Glomerulonephritis

Question 1

What is a common complication of glomerulonephritis.

Answer 1

End stage renal failure.

Question 2

What does glomerulonephritis mean.

Answer 2

Inflammation of the glomeruli and nephrons.

Question 3

What are the consequences of inflammation of the glomeruli and nephrons. (3)

Answer 3

Damage to the glomerulus restricts blood flow, leading to compensatory raise in BP.
Damage to the filtration mechanism allows protein and blood to enter the urine.
Loss of the usual filtration capacity leads to AKI.

Question 4

What are the features of nephrotic syndrome. (3)

Answer 4

Normal to mildly elevated BP.
Proteinuria.
Normal to low GFR.

Question 5

What are the features of nephritic syndrome. (3)

Answer 5

Moderate to severely raised BP.
Haematuria.
Moderate to low GFR.

Question 6

What are some primary causes of nephrotic glomerulonephritis. (3)

Answer 6

Membranous.
Minimal change FSGS.
Mesangiocapillary GN.

Question 7

What are some secondary causes of nephrotic GN. (4)

Answer 7

DM.
SLE.
Amyloid.
Hepatitis B/C.

Question 8

What are some primary causes of nephritic GN. (2)

Answer 8

IgA nephropathy.

Mesangiocapillary GN.

Question 9

What are some secondary causes of nephritic GN. (5)

Answer 9

Post streptococcal. 
Vasculitis. 
SLE. 
Anti-GBM disease. 
Cryoglobinaemia.

Question 10

What are the types of GN. (6)

Answer 10

IgA nephropathy. 
Henoch-Schonlein purpura. 
SLE. 
Post-streptococcal GN. 
Anti-glomerular basement membrane (GBM) disease. 
Rapidly progressive GN.

Question 11

What is the commonest form of GN in the developed world.

Answer 11

IgA nephropathy.

Question 12

How does IgA nephropathy present. (2)

Answer 12

Macro or microscopic haematuria.

Occasionally nephritic syndrome.

Question 13

Young man with episodic macroscopic haematuria. Recovery is often rapid between attacks.

Answer 13

IgA nephropathy.

Question 14

Where does the IgA get deposited in IgA nephropathy. .

Answer 14

In the mesangial cells.

Question 15

What are negative prognostic factors in IgA nephropathy. (4)

Answer 15

Raised BP.
Male.
Proteinuria.
Renal failure at presentation.

Question 16

What is the prognosis for patients with IgA nephropathy.

Answer 16

20% of adults develop end stage renal failure over 20 years.

Question 17

What is Henoch-Schonlein purpura.

Answer 17

A systemic variant of IgA nephropathy, causing a small vessel vasculitis.

Question 18

What are the features of Henoch-Schonlein purpura. (4)

Answer 18

Purple rash on extensor surfaces (typically on the legs).
Flitting polyarthritis.
Abdominal pain (GI bleeding).
Nephritis.

Question 19

How many patients with SLE will have evidence of renal disease with vascular, glomerular and tubulointerstitial damage.

Answer 19

Approximately a third.

Question 20

What classes of SLE are there.

Answer 20

Class 1-4 (increasing severity). 
Class 5 (membranous).

Question 21

What is another name for anti-glomerular basement membrane disease.

Answer 21

Goodpasture’s disease.

Question 22

What is anti-glomerular basement membrane disease caused by.

Answer 22

Auto-antibodies to type 4 collagen (an essential component of the GBM).

Question 23

Where else (apart from the GBM) is type 4 collagen found.

Answer 23

In the lungs (so GBM disease can cause pulmonary haemorrhage, especially in smokers).

Question 24

How does GMB disease present. (3)

Answer 24

Haematuria.
Nephritic syndrome.
AKI may occur within days of onset of symptoms.

Question 25

What sort of GN is post-streprococcal GN.

Answer 25

A diffuse proliferative GN.

Question 26

When does post streptococcal GN present.

Answer 26

1-12weeks after a sore throat or skin infection.

Question 27

What is the cause of post-streptococcal GN.

Answer 27

A streptococcal antigen is deposited on the glomerulus, causing a host reaction and immune complex formation.

Question 28

How does post-streptococcal GN present.

Answer 28

Usually nephritic syndrome.

Question 29

What is rapidly progressive GN.

Answer 29

It is the most aggressive GN, with potential to cause end stage renal failure over days.

Question 30

How is rapidly progressive GN classified. (3)

Answer 30

Immune complex disease (45%, SLE, IgA).
Pauci-immune disease (50%, 80-90% ANCA positive. Wegener’s disease).
Anti-GBM disease (3%. Goodpasture’s disease).

Question 31

How does rapidly progressive GN present clinically. (5)

Answer 31

AKI and systemic features:
Fever. 
Myalgia. 
Weight loss. 
Haemoptysis.

Question 32

What is the commonest cause of death in patients with rapidly progressive GN (in ANCA positive patients).

Answer 32

Pulmonary haemorrhage.