Glomerulonephritis

Question 1

what are the consequences of inflammation of the glomeruli and nephrons

Answer 1

damage to glomerulus- restricts blood flow leading to incr BP. damage to filtration mechanism- blood and protein to enter urine,. loss of usual filtration capacity- AKI

Question 2

what do patients present with

Answer 2

specific syndromes- nephrotic and nephritic syndromes

Question 3

what happens to the bp in nephrotic

Answer 3

mild incr

Question 4

what happens to the urine in nephrotic

Answer 4

proteinuria >3.5g/day

Question 5

what happens to the GFR in nephrotic

Answer 5

mild decr

Question 6

what happens to the bp in nephritic

Answer 6

severe incr

Question 7

what happens to the urine in nephritic

Answer 7

haematuria (mild-macro)

Question 8

what happens to the GFR in nephritic

Answer 8

moderate to severe decr

Question 9

what bloods need to be done

Answer 9

FBC, U&E, LFT, ESR, CRP, immunoglobulins, electrophoresis, complement, autoantibodies, blood culture, ASOT, HBsAg, anti HCV

Question 10

what autoantibodies are checked for

Answer 10

ANA, ANCA, anti-dsDNA, anti-GBM

Question 11

what is tested in the urine

Answer 11

RBC casts, MC&S, Bence Jones protein, ACR

Question 12

what imaging is performed

Answer 12

CXR, renal ultrasound

Question 13

what type of test will give the most information

Answer 13

renal biopsy

Question 14

what are the specific types of GN

Answer 14

IgA nephropathy, Henoch-Schlonlein purpura, SLE, anti-glomerular basement membrane disease, post-streptococcal GN, rapidly progressive GN

Question 15

what is the commonest GN in developed world

Answer 15

IgA nephropathy

Question 16

IgA nephropathy- presentation

Answer 16

macro or microscopic haematuria, occasionally nephritic syndrome. typical patient- young male, recovery rapid between attacks

Question 17

what is increased in IgA nephropathy

Answer 17

IgA- forms immune complexes and deposits in mesangial cells

Question 18

IgA nephropathy- treat

Answer 18

bp control with ACEi. with nephritic presentation- immunosuppression

Question 19

prognosis IgA nephropathy

Answer 19

worse if incr bp, male, proteinuria, renal failure at presentation

Question 20

what is Henoch-Schlonlein purpura

Answer 20

a systemic variant of IgA nephropathy causing small vessel vasculitis

Question 21

features of Henoch-Schlonlein purpura

Answer 21

purpuric rash on extensor surfaces typically legs, polyarthritis, abdo pain, nephritis

Question 22

treatment Henoch-Schlonlein purpura

Answer 22

bp control ACEi

Question 23

what fraction of SLE patients will have renal disease

Answer 23

1/3 with vascular, glomerular and tubulointerstitial damage

Question 24

what are the classes split into in SLE

Answer 24

I-iv: increasing in severity. v- membranous

Question 25

what is Anti-glomerular basement membrane disease also known as

Answer 25

Goodpastures disease

Question 26

Anti-glomerular basement membrane disease- what is it caused by

Answer 26

auto antibodies to type IV collagen which is an essential component of the GBM

Question 27

where else is type IV collagen found and thus is also affected in Anti-glomerular basement membrane disease

Answer 27

in the lung so pulmonary haemorrhage can occur

Question 28

Anti-glomerular basement membrane disease presentation

Answer 28

haematuria/ nephritic syndrome, AKI may occur within days

Question 29

Anti-glomerular basement membrane disease treatment

Answer 29

plasma exchange, steroids, cytotoxics. prognosis poor if dialysis dependent

Question 30

Post streptococcal GN

Answer 30

after sore throat or skin infection.

Question 31

what happens in Post streptococcal GN

Answer 31

strep antigen deposited on glomerulus causes host reaction and immune complex formation

Question 32

Post streptococcal GN presentation

Answer 32

usually nephritic syndrome

Question 33

Post streptococcal GN treatment

Answer 33

supportive

Question 34

what is the most aggressive GN

Answer 34

rapidly progressive GN

Question 35

rapidly progressive GN what can these be classified into

Answer 35

immune complex disease- post infectious; Pauci- immune disease- granulomatosis with polyangiitis; anti-GBM disease

Question 36

rapidly progressive GN clinical presentation

Answer 36

AKI +- systemic features. commonest cause of death in ANCA +ve patients- pulmonary hemorrhage

Question 37

treatment rapidly progressive GN

Answer 37

immunosuppression with high dose steroids IV, cyclophosphamide and plasma exchange.

Question 38

rapidly progressive GN prognosis

Answer 38

5 year survival 80%