Glomerulonephritis

Question 1

What is glomerulonephritis?

Answer 1

An immune mediated disease affecting the glomerulus with secondary tubulointerstitial damage.

Question 2

What is the most common process underpinning glomerulonephritis?

Answer 2

Autoimmune

Question 3

What do you get in the urine of there is damage to endothelial or mesanglial cells?

Answer 3

Proliferative lesion and red cells in urine.

Question 4

If there is endothelial damage then what sorts of lesions do you get in the kidney?

Answer 4

Proliferative

Question 5

If the podocytes are damaged what sort of lesions are there?

Answer 5

Non proliferative

Question 6

What substance appears in the urine if there is damage to podocytes?

Answer 6

Protein

Question 7

Is microscopic haematuria more likely to be a problem in the kidney or lower urinary tract?

Answer 7

Kidney

Question 8

Is macroscopic haematuria more likely to be a problem in the kidney or lower urinary tract?

Answer 8

Lower urinary tract

Question 9

What condition do you get if the podocytes are damaged causing massive protein leakage but no decline in renal function?

Answer 9

Nephrotic syndrome

Question 10

What level of protein in the urine counts as nephrotic syndrome?

Answer 10

More than 3g per day

Question 11

On urine microscopy you see non dysmorphic red blood cells. Where is the blood coming from?

Answer 11

Lower urinary tract

Question 12

On urine microscopy you see dysmorphic red blood cells. Where is the blood coming from?

Answer 12

Kidney. They are squashed to go through the glomerulus.

Question 13

What causes frothy urine?

Answer 13

Protein

Question 14

In nephritic syndrome a proliferative or non proliferative process?

Answer 14

Proliferative

Question 15

A patient has oliguria, hypertension and her urine shows RBCs and granular casts

Answer 15

Nephritic syndrome

Question 16

A patient presents with proteinuria, massive pitting oedema and normal renal function

Answer 16

Nephrotic syndrome

Question 17

In nephrotic syndrome a proliferative or non proliferative condition?

Answer 17

Non proliferative

Question 18

What could cause acute kidney injury in a patient with nephrotic sydrome?

Answer 18

Renal vein thrombosis

Question 19

List some complications of nephrotic sydnrome?

Answer 19

Infections
Renal vein thrombosis
PE
Volume depletion
Vitamin D deficiency
Subclinical hypothyroidism

Question 20

What does proliferative /non proliferative actually mean in glomerulonephritis?

Answer 20

Presence or absence of proliferation of mesangial cells.

Question 21

How would you treat glomerulonephritis? (non immunosuppressive)

Answer 21

Anti hypertensives
ACE inhibitors/ARB
Diuretics
Statins
Anticoagulants if nephrotic syndrome

Question 22

What is the target blood pressure for a patient with glomerulonephritis?

Answer 22

130/80

Question 23

What is the first line immunosuppressive in glomerulonephritis?

Answer 23

Corticosteroids

Question 24

How do you treat patients with nephrotic syndrome?

Answer 24

Fluid restrict
Salt restrict
Diuretics
ACE inhibitors/ARBs
Anticoagulation

Question 25

When would you give a patient with nephrotic syndrome IV albumin?

Answer 25

If the become volume depleted ie the water is in the wrong place!

Question 26

What is the most common type of renal disease seen in patients with SLE?

Answer 26

Diffuse proliferative glomerulonephritis

Question 27

Which antibody shows a ribbon like pattern on immunofluresence?

Answer 27

Anti glomerular basement antibodies

Question 28

What immunosuppressive treatments would you use for treatment of glomerulonephritis?

Answer 28

``` Steroids Azathioprine Cyclophosphamide Cyclosporin Mycophenolate IV immunoglobulin Monoclonal antibodies ```

Question 29

What non drug treatment can you use in the treatment of glomerulonephritis?

Answer 29

Plasmapharesis

Question 30

List the five main types of glomerulonephritis

Answer 30

``` Minimal change disease FSGS Membranous Membranoproliferative IgA nephropathy ```

Question 31

What is the commonest cause of nephrotic syndrome in children?

Answer 31

Minimal change nephropathy

Question 32

A 9 year old girl presents with proteinuria. Her renal biopsy in normal.

Answer 32

Minimal change nephropathy

Question 33

What is the first line treatment for minimal change nephropathy?

Answer 33

Oral steroids

Question 34

When would you use cyclophosphamide in the treatment of minimal change nephropathy?

Answer 34

If it was unresponsive to steroids/dependant on high doses

Question 35

Does minimal change nephropathy cause progressive renal failure?

Answer 35

No

Question 36

What are 4 causes of secondary membranous nephropathy?

Answer 36

Infections (parasites/hep B) Lupus Malignancy Drus (Gold)

Question 37

What do you see in the renal biopsy of membranous nephropathy?

Answer 37

Subepithelial immune complex deposition in the basement membrane

Question 38

What kidney problem is associated with henoch schonlein purpura?

Answer 38

IgA nephropathy

Question 39

You see glomerular crescents on a kidney biopsy. What is the most likely diagnosis?

Answer 39

Rapidly progressive glomerulonephritis

Question 40

List three ANCA +ve diseases that cause glomerulonephritis

Answer 40

Systemic vasculitis Wegners granulomatosis Microscopic polyangiitis

Question 41

List three ANCA negative causes of glomerulonephritis

Answer 41

Goodpastures Henoch Scholein SLE