Glomerulonephritis

Question 1

What is the general most accurate tests for glomerulonephritises

Answer 1

Kidney biopsy - although not necessary

Question 2

What is the best initial and most accurate tests for churg strauss syndrome, wegener’s granulomatousis, and polyarteritis nodosa

Answer 2

1.) Churg Strauss
Best initial - CBC eosinophil count
Most accurate - Biopsy

2.) Wegeners
Best initial: c-anca
Most accurate: Biopsy

3.) Polyarteritis nodosa - multiple motor and sensory neuropathy with pain
Best initial - ESR levels
Most accurate: Biopsy of sural nerve/kidney or angiography showing beading

Treatment for all: Cyclophosphamide and steroids

Question 3

What are the glomerulonephritises to remember

Answer 3

1. ) Goodpastures syndrome
2. ) Churg Strauss syndrome
3. ) Wegener’s granulomatosis
4. ) Polyarteritis Nodosa
5. ) IgA nephropathy (Berger’s disease)
6. ) Henoch-Schonlein Purpura
7. ) Post-streptococcal glomerulonephritis
8. ) Cryoglobulinemia
9. ) Lupus nephritis
10. ) Alport syndrome

Question 4

What is the diagnostic test and treatment for IgA nephropathy (Bergers disease)

Answer 4

Diagnosis: Must do renal biopsy (no blood test including IgA)

Treatment: None, but can give steroids and ACE inhibitors for proteinuria

Question 5

What is the treatment of Henoch Scholein purpura

Answer 5

None - resolves overtime on own

Question 6

What is the treatment for PSGN

Answer 6

Supportive - diuretics for hypertension and fluid overload

Question 7

What are things to look out for in cryoglobinemia

Answer 7

History of Hepatitis C with blood in urine, also has joint pain and purpuric skin lesions

Question 8

What are the initial and best tests for cryoglobinemia, as well as treatment

Answer 8

Initial: Serum cryglobulin component levels with low C4
Best: Biopsy

Treatment: Treat hepatitis C infection

Question 9

Lupus nephritis only happens with real lupus, not drug-induced lupus. What is the treatment levels for the changes in the kidney

Answer 9

Sclerosis: No treatment
Mild disease: Steroids
Severe disease: Mycophenolate mofetil and steroids - important

Question 10

What is contraindicated in TTP and HUS

Answer 10

Platelets and antibiotics

Treat with Plasmapharesis instead

Question 11

What do you do when someone has proteinuria - the algorithm

Answer 11

Can be normal, so repeat urinalysis

If still elevated: Evaluate CHF, fever, exercise, or infection

If all of those negative, then maybe orthostatic proteinuria from which they stand all day

If ruled out,then you get a 24 hour urine protein level

If this is elevated, last step is renal biopsy

Question 12

How do you diagnose orthostatic proteinuria

Answer 12

Morning urine for protein and then one in afternoon

No treatment required

Question 13

In esrd, you get hyperphosphatemia and hypermagnesemia. What is the treatment for both

Answer 13

1. ) Hyperphosphatemia: calcium acetate, calcium carbonate phosphate binders
2. ) Hypermagnesemia: Dietary magnesium restriction