARB (reduced proteinuria and improves prognosis)
Combination of steroid and cyclophosphamide in severe or progressive disease (many patients spontaneously improve)
Anticoagulation for high risk patients

Question 23

What is the prognosis for membranous glomerulonephritis?

Answer 23

Prognosis - rule of thirds
one-third: spontaneous remission
one-third: remain proteinuric
one-third: develop ESRF