glomerulonephritis

Question 1

• terms used to describe histologically the number of glomeruli affected in a given condition:

Answer 1

diffuse: majority of glomeruli abnormal (>50%)
focal: some glomeruli affected

Question 2

terms used to describe histologically the extent to which individual glomeruli are affected in a given condition:

Answer 2

ƒ global: entire glomerulus abnormal

ƒ segmental: only part of the glomerulus abnormal

Question 3

proliferation

Answer 3

hyperplasia of one of the glomerular cell types (mesangial, endothelial, parietal epithelial), +/- inflammatory cell infiltration

Question 4

membranous changes

Answer 4

capillary wall thickening due to immune deposits or alterations in basement membrane

Question 5

crescent formation

Answer 5

parietal epithelial cell proliferation and mononuclear cell infiltration form crescent-shape in Bowman’s space

Question 6

gold standard to assess degree of proteinuria

Answer 6

24-h urine protein

Question 7

microalbuminuria defn

Answer 7

ACR ≥2.8 mg/mmol (female) or ≥2.0 mg/mmol (male)

Question 8

screen for diabetic nephropathy

Answer 8

urine ACR

Question 9

normal daily excretion of protein

Answer 9

<30g albumin

Question 10

microalbuminuria, proteinuria, nephrotic syndrome

Answer 10

30-300mg albumin, 300mg-3g protein, >3.5g protein with hypoalbuminaemia (<35g/L)

Question 11

ix for nephrotic syndrome or nephritic syndrome

Answer 11

Nephrotic:
Urinalysis
FBE, UEC, LFT, CRP/ESR
Glucose
Serology: ANA, RF, p-ANCA, c-ANCA, HBV, HCV, HIV, ASOT
Immunoglobulins
Urine MCS, 24h urinary protein and creatinine
Renal ultrasound

Nephritic is same, but add 24h urine stone workup if there is a history of stone formation

Question 12

indications for nephrology referral

Answer 12

heavy proteinuria (ACR >30mg/mmol) or nephrotic syndrome

Question 13

broad categories of proteinuria

Answer 13

tubulointerstitial, glomerular, overflow

Question 14

tubulointerstitial proteinuria

Answer 14

impaired resorption

s syndrome

Question 15

glomerular proteinuria categories

Answer 15

primary, secondary

Question 16

primary glomerular proteinuria

Answer 16

minimal change, membranous, FSGS, membrano-proliferative, post-strep, IgA

Question 17

secondary glomerular proteinuria categories

Answer 17

systemic disease
hereditary/metabolic
infectious
medications
cancer
others

Question 18

secondary glomerular proteinuria systemic disease

Answer 18

diabetes, SLE, vasculitis

Question 19

hereditary/metabolic

Answer 19

Alford’s, PCKD, Fabry’s, SCD

Question 20

infectious

Answer 20

HBV, HCV, HIV, bacterial endocarditis

Question 21

medications

Answer 21

NSAIDs, gold, heavy metals

Question 22

cancer

Answer 22

lymphoma, RCC

Question 23

others

Answer 23

cryoglobulinaemia, hypertensive nephrosclerosis

Question 24

overflow proteinuria

Answer 24

overflow of low molecular weight proteins e.g. multiple myeloma, amyloidosis, Waldenstrom’s macroglobulinaemia

Question 25

urine workup for gross haematuria

Answer 25

Centrifuge. If sediment red - true haematuria (RBC+, dipstick+) If supernatant red (RBC-) - dipstick for haeme If dipstick+, myoglobinuria or haemoglobinuria If dipstick-, pseudohaematuria (beetroot, rifampicin, porphyria)

Question 26

primary nephritic syndrome causes

Answer 26

``` post-strep IgA rapidly progressive membrano-proliferative interstitial nephritis papillary necrosis ```

Question 27

features of nephritic syndrome

Answer 27

``` PHAROH proteinuria haematuria azotemia RBC casts oliguria hypertension ```

Question 28

acute nephritic syndrome defn

Answer 28

a subset of nephritic syndrome in which the clinical course proceeds over days

Question 29

nephritic syndrome pathology types

Answer 29

1. Anti-GBM mediated (15%) 2. Immune complex mediated (24%) 3. Non-immune mediated (60%) 4. Double antibody positive

Question 30

anti-GBM mediated pathology

Answer 30

anti-GBM positive. linear inflammatory pattern due to IgG and C3 deposition along the capillary loops.

Question 31

anti-GBM ddx

Answer 31

with lung haemorrhage: goodpasture's | without lung haemorrhage: anti-GBM

Question 32

type II pathology

Answer 32

granular pattern due to sub endothelial or subepithelial deposits of IgG and C3

Question 33

type II ddx

Answer 33

C3 normal - IgA nephropathy, HSP | C3 decreased - post-strep, membrano-proliferative, SLE, IE, cryoglobulinaemia

Question 34

type III pathology

Answer 34

pauci-immune. no immune staining. ANCA +ve

Question 35

type III ddx

Answer 35

c-ANCA +: granulomatosis with polyangitis | p-ANCA +: microscopic polyangitis, churg-strauss

Question 36

type IV pathology

Answer 36

features of type I and type III. double anti-body positive

Question 37

lab features of RPGN

Answer 37

fibrous crescents on histopathology | RBC casts and/or dysmorphic RBCs in urine